Caudal anesthesia with sedation for inguinal hernia repair in high risk neonates

Balent, Eric M.; Edwards, Mary J.; Lustik, Michael B.; Martin, Paul J.

doi:10.1016/j.jpedsurg.2013.11.005

Cited by 8 publications

(4 citation statements)

References 18 publications

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“…There were 8 prospective trials, 24–31 7 retrospective trials, 32–38 6 case reports 39–44 and 3 randomized controlled trials. We identified 14 reports involving 796 caudal anesthetics with sedation of which there were 6 prospective trials, 31,45–49 5 retrospective trials 19,50–53 and 3 randomized controlled trials. There were a further 7 reports involving 153 patients where awake combined spinal caudal anesthesia was performed.…”

Section: Resultsmentioning

confidence: 99%

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

Frawley,

McCann

2023

Pediatric Anesthesia

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Background and ObjectivesThe aim of this narrative review is to evaluate the literature describing the use of caudal anesthetic‐based techniques in premature and ex‐premature infants undergoing lower abdominal surgery.MethodsAll available literature from inception to August 2023 was retrieved according to Preferred Reporting Items for Systematic Reviews and Meta‐Analysis guidelines from Medline, PubMed, Embase, and the Cochrane Library. Two authors reviewed all references for eligibility, abstracted data, and appraised quality.ResultsOf the 211 articles identified, 45 met our inclusion criteria yielding 1548 cases with awake caudal anesthesia. The review included 558 (36.0%) cases of awake caudal anesthesia, 837 cases (54.1%) of “awake” caudal anesthesia with sedation, and 153 cases (9.9%) of combined spinal caudal epidural anesthesia without sedation.The overall anesthetic failure rate was 7.2% (71.9:1000 caudals). Failure rates were highest for CSEA (13.7%, 7.7–18.4), intermediate for awake caudal (6.6%, 5.26–9.51), and lowest for sedated caudal anesthesia (5.85%, 4.48–7.82). The incidence (range) of perioperative apnea was highest for sedated caudal anesthesia (8.16, 0%–24%), intermediate for awake caudal (7.62%, 0%–60%), and lowest for CSEA (5.53%, 0%–14.3%).High spinal anesthesia occurred in 0.84%, or 8.35:1000 caudals overall. The incidence was highest in awake caudal anesthesia cases (1.97% or 19.7:1000 caudals), intermediate with caudal with sedation (1.07% or 10.7:1000 caudals), and lowest in CSEA (0.7% or 6.6:1000 caudals).Our review was confounded by incomplete data reporting and small sample sizes as most were case reports. There were no high‐quality randomized controlled trials, and the eight single‐center retrospective data reviews lacked sufficient data to perform meta‐analysis.ConclusionsThere is insufficient evidence to validate or refute the benefits of the use of “awake” caudal anesthesia in premature and ex‐premature infants. The high doses of local anesthetics used, the high failure rate, and the increased incidence of high spinal anesthesia would suggest that the techniques offer no real advantages over awake spinal anesthesia or general anesthesia with a regional block.

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Section: Resultsmentioning

confidence: 99%

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

Frawley,

McCann

2023

Pediatric Anesthesia

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“…[4] Thirdly, when combined with a spinal local anaesthetic or utilised in peripheral blocks, clonidine amplifies the effects of analgesia and extends their duration. [5] Spinal alpha-2 adrenergic agonists have the potential to cause analgesia by activating cholinergic neurons in the spinal cord, which then results in the release of acetylcholine. [6] Compared to clonidine, dexmedetomidine has an affinity for alpha 2 adrenergic receptors that is eight times higher and a much smaller effect on alpha-1 receptors.…”

Section: Issn: 2320-5407mentioning

confidence: 99%

Comparison of Dexmedetomidine and Clonidine as Additive When Given Separately, Premixed With 0.25% Ropivacaine in Pediatric Caudal Block, on Intra Operative Anesthetic/ Analgesic Drug Requirement and Duration of Post Operative Analgesia in Hypospadias Repair Surgeries

Bamoriya,

Maheshwari Rathi,

Chaturvedi

et al. 2023

IJAR

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Aim:Comparison of dexmedetomidine and clonidine as additive when given separately, premixed with 0.25% ropivacaine in pediatric caudal block,on intra operative anesthetic/ analgesic drug requirement and duration of post operative analgesia in hypospadias repair surgeries. Methods and Materials:Children,whose parents or guardians,were willing to give consent and fulfilled inclusion criteria were selected for the study.Thepatients were randomly allocated, by double blinding into two groups. Group RD received 0.25% ropivacaine 1 ml/kg +2Âµg/kg dexmedetomidine (in 0.5 ml volume).Group RC received 1 ml/kg of 0.25% ropivacaine + 1 Âµg/kg of clonidine (in 0.5 ml volume). Results:Mean age of patients receiving dexmedetomidine and clonidine was 3.20Â±1.821 and 4.47Â±1.727 years respectively. No significant difference was obtained in terms of mean age.Blood pressure,Heart rate and Saturation was maintained by both dexmedetomidine and clonidine similarly as revealed by the insignificant p value of >0.05 across the time points during hypospadias repair surgeries.Requirement of adjuvant analgesics intraoperativery and post operative complicationsand was found to be similar in both the groups as revealed by the insignificant P value of 0.309. Time for rescue analgesic postoperatively (min) was significantly (p<0.001) longer among patients receiving dexmedetomidine (706.73Â±107.428) than clonidine (504.33Â±97.573). Conclusion:We observed that a single caudal injection of dexmedetomidine (2Âµg/kg) added to ropivacaine 0.25% offers an advantage over a similar injection of clonidine (1Âµg/kg) added to ropivacaine 0.25% for postoperative pain relief in children undergoing hypospadias repair surgeries without increase in post operative complications.

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“…Caudal anesthesia has many advantages over general anesthesia in children undergoing inguinal hernia repair surgery (3). Topical anesthesia for surgical procedures in newborns has many benefits, including maintaining the patient's respiratory conditions and rapid return to nutrition (4).…”

Section: Introductionmentioning

confidence: 99%

Cardiovascular Effects of Adding Epinephrine to Bupivacaine in Children Undergoing Caudal Block: A Double-blind Randomized Clinical Trial

Seyedhejazi

Karami

2022

Interv Pain Med Neuromod

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Background: Caudal block is a common, safe, and effective anesthetic technique for lower abdominal, urological, and lower extremity surgeries in pediatrics. Objectives: This study aimed to evaluate the cardiovascular effects of adjuvant epinephrine in the caudal block on heart rate and blood pressure changes in children. Methods: This double-blind, randomized clinical trial was performed on 60 children who underwent elective infra-umbilical surgeries. They were under general anesthesia with midazolam, fentanyl, lidocaine, and propofol. The patients were ventilated through laryngeal mask airway (LMA), and anesthesia was maintained with sevoflurane in O2 and N2O mixture. The intervention group received a caudal block with 0.2% bupivacaine and 1/200000 epinephrine (1 mL/kg), while the control group received a caudal block without epinephrine. Heart rate, blood pressure, and ECG were monitored before the block and in the first, fifth, and 20th minutes after surgery. Results: The two groups showed no statistically significant differences in demographics and systolic and diastolic blood pressures. However, sinus arrhythmia was more prevalent in the study group in the first minute after the block (P < 0.001). No differences were observed in the incidence of arrhythmia in the fifth and 20th minutes after the block. Conclusions: It appears that epinephrine as an adjuvant to the caudal block does not have long-lasting effects after the block, except sinus tachycardia in the first minute. Considering that no changes in blood pressure and other hemodynamic parameters were observed, it seems that epinephrine can be used safely in the caudal block in pediatric patients.

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Caudal anesthesia with sedation for inguinal hernia repair in high risk neonates

Cited by 8 publications

References 18 publications

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

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

Comparison of Dexmedetomidine and Clonidine as Additive When Given Separately, Premixed With 0.25% Ropivacaine in Pediatric Caudal Block, on Intra Operative Anesthetic/ Analgesic Drug Requirement and Duration of Post Operative Analgesia in Hypospadias Repair Surgeries

Cardiovascular Effects of Adding Epinephrine to Bupivacaine in Children Undergoing Caudal Block: A Double-blind Randomized Clinical Trial

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