Caudal blocks

Background: Caudal analgesia is a good, reliable and easy method to provide intraoperative and postoperative analgesia in the infraumbilical surgery in pediatrics. Many additives were used in combination with local anesthetics in caudal block to prolong the postoperative analgesia (fentanyl, dexmedetomidine and dexamethasone). Aim of the study: This study aimed to compare the intraoperative hemodynamics, postoperative analgesia, postoperative sedation and postoperative side effects of fentanyl, dexmedetomidine and dexamethasone as adjuvant to bupivacaine in caudal analgesia in pediatrics. Methods: 120 pediatric patients (3-10 years old) scheduled for lower abdominal surgeries under general anesthesia allocated to 4 groups. Group I (control), in this group the patients received 0.5 ml of a equal mixture of bupivacaine 0.25% and lidocaine 1% diluted in saline (in a dose of 0.5 ml/kg) caudally. In Group II (fentanyl group), the patients received the same mixture of Group I + fentanyl (1 lg/kg) caudally. In Group III (dexmedetomidine group), the patients received the same mixture of Group I + dexmedetomidine (1 lg/kg) caudally. In Group IV (dexamethasone group), the patients received the same mixture of Group I + dexamethasone (0.1 mg/kg) caudally. Results: The demographics and hemodynamics were comparable among the studied groups. The dexmedetomidine group and dexamethasone group were less in pain score, prolong the duration of analgesia and less in number of patients required analgesia compared to control and fentanyl groups. More sedation was present in the fentanyl and dexmedetomidine groups. The fentanyl group showed significant increase in the adverse effect incidence. Conclusion: Both caudal dexmedetomidine and caudal dexamethasone added to local anesthetics are good alternatives in prolongation of postoperative analgesia compared to caudal local anesthetic alone or added to caudal fentanyl. Also they showed less side effects compared to caudal fentanyl.

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“…Many additives were used in combination with local anesthetics in caudal block to prolong the postoperative analgesia [3].…”

Section: Introductionmentioning

confidence: 99%

Fentanyl, dexmedetomidine, dexamethasone as adjuvant to local anesthetics in caudal analgesia in pediatrics: A comparative study

El-Feky

Aziz

2015

Egyptian Journal of Anaesthesia

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“…The inherent safety of a transcaudal approach to thoracic epidural catheter insertion obviates this risk, as the spinal cord and thecal sac have both terminated at this level [15]. Accessing the caudal space in young children is a familiar technique in many practitioners with significant pediatric expertise [16]. Blind advancement of either a styletted or unstyletted epidural catheter placed in the caudal space to the thoracic epidural space has a high failure rate, both in our clinical experience as well as noted in the literature.…”

Section: Discussionmentioning

confidence: 98%

Fluoroscopically guided tunneled trans-caudal epidural catheter technique for opioid-free neonatal epidural analgesia

Franklin

Hughes

2016

J Anesth

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Epidural analgesia confers significant perioperative advantages to neonates undergoing surgical procedures but may be very technically challenging to place using a standard interlaminar loss-of-resistance to saline technique given the shallow depth of the epidural space. Thoracic epidural catheters placed via the caudal route may reduce the risk of direct neural injury from needle placement, but often pose higher risks of infection and/or improper positioning if placed without radiographic guidance. We present a detailed method of placing a fluoroscopically guided, tunneled transcaudal epidural catheter, which may reduce both of these risks. The accuracy and precision of this technique often provides adequate analgesia to allow for opioid-free epidural infusions as well as significant reductions in systemic opioids through the perioperative period. Opioid-free analgesia using a regional anesthetic technique allows for earlier extubation and reduced perioperative sedation, which may have a less deleterious neurocognitive effect on the developing brain of the neonate.

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“…Though the CB is considered to be the golden standard regional anesthesia technique for pediatric surgeries (20,21), it has some contraindications in application, such as spinal deformities and coagulopathy. Considering these contraindications, UTAP should be a valuable alternative regional technique to CB, in view that the posture requirements for UTAP is lower and the puncture wounds are hardly affected by the coagulopathy even after cirrhosis and trauma (22,23).…”

Section: Discussionmentioning

confidence: 99%

Ultrasound-Guided Transverses Abdominis Plane Block versus Caudal Block for Postoperative Analgesia in Children Undergoing Inguinal Hernia Repair: A Randomized Controlled Trial

Yang¹,

Lin²,

Yao³

et al. 2016

J Anesth Perioper Med

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Caudal blocks

Cited by 185 publications

References 108 publications

Fentanyl, dexmedetomidine, dexamethasone as adjuvant to local anesthetics in caudal analgesia in pediatrics: A comparative study

Fentanyl, dexmedetomidine, dexamethasone as adjuvant to local anesthetics in caudal analgesia in pediatrics: A comparative study

Fluoroscopically guided tunneled trans-caudal epidural catheter technique for opioid-free neonatal epidural analgesia

Ultrasound-Guided Transverses Abdominis Plane Block versus Caudal Block for Postoperative Analgesia in Children Undergoing Inguinal Hernia Repair: A Randomized Controlled Trial

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