Caudal Nerve Block Research Articles

Analgesic Effect of Caudal and Abdominal Nerve Blocks among Children Undergoing Inguinal Surgeries: An Original Research.

Pediatric inguinal surgeries sometimes cause considerable post-operative pain that requires effective analgesics. Caudal and abdominal nerve blocks may help this population with pain. It is uncertain how successful they are compared. A randomized controlled trial included 70 pediatric inguinal surgery patients. An abdominal (ANB) or caudal nerve block (CNB) was randomly assigned to participants in addition to usual analgesic treatment. Post-operative pain was measured at various times using a standardized scale. The initial rescue analgesia time and dose were recorded. Statistics were used to compare CNB and ANB results. The CNB and ANB groups were demographically similar. At every time point, the two groups' analgesic usage and post-operative pain were similar. No serious adverse events occurred in either group. CNB and ANB provide equivalent analgesia for pediatric inguinal surgeries. Both approaches alleviate pain well and have similar post-operative effects. Individual nerve block approaches must be chosen based on patient features and clinical considerations. More research is needed to determine each procedure's long-term safety and results.

Low Dose Caudal vs Dorsal Penile Nerve Block for Postoperative Analgesia after Circumcision

Abstract Background Circumcision is a painful surgery that is mostly performed under general anesthesia in order to eliminate fear and anxiety. Regional techniques are more effective than systemic opioids, non steroidal anti-inflammatory drugs, and acetaminophen for postoperative analgesia in circumcision, The most preferred techniques are dorsal penile nerve block and caudal block. Objective To investigate the effectiveness of post operative analgesia and complications among dorsal penile nerve block, caudal block and the combination of both. Patients and Methods Our study was carried out to compare the effectiveness, duration of postoperative analgesia, and the complications among dorsal penile nerve block (DPNB), caudal nerve block (CNB) and the combination of both. This study was carried out on 81 male patients, aged from 3-12 years old & undergoing circumcision. The patients were divided into 3 groups, each is composed of 27 patients; group 1 including DPNB patients, group 2 including CNB patients and group 3 for combined block. This study compared between the three groups regarding the intraoperative vital data (HR,BP), post-operative VAS scores and the complications (nausea, vomiting, urinary retention, itching, constipation & CNS depression). Results The demographic data (age, weight & height) does not differ between the three groups of the study. There is difference in the VAS score post operatively, being significantly less in the CNB group. There was no significant difference in the percentage of complications between the groups, except for urinary retention being slightly increased in the CNB group. Conclusion Our results showed that, CNB is superior to DPNB in intraoperative and postoperative analgesia after circumcision as regarding pain control. However CNB is associated with more complications compared to the DPNB. Also, the results showed that there‟s no need to combine both blocks as it gave the same results as with the CNB alone.

Caudal anesthesia is not associated with post-operative complications following distal hypospadias repair

The use of caudal anesthesia at the time of hypospadias repair remains controversial as some prior studies have reported increased postoperative complication rates associated with caudal nerve block. However, these results have been called into question due to confounding factors and heterogeneous study groups. Given the importance of identifying true risk factors associated with increased hypospadias complication rate, we examined our experience with caudal anesthesia limiting our analysis to distal repairs. We hypothesized that caudal anesthesia would not be associated with increased postoperative complications. We retrospectively reviewed our institutional hypospadias database from June 2007 to January 2021. All boys who underwent single-stage distal hypospadias repair with either caudal or penile block with minimum 1 month follow up were included. Records were reviewed to determine the type of local anesthesia, type of hypospadias repair, all complications, and time to complication. Association between any complication and local anesthesia type was evaluated by univariate and multivariate logistic regression analysis controlling for age at surgery and type of repair. A sub-analysis was performed for complications occurring ≤30 days. Overall, 1008 boys, 832 (82.5%) who received caudal and 176 (17.5%) penile block, were included. Median age at surgery was 8.1 months and median follow up was 13 months. Overall complication rate was 16.4% with 13.8% of patients requiring repeat operation. Median time to complication was 10.59 months and was significantly shorter in the caudal group (8.45 vs. 25.2 months). Caudal anesthesia was associated with higher likelihood of complication on univariate analysis; however, this was not true on multivariate analysis when controlling for age and type of repair. Caudal anesthesia was not associated with increased likelihood of complication within 30 days. Since the association between caudal anesthesia and hypospadias complications was first suggested, several studies have tried to answer this question with variable results. Our findings add to the evidence that there is no association between caudal anesthesia and increased hypospadias complications in either the short or long term. The major strengths of our study are a large, homogenous study population, robust follow up and inclusion of data from 14 surgeons over 14 years. Limitations include the study's retrospective nature as well as lack of standardized follow up protocol throughout the study period. After controlling for possible confounders, caudal nerve block was not associated with increased risk of postoperative complications following distal hypospadias repair.

MP08-18 CAUDAL ANESTHESIA IS NOT ASSOCIATED WITH COMPLICATIONS FOLLOWING DISTAL HYPOSPADIAS REPAIR

You have accessJournal of UrologyCME1 May 2022MP08-18 CAUDAL ANESTHESIA IS NOT ASSOCIATED WITH COMPLICATIONS FOLLOWING DISTAL HYPOSPADIAS REPAIR Katherine Fischer, Jason VanBatavia, Nathan Hyacinthe, Sameer Mittal, Karl Godlewski, Stephen Zderic, Aseem Shukla, Arun Srinivasan, Dana Weiss, Thomas Kolon, Douglas Canning, Mark Zaontz, and Christopher Long Katherine FischerKatherine Fischer More articles by this author , Jason VanBataviaJason VanBatavia More articles by this author , Nathan HyacintheNathan Hyacinthe More articles by this author , Sameer MittalSameer Mittal More articles by this author , Karl GodlewskiKarl Godlewski More articles by this author , Stephen ZdericStephen Zderic More articles by this author , Aseem ShuklaAseem Shukla More articles by this author , Arun SrinivasanArun Srinivasan More articles by this author , Dana WeissDana Weiss More articles by this author , Thomas KolonThomas Kolon More articles by this author , Douglas CanningDouglas Canning More articles by this author , Mark ZaontzMark Zaontz More articles by this author , and Christopher LongChristopher Long More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002530.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The use of caudal anesthesia at the time of hypospadias repair remains controversial as some studies have reported increased postoperative complication rates associated with caudal nerve block. However, these results have been called into question due to confounding factors and heterogeneous study groups. Given the importance of identifying true risk factors associated with increased hypospadias complication rate, we examined our experience with caudal anesthesia limiting our analysis to distal repairs. We hypothesized that caudal anesthesia would not be associated with increased postoperative complications. METHODS: We retrospectively reviewed our IRB approved hypospadias database from June 2007 to January 2021. All boys who underwent single-stage distal hypospadias repair with either caudal or penile block and minimum 1 month follow up were included. Records were reviewed to determine the type of local anesthesia, type of repair, all complications, and time to complication. Association between any complication and local anesthesia type was evaluated by univariate and multivariate logistic regression analysis controlling for age at surgery and type of repair. A sub-analysis was performed for complications occurring <30 days. RESULTS: Overall, 1,008 boys were included, 176 (17.5%) who had penile nerve block and 832 (82.5%) caudal at the time of repair. Median age at repair was 8.1 months and median follow up time 13 months. Overall complication rate was 16.4% with 13.8% of patients requiring repeat operation and median time to complication 322 days (IQR= 98-990). Caudal anesthesia was associated with higher likelihood of complication on univariate analysis (OR 1.7, 95%CI=1.1-2.9; p=0.03). This association did not hold up on multivariate analysis when controlling for age and type of repair (OR=1.3, 95%CI=0.8-2.2; p >0.05). Caudal anesthesia was not associated with increased likelihood of complication <30 days on either multivariate or univariate analysis. CONCLUSIONS: After controlling for possible confounders, caudal nerve block was not associated with increased risk of postoperative complications following distal hypospadias repair. The major strengths of this study are a large, homogenous study population, robust follow up and inclusion of data from 14 surgeons over 14 years. Source of Funding: This work was supported in part by the 2021-2022 Urology Care Foundation Research Scholar Award Program (KF) © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e133 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Katherine Fischer More articles by this author Jason VanBatavia More articles by this author Nathan Hyacinthe More articles by this author Sameer Mittal More articles by this author Karl Godlewski More articles by this author Stephen Zderic More articles by this author Aseem Shukla More articles by this author Arun Srinivasan More articles by this author Dana Weiss More articles by this author Thomas Kolon More articles by this author Douglas Canning More articles by this author Mark Zaontz More articles by this author Christopher Long More articles by this author Expand All Advertisement PDF DownloadLoading ...

Técnicas locorregionales para analgesia perioperatoria en anestesia pediátrica: estudio en 116 pacientes

Pain control is essential to patient comfort and reduced stress response, morbidity, and mortality after pediatric anesthesia. We assessed analgesic quality and the incidence of complications of regional blocks in combination with general anesthesia. Prospective study of 116 patients under 3 years of age who underwent surgery in our hospital over a period of 2 years. The studied patients were classified in 3 groups according to whether they received general anesthesia only, a regional block by single injection, or a caudal nerve block via catheter. We recorded demographic and intraoperative variables, postoperative analgesic requirements, and the time the first postoperative analgesic dose was needed. Analgesia was significantly more effective in the patients who received either type of regional block. The patients who received general anesthesia alone needed supplemental analgesia earlier than the others (P < .001); patients with nerve blocks required fewer doses of rescue analgesics (P < .001). The incidence of complications was low and all were minor. No case of caudal catheter contamination occurred. Regional nerve blocks combined with general anesthesia in children are effective and safe. Advantages of providing nerve blocks include hemodynamic stability, prolonged postoperative analgesia, lower consumption of analgesics, and few complications.

Utilidad del BIS® y AEP Monitor/2® para el mantenimiento de la anestesia combinada sevoflurano-regional, comparada con la práctica estándar en población pediátrica

To compare the indices computed by a bispectral (BIS) monitor and an auditory evoked potential (AEP) monitor during maintenance of anesthesia in pediatric patients. A secondary objective was to compare anesthetic consumption and recovery times. Patients aged 6 months to 12 years under inhaled anesthesia with sevoflurane were administered a penile or caudal nerve block. BIS and AEP monitoring was then started. The patients were randomized to 3 groups in which the sevoflurane dosage was guided by the BIS index, the A-line ARX index (AAI), or standard procedures (control group). The BIS index, the AAI, the fraction of expired sevoflurane, hemodynamic parameters, and recovery time were the variables recorded for all patients. Thirty-five patients were enrolled. Significant differences between the 2 monitor groups were observed. The mean (SD) AAI was lower in patients whose dosage was controlled by the BIS index (19 [2]) than in those whose dosage was based on the AEP monitor's reading (22 [4]) (P=.04). According to a Bland and Altman plot, there was good agreement between the BIS index and the AAI except for the highest and, in particular, the lowest values. The volumes of sevoflurane used and the recovery times were similar between groups. There was a positive correlation between the 2 indices (Pearson correlation coefficient, 0.207; P<.001). BIS monitoring provided a more stable index than did AEP monitoring and BIS-index guidance achieved a deeper level of hypnosis. There was good correlation between the 2 indices during maintenance of anesthesia. Neither monitor offered advantages over standard procedures with regard to movement, volume of anesthetic consumed, or recovery time.

Postoperative pain following outpatient pediatric urologic surgery: A comparison of anesthetic techniques

Objectives. To evaluate and compare the efficacy of caudal and local nerve blocks in preventing pain following outpatient pediatric urologic surgery. Methods. Seventy-seven boys undergoing outpatient urologic surgery were randomized into one of three groups: general anesthesia alone, general anesthesia and caudal nerve block, or general anesthesia and local nerve block. Pain scores, frequency of medication, and total dosage of medication were recorded in the immediate postoperative period. Long-term pain and discomfort were measured using â 24-hour and 1-week questionnaire. Results. The caudal and local groups had lower pain scores and significantly lower medication requirements than the control group in the short-term postoperative period. The caudal group had lower pain scores than the local group in all categories; however, the only significant difference was at 24 hours postoperatively. At 1 week postoperatively, the only difference among the three groups was a lower pain score in the caudal group compared with the control group. Conclusions. This study demonstrates that for outpatient pediatric urologic procedures,both caudal and local nerve blocks significantly reduce pain and medication given in the immediate postoperative period and indicates that caudal block may decrease pain for up to 1 week following surgery.