Caudal Epidural Analgesia Research Articles

Morphological and morphometric analysis of the Sacral Hiatus using lumbosacral spine CT scans: clinical relevance in Caudal Epidural Analgesia.

To conduct a morphological and morphometric analysis of the sacral hiatus (SH) using lumbosacral spine CT scans and to evaluate its clinical relevance in caudal epidural analgesia (CEA). This retrospective study analyzed 77 lumbosacral spine CT scans from a diverse patient population. The shape of the SH was classified into common types: inverted U, inverted V, irregular, and bilobed. Morphometric measurements included the length, width, and depth at the apex of the SH. The apex level of the SH was also determined in relation to the sacral vertebrae, and statistical analysis was performed to identify any correlation between the apex level and the morphometric dimensions. The most frequent SH shape was inverted U (68.83%), followed by inverted V (20.77%), irregular (9%), and a single instance of a bilobed shape (1.29%). The apex of the SH was most commonly located at the level of the S4 vertebra (75.32%), followed by the S3 vertebra (20.77%), S5 in two (2.59) and S2 in one (1.29%). No significant correlation was found between the level of the apex and the length, width, or depth of the SH. These findings indicate a high degree of anatomical variability in the SH, independent of the apex level. The anatomical variability of the SH, as observed in this study, underscores the need for individualized assessment during CEA. The lack of correlation between the apex level and the morphometric dimensions of the SH highlights the importance of imaging modalities such as ultrasound or fluoroscopy to ensure precise localization and effective analgesia administration. These insights can improve clinical outcomes by enhancing the accuracy and safety of caudal epidural procedures.

Lumbar Epidural versus Caudal Epidural for Postoperative Analgesia After Lower Extremity Osteotomy Surgery in Pediatric Patients with Osteogenesis Imperfecta: A Propensity-Matched Cohort Analysis in a Single-Center Over 9 Years.

Although pediatric epidural analgesia is a well-established technique used perioperatively. It is unclear whether a lumbar or caudal epidural is suitable for osteogenesis imperfecta (OI) patients, which may be associated with brittle bones and spine deformity. We conducted a retrospective study to investigate and compare the efficacy of the two continuous epidural techniques in pediatric patients undergoing lower extremity osteotomy surgery using a propensity score-matched analysis (PSMA). A total of 274 patients were included. Patients' age, weight, and height were adjusted using PSMA. 90 patients were matched for further analysis, with 45 patients in the lumbar epidural group (Group L) and 45 patients in the caudal epidural group (Group C). Pain scores were categorized into three grades: mild (0-3), moderate (4-6), and severe (7-10), and compared between the two groups. Additionally, operation time, operation site, blood loss, scoliosis, oral analgesic medications, and catheter or nerve-related complications were compared. There were no significant differences in operation time, operation site, scoliosis, and blood loss between the two groups. The percentage of moderate to severe pain during movement was significantly higher in Group L than in Group C, with 37.5% versus 17.5% on the second-day post-operation (P=0.039). However, no statistically significant difference was observed on other days. Additionally, there was no significant difference in oral medication consumption and complications between the two groups. Both lumbar and caudal epidural analgesia can be effectively used postoperatively, and a caudal epidural should be considered where performing a lumbar epidural is challenging in OI pediatric patients.

Perioperative Ultrasound-Guided Continuous Caudal Epidural Analgesia in Newborns: A Case Series in a Tertiary Medical Center.

Background Caudal epidural anesthesia technique is a relevant method for postoperative analgesia in newborns, allowing for the reduction of drug-induced respiratory depression. The threading of a catheter is, however, uncommon in clinical practice. Our main purpose was to describe our experience regarding caudally inserted epidural catheters in neonates undergoing major abdominal surgery. Methods We included every full-term neonate undergoing surgery under combined caudal epidural-general anesthesia from 2017 to 2022 in our institution. After induction of general anesthesia, an ultrasound-guided caudal epidural injection was performed, and an epidural catheter was inserted for perioperative analgesia. An epidural bolus of ropivacaine was administered to every patient before the surgical incision, and an epidural infusion of ropivacaine 0.05% was administered for 24 hours. Results Retrospectively obtained data included six full-term neonates with American Society of Anesthesiologists (ASA) physical status II to IV. Intraoperatively, good analgesia was achieved without hemodynamic instability or need for additional systemic opioids after induction. At the end of surgery, five of the six neonates were extubated without adverse respiratory events. Postoperatively, effective analgesia was achieved in four cases with an epidural infusion of ropivacaine 0.05%, at a rate between 0.2 and 0.4 mg/kg/h, and intravenous paracetamol. Epidural pain control was not successful in one neonate, and thus an intravenous fentanyl infusion was added. The sixth neonate remained intubated for prolonged mechanical ventilation due to surgical complications, and thus an intravenous fentanyl infusion was introduced for sedation in the neonatal intensive care unit (NICU), not allowing to evaluate the effectiveness of the epidural infusion alone. No other complications related to the epidural catheters were reported. Conclusion Continuous caudal epidural analgesia may be a valuable technique with a low risk of complications, decreasing the incidence of respiratory adverse events in this patient population. Although more cases are needed for a stronger conclusion, it has become a useful analgesic strategy for major abdominal surgery in neonates in our institution.

The dilutional volume of morphine and xylazine administered via caudal epidural catheter affects cranial spread of analgesia in healthy standing horses.

To test the influence of increasing injectate volumes on the regional effects of xylazine and morphine epidural analgesia, with the hypothesis that increasing volume produces more cranial spread of analgesia as determined by thermal threshold (TT) testing. 6 university-owned research/teaching horses (2 mares, 4 geldings) deemed healthy on physical examination and basic lameness evaluation, aged 6-19 years and weighing 420-560 kg, were used in this prospective, randomized, blinded, cross-over experimental study. After routine placement of a caudal epidural catheter, all animals were subsequently instrumented with a TT testing system at the withers (Location A), the cranial (Location B), and caudal (Location C) abdominal area, over the tuber coxae (Location D), and the hind limb dorsal pasterns (Location E). All horses underwent five testing cycles with 0.2 mg/kg morphine and 0.2 mg/kg xylazine diluted to 20, 35, 50, 75, and 100 mL. TT testing was performed at 2, 4, 6, 8, and 10 hours by blinded investigators. With increased epidural volume, significantly greater cranial spread of analgesic effect was noted. All epidural volumes caused significant changes in TT testing at location E but only the largest volume resulted in a significant TT testing change at location A. Volume influences the regional effects of caudal epidural analgesia in horses but might affect analgesic reliability.

Epidural lidocaine, butorphanol, and butorphanol – lidocaine combination in dromedary camels

BackgroundThe use of general anesthesia in dromedary camels is constrained by risks related to decubitus. Caudal epidural analgesia is an alternative convenient technique providing loco-regional analgesia for numerous invasive and noninvasive painful conditions. Lidocaine is probably the most commonly used local anesthetic in clinical practice, but has a relatively short duration and may not provide significant long term analgesic benefits. Epidural administration of an opioid-local anesthetic mixture would improve the quality and length of analgesia and minimizes the adverse motor effects provoked by local anesthetics. Butorphanol (potent agonist–antagonist opioid) has been used to improve the duration of epidural analgesia in some animal species, but not in camels. Therefore, our purpose was to investigate the onset and duration of analgesia as well as the clinical and hemato-biochemical effects produced by the epidural administration of butorphanol (0.04 mg/kg), lidocaine (0.22 mg/ kg), and butorphanol-lidocaine (0.04 mg/kg—0.22 mg/ kg) mixture in nine adult dromedary camels in a crossover experimental study.ResultsThe onset of analgesia was not statistically different between lidocaine (6.5 ± 2.3 min) and butorphanol-lidocaine (7.3 ± 1.5 min) combination. Delayed onset of analgesia was reported after butorphanol administration (14.7 ± 3.5 min). Butorphanol-lidocaine combination produced marked longer duration (175 ± 8.7 min) than lidocaine (55 ± 6.8 min) and butorphanol (158 ± 5.3 min). Mild ataxia was observed in the butorphanol–lidocaine and lidocaine treated animals and slight sedation was reported after butorphanol and butorphanol-lidocaine administration. A transient significant increase in the glucose levels was recorded after all treatments.ConclusionsEpidural administration of butorphanol augments the analgesic effects and duration of lidocaine with minimal adverse effects.

Plasma concentrations of levobupivacaine in neonates during caudal epidural analgesia maintained over 48 hours.

Differences in neonatal pharmacokinetics are known to cause systemic accumulation of levobupivacaine with adverse effects during epidural analgesia. Therefore, it is not recommended to surpass 48 hours of administration in neonates. Free and total levobupivacaine levels are considered as predictors of toxicity. The aim of the LEVON pilot study was to detect the accumulation of levobupivacaine during epidural analgesia exceeding 48 hours in neonates. Ten neonates received a loading dose of levobupivacaine (1.25 mg/kg) followed by a continuous infusion (0.2 mg/kg/hour) epidurally. Free and total levobupivacaine concentrations were measured 0.5, 1, 6, 12, 36, 72 and 144 hours after the start of infusion. Cumulative doses of levobupivacaine, pain scores and clinical signs of toxicity were used for assessing efficacy and safety. The median concentrations of total levobupivacaine were 586.0, 563.0, 837.5, 957.0, 1930.0, 708.5 and 357.5 ng/ml. The median concentrations of free levobupivacaine were 4.0, 3.6, 5.5, 3.6, 5.5, 0.8 and 0.0 ng/ml. Three patients reached concerning concentrations of total levobupivacaine. Levels of free levobupivacaine remained low. No signs of toxicity were observed. Caudal epidural analgesia with levobupivacaine lasting longer than 48 hours appears to be safe providing that free levobupivacaine levels are below the presumed threshold for toxicity (Tab. 1, Fig. 1, Ref. 29). Text in PDF www.elis.sk Keywords: free levobupivacaine, total levobupivacaine, neonate, caudal continuous epidural analgesia, postoperative pain.

Comparative evaluation of sedative and anti-nociceptive effects of epidural romifidine, romifidine-lidocaine, and lidocaine in donkeys (Equus asinus).

Local and regional anesthetic procedures are valuable tools in veterinary practice. Caudal epidural administration of local anesthetic agents is widely reported for surgical interventions of the tail, anus, rectum, vulva, vagina, urethra, and bladder in the standing horse. Epidural analgesia is also obtained using various drugs such as alpha-2 adrenoceptor agonists, dissociative anesthetics, and opioids. The present study evaluates the anti-nociceptive and sedative effects of epidural administration of romifidine, a romifidine-lidocaine combination, and lidocaine alone in donkeys. In a randomized prospective study, twenty-four healthy adult donkeys were assigned to four groups (three experimental and one control; n = 6) received either 50 μg/kg of romifidine, 0.30 mg/kg of lidocaine, combined romifidine (50 μg/kg) and lidocaine (0.30 mg/kg) diluted in 0.9% sterile normal saline solution to a total injection volume of 12 ml, or an equivalent volume of sterile saline epidurally. After epidural injection of each treatment, the onset, degree, and duration of sedation and anatomical extension of anti-nociception were documented. Observations began immediately (time 0) pre-administration and at 5, 15, 30, 45, 60, and 30-min intervals subsequently until 210 min after drug injection. Time to onset of perineal analgesia was documented every minute after the epidural injection by evaluating the animal's response to pinpricks. Only romifidine and romifidine-lidocaine induced mild to moderate sedation. Romifidine, romifidine-lidocaine, and lidocaine induced complete bilateral caudal epidural analgesia with loss of sensation in the perineum, tail, inguinal region, caudal aspect of the upper hind limb, chest areas, and extended distally to the dorsal metatarsal area. Sedation lasted longer (p < 0.05) with romifidine (160 ± 15.4 min) than with romifidine-lidocaine (141.6 ± 13.2 min). Longer-lasting analgesia (p < 0.05) was obtained with romifidine (158.3 ± 9.8 min) and romifidine-lidocaine (165 ± 9.4 min) than with lidocaine (75.8 ± 8 min). Epidural administration of a single dose of romifidine or a combination of romifidine-lidocaine produced mild to moderate sedation and complete anti-nociception in the perineal and inguinal regions of donkeys. The clinical usefulness of epidural romifidine or romifidine-lidocaine combinations to perform obstetric procedures in donkeys needs to be assessed.

Comparison of Patient-Controlled Caudal Epidural Analgesia and Patient-Controlled Intravenous Analgesia After Perianal Surgery: A Randomized Controlled Trial.

IntroductionThis study aimed to compare the efficacy between patient-controlled caudal epidural analgesia (PCCA) and patient-controlled intravenous analgesia (PCIA) after perianal surgery, to provide a feasible solution to postoperative pain.MethodsThis was a prospective, randomized controlled trial comprising 100 patients who underwent caudal epidural block on perianal surgery at Chengdu Shang Jin Nan Fu Hospital of West China Hospital at Sichuan University between April and August 2020. Patients were randomly divided into the PCCA and PCIA groups. Visual analog scale (VAS) scores were recorded at 2, 4, 6, 24, 48, and 72 h after surgery, and at the first dressing change and first defecation. The lower limb mobility in the post-anesthetic recovery room (PACU) was determined. The analgesic effect, usage amount of patient-controlled analgesia (PCA), usage amount and frequency of remedial analgesic measures, number of individuals who must be catheterized, and incidence of adverse reactions were recorded. Satisfaction of postoperative analgesic effect and convenience of PCA were also assessed.ResultsThe patients in the PCCA group had significantly lower VAS scores at 4, 6, 24, 48, 72 h, the first dressing change, and the first defecation compared with the PCIA group. There were more patients receiving postoperative remedial analgesics in the PCIA group than in the PCCA group. The outcome of the number of PCA and catheterization rates did not differ significantly between the groups. There were two cases of sensory numbness below the S3 plane. The major postoperative complications in the PCIA group were pruritus (3/47, 6.4%), nausea, and vomiting (6/47, 12.8%) (one case combined with pruritus). Patients in the PCCA group were more satisfied with the analgesic effect, while those in the PCIA group were more satisfied with the convenience.ConclusionIn the postoperative analgesia program of perianal surgery, PCCA may provide a better analgesic effect without increasing the incidence of complications.Trial RegistrationChinese Clinical Trial Registry identifier, ChiCTR2000038425, September 2020, retrospectively registered.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40122-022-00411-y.

Caudal Morphine in Pediatric Patients: A Comparison of Two Different Doses in Children Undergoing Infraumbilical Surgery - A Prospective, Randomized, Double-Blind Study.

One of the most feared symptoms of any disease is PAIN. It is a complex phenomenal experience, especially in children. Various methods and medications have been administered through different routes. Regional anesthesia produces marvelous postoperative analgesia and cessation of stress response in infants and children. Caudal epidural analgesia is the most acceptable and popular method of providing intra- and postoperative analgesia for abdominal, perineal, and lower limb surgeries in children. The use of preservative-free morphine as an adjunct to ropivacaine increases the quality and duration of analgesia despite the various side effects. Various articles use various doses of morphine as an adjuvant in caudal epidural analgesia. Hence, we conducted the study to compare the two dosages of morphine that is 20 μg.kg-1 and 30 μg.kg-1 of caudal epidural morphine for infraumblical surgeries with regard to its efficacy and safety and side effect profiles. The study is a prospective, randomized, double-blinded study. Sixty patients were divided into two groups. Group A: 20 μg.kg-1 of morphine was added to 0.2% ropivacaine 1 mL.kg-1 and the solution was made. Group B: 30 μg.kg-1 of morphine was added to 1 mL.kg-1 of 0.2% ropivacaine. Heart rate, systolic blood pressure, diastolic blood pressure, SPO2, pain score, and sedation score were recorded immediately, after 15 min, 30 min, 45 min, 1 h, 2 h, 4 h, 8 h, 12 h, 16 h, 18 h, and 24 h were recorded. The mean duration of analgesia is similar in both groups (P = 0.011). The mean duration was 20.517 ± 1.9143 h in Group A and 22.233 ± 1.6853 h in Group B. Children with the requirement of one dose of rescue analgesia in Group A was 83.3% which was higher than Group B being 66.7%. Children with no analgesic requirement were 16.7% in Group A and 33.3% in Group B. The incidence of side effects was more in Group B (8 [26.7%] children with nausea and vomiting; 1 [3.3%] children with urinary retention) than in Group A (2 [6.6%] children with nausea and vomiting. From the above observations, it can be concluded that morphine of less dosage (20 μg.kg-1) when added to 0.2% ropivacaine for the caudal epidural block has better efficacy than morphine of higher dosage (30 μg.kg-1) as the duration of analgesia is similar with decreased incidence of side effects.

A Comparison Between Caudal Epidural Analgesia and Paracetamol Suppository in Relieving Pain after Inguinal Hernia Repair in Pediatric Age Group

Background: the control of postoperative pain is important in children, and poor pain control leads to organdysfunction and behavioral problem.Aim of study: we compare the analgesic effect of bupivacaine by caudal block root and acetaminophen suppositoryon postoperative pain in pediatric inguinal hernial repair surgery.Patient and Methods: A prospective, randomized, controlled trail of 40 children, aged between (1-7 years), ASAgrade I-II, scheduled for elective day case unilateral inguinal surgery. For all the patients included in this study,a standardized controlled anesthetic protocol was used. Preoperatively the patients were randomized into twogroups according to the operation waiting lists. group 1 included (18) patients who received single - shot caudalblock with (1ml/kg) of 25% bupivacaine preoperatively after induction of anesthesia by the anesthetist, group 2included (22) patients who received (15-20 mg/kg) acetaminophen suppository.Results: The number of patients (who had first three hours free of pain); was significantly higher in the Caudalgroup than those of the other group. Patients of the Caudal group; needed significantly a longer duration of timefor the first analgesic drug. Patients of the Caudal group; had significantly a lower (Face, Legs, Activity, Cry,Consolability scale) in (1/2, 1, and 2 hours) time intervals of the study.Conclusion: Caudal anesthesia with bupivacaine has better painless period postoperatively.

Anesthetic Management in Pediatric Patient with Moyamoya Disease in Orthopaedic Surgery

A 12-year-old female, diagnosed case of Down phenotype with Moyamoya disease (MMD) was posted for internal fixation of compound fracture shaft of femur. Preanesthetic evaluation revealed history of acute URI, abnormal body movements, left hemiparesis and mental retardation. Patient was managed under general anesthesia with proseal LMA and caudal epidural was administered for adequate analgesia in the perioperative period. The goal of anaesthetic management in a case of MMD is to maintain the balance between cerebral metabolic oxygen consumption rate (CMRO2) and cerebral blood flow (CBF) in order to prevent any neurologic morbidity. Though there is no ideal anaesthetic agent in MMD, the anaesthetic technique should ensure normotension, normocapnia and normothermia in the perioperative period. To our knowledge regional analgesia has not been used in the pediatric orthopedic surgeries in patients diagnosed with Moya moya. The technique of general anaesthesia supplemented with caudal epidural analgesia ensures that all the anesthetic goals are met adequately and the precarious cerebral circulation in moya moya patient is not compromised.

Establishment of a Novel Method for Spinal Discectomy Surgery in Elderly Rats in an In Vivo Spinal Fusion Model.

The rat model is a common model for intervertebral disc (IVD) and spinal research. However, complications remain challenging. Standard Operating Procedures (SOPs) are validated methods to minimize complications and improve safety and quality of studies. However, a SOP for rat spinal fusion surgery has been missing until now. Therefore, the aim of the study was to develop a SOP for spinal tail disc surgery in elderly Wistar rats (419.04 ± 54.84 g). An initial preoperative, intraoperative, and postoperative surgical setup, including specific anaesthesia and pain management protocols, was developed. Anaesthesia was induced by subcutaneous injection of a pre-mixture of fentanyl, midazolam, and medetomidin with the addition of 0.5% isoflurane in oxygen and caudal epidural analgesia. The surgery itself consisted of the fixation of a customized external ring fixator with ⌀ 0.8 mm Kirschner wires at the proximal rat tail and a discectomy and replacement with bone morphogenetic protein coated beta-tricalcium-phosphate carrier. The postoperative setup included heating, analgesia with buprenorphine, and meloxicam, as well as special supplementary food. Anaesthesia, surgery, and pain management were sufficient. In the presented optimized SOP, no animals developed any complications. A SOP for spinal surgery in elderly rats in an in vivo spinal fusion model was developed successfully. This novel protocol can improve transparency, reproducibility, and external validity in experimental rat spinal surgery experiments.

Comparison of Midazolam with Bupivacaine and Fentanyl with Bupivacaine in Caudal Epidural Analgesia for Efficacy and Duration of Post­ Operative Analgesia in Children Undergoing Infra Umblical Surgeries

Caudal anaesthesia is a useful adjunct to general anaesthesia for infra umbilical surgeries in children as it provides post-operative analgesia and reduces pen­ operative narcotic requirements There is prolongation o. f duration of analgesia by mean duration of 318.20±24.49 minutes with addition Fentanyl to Bupivacaine. When comparing the efficacy of two differential drugs fentanyl I µg/kg and midazolam 5 0µg/kg in combination with Bupivacaine 0.2 5%, lml/kg. Duration of analgesia was found significantly more in group using Fentanyl with mean duration of 318.20 ± 24.49 minutes compared to Midazolam with mean duration of 247.25 ±12.19 minutes.

Comparison between Caudal Dexmedetomidine and Morphine for Postoperative Analgesia in Pediatric Infraumbilical Surgeries

Background: The usage of caudal opioids extends the length of analgesia substantially, but it often comes with a slew of adverse side effects, including fatigue, vomiting, pruritus, urinary retention, and a chance of respiratory distress later on. Objective: The aim of this analysis was to compare the effects of caudal dexmedetomidine versus morphine in conjunction with bupivacaine in pediatric infraumbilical surgeries. Patients and Methods: This randomized controlled sample involved 90 pediatric patients aged 1 to 7 years old, of American Society of Anesthesiologists (ASA) physical status I-II, of both sexes, who were scheduled for lower abdominal surgeries. Patients were allocated to three equal groups. Group D got a 0.25% bupivacaine + 1 g/kg dexmedetomidine. Group M obtained a 0.25% bupivacaine + 30 g/kg morphine mixture. Group MD: dexmedetomidine 1 g/kg and morphine 30 g/kg with bupivacaine were used in a single dose caudal epidural analgesia. Results: Intraoperative heart rate, mean arterial blood pressure at 20, 25, 30 and 45 min was significantly decreased in group MD than group D and group M while in postoperative period were insignificantly among the three groups at all times of measurement. FLACC was significantly lower in MD group at discharge, 1, 2, 3, 6, 12 and 18 hours. Ramsey sedation score (RSS) at 30 min was significantly decreased in group M than group D and in group MD than group M. Time for 1st analgesia and paracetamol dosage was significantly earlier in group M than group D and group MD. Pruritus and vomiting were significantly lower in group D than other groups. Conclusions: The addition of dexmedetomidine to caudal morphine in pediatric patients produced longer postoperative analgesia, more sedation and with better emergence from anesthesia and hemodynamic stability, with fewer side effects than morphine.

A narrative review of caudal epidural anaesthesia and analgesia in horses. Part 1: Safety and efficacy of epidural drugs

SummaryThe importance of adequate pain management in horses has gained increased clinical attention over the last decade or so, and many drugs and administration techniques have been investigated for the purpose of improving equine pain management. Caudal epidural anaesthesia and analgesia (CEAA) has the potential to be one of the most efficient techniques for management of moderate to severe pain of the pelvic limbs, the caudal part of the body and even the thoracic limbs. The epidural administration of many different drugs has been studied and clinically applied, most of them with good efficacy and minimal side‐effects. In order to guide the clinician on when and how to perform CEAA in horses, this 2‐part review provides a detailed review of the efficacy, safety, indications and techniques. Part 1 focuses on the efficacy and safety of epidurally administered drugs and Part 2 considers indications and contraindications, and provides a practical description on how to perform the epidural procedure.

A narrative review of caudal epidural anaesthesia and analgesia in horses. Part 2: Clinical indications and techniques

SummaryThis is the second of a two‐part review of caudal epidural anaesthesia and analgesia in horses (CEAA). In Part 1, we provided a detailed review of the efficacy and safety of epidurally administered drugs showing that the epidural administration of many different drugs can provide effective regional anaesthesia or analgesia with only minimal side effects. In Part 2, the clinical indications and benefits of CEAA are reviewed and a detailed practical guide on how to perform an epidural injection and insert an epidural catheter is provided.

Assessment of Morphological and Morphometrical Variations of Sacral Hiatus in Dry Human Sacrum in Ethiopia.

BackgroundThe sacral hiatus is an opening present at the lower end of the sacral canal. The anatomy of the sacral hiatus and its variations are clinically important during administration of caudal epidural block (CEB) in obstetrics and gynecology, orthopedic, urology and general surgical practices. The success and reliability of CEB depends upon the sound knowledge of anatomical variations of the sacral hiatus.ObjectiveThe aim of this study was to assess the morphological and morphometric variation of the sacral hiatus in dry human sacrum.MethodsAn institution-based observational cross-sectional study design was conducted to assess morphological and morphometric variations of the sacral hiatus in 61 dry human sacrum specimens at the anatomy departments of Gondar, Addis Ababa, Hawassa and Jimma universities and Hayat and Korea Medical Colleges in Addis Ababa. Descriptive analysis was applied to analyze the data.ResultsThe most commonly recorded shape of the sacral hiatus is inverted-V (41%) followed by inverted-U (37.7%). The least common was complete bifida (1.6%). The apex of the sacral hiatus is mostly seen at the level of the 4th sacral vertebra (60.7%), while the base is commonly located at the level of the 5th sacral vertebra (78.7%). The mean length of the sacral hiatus is 22.67 ± 11.84 mm. The mean transverse width and mean anteroposterior diameter of the sacral hiatus at the apex are 13.14 mm ± 2.85 mm and 5.57 mm ± 1.53 mm, respectively.ConclusionThe sacral hiatus has anatomical variations. These variations should be kept in mind during administration of caudal epidural anesthesia and analgesia.

Comparison of Subcutaneous Ring Block of the Penis with Caudal Epidural Block for Post Circumcision Analgesia in Children

Background: Pain is an inevitable consequence of circumcision and a number of methods have nowbeen described to ameliorate this. Local anesthetic techniques have been shown to be more effective thansystemic opioids. Objective: This study compared the subcutaneous ring block of the penis with caudal epidural block forpost circumcision analgesia in children. Materials and method: This comparative study was done during the period of January 2020 to December2020 in BIRDEM General Hospital, Dhaka, Bangladesh. A randomized, prospective, blind trial wasconducted comparing caudal epidural blockade (caudal block) with subcutaneous ring block of the penis(penile ring block) in forty healthy boys between three to five years of age undergoing elective circumcision. Results: Subjects receiving caudal block had a longer duration of analgesia (p &lt;0.05), and longer to firstmicturition (p &lt;0.05) but there was no difference in time taken to awaken from anesthesia or spontaneouslywalk unaided. There were no local or systemic complications related to either block and a very lowincidence of vomiting. Conclusion: It is concluded that both techniques are effective. Caudal block is more reliable and providesa longer duration of analgesia but penile ring block is inherently safer and has a lower incidence ofadverse effects. JBSA 2021; 34(1): 50-53

Ultrasound guided continuous caudal epidural analgesia in neonates undergoing thoracotomy

ABSTRACT Background and Aims: Adequate postoperative analgesia guarantees adequate ventilation and minimizes respiratory complications after thoracotomy. This study compares postoperative outcomes of continuous caudal epidural blockade to systemic intravenous analgesia in neonates undergoing thoracotomy for trachea-esophageal fistula (TOF) repair. Methods: A randomized, single-center, prospective, controlled study was conducted at El-Shatby University Hospital, from August 2016 to September 2020 where 40 neonates, weighing 2.5–4 kg belonging to the ASA physical Grade II to IV, posted for a TOF repair via thoracotomy. After general anesthesia, in group A, the epidural catheter was inserted through standard caudal epidural technique. Initial bolus of 0.25% bupivacaine (0.2 ml/kg) and postoperatively continuous infusion of 0.125% bupivacaine (0.1 ml/kg/h) was given. In group B, they received fentanyl (2 μg/kg) and paracetamol (10 mg/kg) IV Intraoperatively and postoperatively paracetamol (10 mg/kg/6 h) intravenously. Results: In group A, good quality of analgesia for 48 h postoperative with a lesser doses of rescue opioids (1 µg/kg fentanyl) required to maintain adequate analgesia, which shortened the length of hospital stay compared to group B. Conclusion: Very efficient postoperative analgesia can be achieved via continuous caudally inserted epidural blockade compared to intravenous fentanyl in neonatal post-thoracotomy pain.

Use of caudal epidural analgesia for management of orthopaedic limb pain in horses

Use of caudal epidural analgesia for management of orthopaedic limb pain in horses