Caudal Anesthesia in Surgical Interventions on the Lower Extremities in Children

Abstract

The goal of the study: Comparative study of the effects of bupivacin and ropivacaine in caudal anesthesia in surgical interventions on the lower extremities in children. Material and methods. 59 children operated under caudal anesthesia for congenital dislocation of the thigh, deformities of pelvic bones, clubfoot, etc. were included in the study. The patients were divided into 2 groups depending on the type of local anesthetic used: in group I (n = 39) caudal anesthesia was performed with a 0.75% solution of ropivacaine with intravenous sedation with propofol; in the second group (n = 20), the caudal block was administered with a 0.5% solution of bupivacaine. During the operation and in the postoperative period, the indices of central hemodynamics, the concentration of cortisol and blood plasma glucose were studied, the intensity of postoperative pain syndrome was assessed. Results. Serious complications of anesthesia were not recorded. The indices of central hemodynamics remained stable during anesthesia, the indices of stress markers decreased somewhat, which indicates the adequacy of both variants of anesthesia. Twelve hours after the operation, a significant increase in the cardiac index, heart rate and blood pressure, as well as an increase in the concentration of cortisol and glucose, was noted in Group II patients who had anesthesia with bupivacaine. This was accompanied by an intensive pain syndrome, which required an additional appointment of tramadol. In group I patients (caustic anesthesia with ropivacaine), the indices of central hemodynamics and stress markers remained stable after the operation, and the intensity of the pain syndrome was significantly lower. Conclusions. Caudal anesthesia with 0.75% ropivacaine is a highly effective, reliable and safe method of anesthesia in traumatological operations on the lower extremities in children. Caudal administration of a 0.75% ropivacaine provides a longer sensory and motor block compared with a 0.5% bupivacaine. The superiority of caudal anesthesia with ropivacaine is due to the more potent and prolonged action of the drug, as evidenced by the wider spread of the sensory block, deeper motor blockade, stability of hemodynamic parameters and stress markers.

Endocrine and metabolic monitoring for anesthesia care in orthopedic trauma surgery on the lower extremities of children: prospective comparative study

“…В последнее десятилетие появились публикации, анализирующие показатели кортизола, глюкозы, лактата, интерлейкина-6 во время анестезиологического обеспечения травматичных оперативных вмешательств в абдоминальной хирургии, онкологии, кардиохирургии, урологии у взрослых и детей [7][8][9]. Имеются лишь единичные исследования, в которых изучены показатели кортизола, глюкозы и лактата при ортопедо-травматологических операциях на нижних конечностях у детей [10,11]. Анализ источников литературы в базе данных Национальной медицинской библиотеки США (PubMed.gov) показал следующее: число статей при введении ключевых слов «cortisol», «pediatric orthopedic surgery» составило 10, а при введении ключевых слов «cortisol», «nerve block anesthesia in children» мы обнаружили лишь 7 публикаций.…”