The success rate and complications of awake caudal epidural bupivacaine alone or in combination with intravenous midazolam and ketamine in pre-term infants

Abstract

Background:The aim of the present study is to compare the success rate and complications of caudal epidural bupivacaine alone or in combination with intravenous (IV) midazolam and ketamine in awake infants undergoing lower abdominal surgery.Materials and Methods:In this double-blind, clinical trial study, 90 infants (aged below 3 months and weight below 5 kg) with American Society of Anaesthesiologists I-II, were divided into three groups of each 30: Group 1 received bupivacaine 0.25%, 1 mL/kg for caudal epidural block; Groups 2 and 3 received caudal block with same dose bupivacaine along with IV pre-treatment with midazolam 0.1 mg/kg or IV midazolam 0.1 mg/kg and ketamine 0.3 mg/kg, respectively.Results:The success rates in Groups 2 and 3 were 93.3% and 93.1%, respectively, compared with a caudal block with bupivacaine alone 80%; P = 0.015). There was no significant difference among the three groups in terms of mean systolic and diastolic blood pressures and mean heart rate at intervals of 0, 20, 40 and 60 min (P < 0.05). There were no significant differences in the pain scores >3 on the Neonatal Infant Pain Scale at three intervals (30, 60 and 120 min) after surgery among the three groups. The complications such as apnoea or desaturation were not found in any of the studied groups.Conclusions:Adding IV ketamine and/or midazolam to bupivacaine caudal epidural block in the conscious infants can positively affect block success rate.

Awake caudal anesthesia in ex‐premature infants undergoing lower abdominal surgery: A narrative review

“…Our search retrieved eight randomized controlled trials 15–22 . An attempt at meta‐analysis of the incidence of anesthetic failure and perioperative adverse events especially postoperative apneas was performed.…”

“…Our search retrieved eight randomized controlled trials. [15][16][17][18][19][20][21][22] An attempt at meta-analysis of the incidence of anesthetic failure and perioperative adverse events especially postoperative apneas was performed. Of the 8 series where anesthetic success was reported, there was considerable clinical heterogeneity with three series being awake caudal anesthesia, [15][16][17] three caudal anesthesia with sedation 18,23 and two being combined spinal caudal anesthesia.…”

“…[15][16][17][18][19][20][21][22] An attempt at meta-analysis of the incidence of anesthetic failure and perioperative adverse events especially postoperative apneas was performed. Of the 8 series where anesthetic success was reported, there was considerable clinical heterogeneity with three series being awake caudal anesthesia, [15][16][17] three caudal anesthesia with sedation 18,23 and two being combined spinal caudal anesthesia. 21,22 The comparator group in these series was general anesthesia (5 series), caudal anesthesia with two different sedation protocol groups (1), 18 spinal anesthesia (1) 17 and low-dose awake caudal anesthesia (1).…”

“…Of the 8 series where anesthetic success was reported, there was considerable clinical heterogeneity with three series being awake caudal anesthesia, [15][16][17] three caudal anesthesia with sedation 18,23 and two being combined spinal caudal anesthesia. 21,22 The comparator group in these series was general anesthesia (5 series), caudal anesthesia with two different sedation protocol groups (1), 18 spinal anesthesia (1) 17 and low-dose awake caudal anesthesia (1). 16 An attempt at meta-analysis of the risk of postoperative apnea was similarly difficult due to clinical heterogeneity and incomplete data.…”