Caudal block with 4 mg·kg⁻¹ (1.6 ml·kg⁻¹) of bupivacaine 0.25% in children undergoing surgical correction of congenital pyloric stenosis

Abstract

Caudal block with bupivacaine 0.25% (4 mg x kg-1) was associated with a low rate of anaesthetic complications. Further prospective studies to clarify the risks and benefits are required.

Ultrasound-guided paravertebral block for pyloromyotomy in 3 neonates with congenital hypertrophic pyloric stenosis

“…However, it is associated with other complications, such as soft tissue trauma, bradycardia, laryngospasm and hypoxia. 4 Inhalational induction has been recommended due to its safety in pediatric patients. 2,4,6 In the neonatal period, the regional analgesia is indicated when our goal is an early extubation.…”

“…4 Inhalational induction has been recommended due to its safety in pediatric patients. 2,4,6 In the neonatal period, the regional analgesia is indicated when our goal is an early extubation. Besides providing an adequate level of intraoperative analgesia and its longer duration in the postoperative period, 5 it provides a degree of muscle relaxation to facilitate the surgical technique.…”

“…5 Somri et al 3 suggested that spinal anesthesia with isobaric bupivacaine at a concentration of 0.5% and a dose of 0.8 mg/kg −1 was an alternative to general anesthesia; however spinal block for pyloromyotomy can cause uncontrolled high block with consequent respiratory 1 failure and the need for urgent endotracheal intubation. 3 Moyao-Garcia et al 4 show a case series of pyloromyotomy with performance of caudal block with 0.25% bupivacaine and a volume of 1.6 mL/kg −1 . Despite the use of high doses of local anesthetic, the analgesic level required could be insufficient, with a T4---T6 1 level being necessary.…”

“…The classic clinical picture is characterized by projectile vomiting, malnutrition, dehydration and electrolyte and metabolic disturbances. 1 The treatment of this condition consists of the performance of pyloromyotomy under general anesthesia and orotracheal intubation, 2 which is a challenge for anesthesiologists given the risk of bronchopulmonary aspiration, 3,4 and frequent metabolic alterations in the context of a general anesthesia by hyperventilation 3,4 or administration of opioids and neuromuscular blockers may increase the risk of central apnea. An operation under general anesthesia combined with locoregional techniques could reduce the risk of apnea and postoperative complications.…”

The Pierre Limoges Pediatric Anesthesia Lecture: Tricky problems in pediatric anesthesia

“…7 There are reports of caudal, as well as spinal anesthesia, being used for this procedure. [8][9][10] Spinal anesthesia has been reported as effective and safe in this patient population. Somri describes the successful use of spinal anesthesia in 23 of 25 infants scheduled for pyloromyotomy, using hyperbaric bupivacaine 0.5%, 0.8 mg·kg -1 .…”