Background and objectivesis commonly used for children undergoing hypospadias repair. However, the safety of caudal block for hypospadias repair in children is controversial in terms of surgical complications such as urethrocutaneous fistula and glans dehiscence. We sought to perform a meta-analysis to estimate the analgesic efficacy and relative complications of caudal block for hypospadias repair in children.MethodsWe identified comparative studies of caudal block versus peripheral nerve block or no caudal block; studies were published or presented through 1 January 2018, and reports of analgesic efficacy or surgical complications of hypospadias repair in children were identified. Peripheral nerve block includes dorsal nerve penile block and pudendal nerve block. Data were abstracted from studies comparing caudal block with peripheral nerve block or no caudal block; original source data were used when available. We prespecified separate assessments of randomized controlled trials (RCTs) and observational studies given the inherent differences between types of study designs. Data from 298 patients in four RCTs and from 1726 patients in seven observational studies were included. RCT and observational data were analyzed separately.ResultsIn RCTs, caudal blocks (compared with peripheral nerve blocks) showed no detectable differences in terms of need for additional analgesia within 24 hours after the surgery (OR 10.49; 95% CI 0.32 to 343.24; p=0.19), but limited data showed lower pain scores 24 hours after the surgery (standardized mean difference (SMD) 1.57; 95% CI 0.29 to 2.84; p=0.02), a significantly shorter duration of analgesia (SMD −3.33; 95% CI −4.18 to −2.48; p<0.0001) and analgesics consumption. No significant differences were observed in terms of postoperative nausea and vomiting (OR 3.08; 95% CI 0.12 to 77.80; p=0.50) or motor weakness (OR 0.01; 95% CI −0.03 to 0.05; p=0.56). Only one randomized study showed that caudal blocks (compared with peripheral nerve blocks) were associated with detectable differences in urethrocutaneous fistula rate (OR 25.27; 95% CI 1.37 to 465.01; p=0.03) and parental satisfaction rate (OR 0.07; 95% CI 0.02 to 0.21; p<0.00001). In observational studies, caudal block was not associated with surgical complications in all types of primary hypospadias repair (OR 1.83; 95% CI 0.80 to 4.16; p=0.15). To adjust for confounding factors and to eliminate potential selection bias involving caudal block indication, we performed subgroup analysis including only patients with distal hypospadias. This analysis revealed similar complication rates in children who received a caudal block and in children not receiving caudal block (OR 1.02; 95% CI, 0.39 to 2.65; p=0.96). This result further confirmed that caudal block was not a risk factor for surgical complications in hypospadias repair. The direction of outcomes in all the other subgroup analyses did not change, suggesting stability of our results.ConclusionsIn RCTs, only limited data showed peripheral nerve blocks providing better analgesic qua...

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BACKGROUND Atelectasis is a common postoperative complication. Peri-operative lung protection can reduce atelectasis; however, it is not clear whether this persists into the postoperative period. OBJECTIVE To evaluate to what extent lung-protective ventilation reduces peri-operative atelectasis in children undergoing nonabdominal surgery. DESIGN Randomised, controlled, double-blind study. SETTING Single tertiary hospital, 25 July 2019 to 18 January 2020. PATIENTS A total of 60 patients aged 1 to 6 years, American Society of Anesthesiologists physical status 1 or 2, planned for nonabdominal surgery under general anaesthesia (≤2 h) with mechanical ventilation. INTERVENTIONS The patients were assigned randomly into either the lung-protective or zero end-expiratory pressure with no recruitment manoeuvres (control) group. Lung protection entailed 5 cmH 2 O positive end-expiratory pressure and recruitment manoeuvres every 30 min. Both groups received volume-controlled ventilation with a tidal volume of 6 ml kg −1 body weight. Lung ultrasound was conducted before anaesthesia induction, immediately after induction, surgery and tracheal extubation, and 15 min, 3 h, 12 h and 24 h after extubation. MAIN OUTCOME MEASURES The difference in lung ultrasound score between groups at each interval. A higher score indicates worse lung aeration. RESULTS Patients in the lung-protective group exhibited lower median [IQR] ultrasound scores compared with the control group immediately after surgery, 4 [4 to 5] vs. 8 [4 to 6], (95% confidence interval for the difference between group values −4 to −4, Z = -6.324) and after extubation 3 [3 to 4] vs. 4 [4 to 4], 95% CI −1 to 0, Z = −3.161. This did not persist from 15 min after extubation onwards. Lung aeration returned to normal in both groups 3 h after extubation. CONCLUSIONS The reduced atelectasis provided by lung-protective ventilation does not persist from 15 min after extubation onwards. Further studies are needed to determine if it yields better results in other types of surgery. TRIAL REGISTRATION Chictr.org.cn (ChiCTR2000033469).