Comparison of saddle, lumbar epidural and caudal blocks on anal sphincter tone: A prospective, randomized study

Shon, Yoonjung; Huh, Jin; Kang, Seung-Ji; Bae, Seung-Kil; Kang, Ryeong-Ah; Kim, Duk Kyung

doi:10.1177/0300060516659393

Cited by 15 publications

(10 citation statements)

References 30 publications

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“…The duration of operation, and in particular that of transanal operation of the GA + CA group were significantly shorter, and the mean dose of rocuronium was smaller than that in the GA group, indicating that the caudal block could effectively relax the anal muscles, making it easy to pull out the colon through the muscular sheath, thus greatly reducing the difficulty of the operation and shortening the time required by transanal operation. Caudal block has been used in anorectal surgery [ 16 , 17 ], and was found to be effective in depressing anal sphincter tone, including maximal resting pressure (MRP) and maximal squeezing pressure (MSP), with the percentage of MSP inhibition being greater than that of MRP [ 18 ]. In this study, we could not measure the anal sphincter tone because of the limitations of medical conditions.…”

Section: Discussionmentioning

confidence: 99%

General versus general anaesthesia combined with caudal block in laparoscopic-assisted Soave pull-through of Hirschsprung disease: a retrospective study

et al. 2021

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Background Caudal block is one of the most preferred regional anesthesia for sub-umbilical region surgeries in the pediatric population. However, few studies are available on caudal block performed in laparoscopic-assisted Soave pull-through of Hirschsprung disease (HD). We aimed to compare general anesthesia (GA) and general anesthesia combined with caudal block (GA + CA) in laparoscopic-assisted Soave pull-through of HD. Methods A retrospective review was performed in children with HD operated in our hospital between 2017 and 2020. Patients were divided into the GA and GA + CA group. The primary outcome was the duration of operation, and secondary outcomes included intraoperative hemodynamic changes, the Face, Legs, Activity, Cry, Consolability (FLACC) scale, dose of anesthetics, and incidence of side effects. Results A total of 47 children with HD were included in the study, including 20 in the GA group and 27 in the GA + CA Group. The two groups were similar in age, gender, weight and type of HD (P > 0.05). The GA + CA group had significantly shorter duration of operation (especially the transanal operation time) (median 1.20 h vs. 0.83 h, P < 0.01) and recovery time (mean 18.05 min vs. 11.89 min, P < 0.01). The mean doses of sufentanil and rocuronium bromide during the procedure and FLACC scores at 1 h and 6 h after surgery were also lower in the GA + CA group (p < 0.01). The hemodynamic changes in the GA + CA group were more stable at time of t2 (during transanal operation) and t3 (10 min after transanal operation), but there was no significant difference in the incidence of postoperative side effects between the two groups (P = 1.000). Conclusion General anesthesia combined with caudal block can shorten the duration of operation, and provide more stable intraoperative hemodynamics and better postoperative analgesia.

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Section: Discussionmentioning

confidence: 99%

General versus general anaesthesia combined with caudal block in laparoscopic-assisted Soave pull-through of Hirschsprung disease: a retrospective study

et al. 2021

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“…Second, caudal block was very suitable for these anorectal surgeries. A recent clinical randomized study also con rmed this view, the maximal resting anal pressure (MRP) and maximal squeezing anal pressure (MSP) were measured by anorectal manometry before and after caudal block, and caudal block could signi cantly decrease both pressures [23].…”

Section: Discussionmentioning

confidence: 85%

Major complications of caudal block: a prospective survey of 973 cases in adult anorectal surgery

Kang

Xie

Bao

et al. 2022

Preprint

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Background: We conducted a prospective study of surgical inpatients at a teaching hospital to assess the incidence and potential risk factors for major complications of caudal anesthesia in anorectal surgery.Methods: A total of 973 patients undergoing anorectal surgery under caudal block were included in this prospective, observer-blinded trial after providing consent. Demographic information, detailed perioperative information, anesthesia-related complications and postoperative follow-up information were recorded. Meanwhile, the incidence and risk factors for major caudal anesthesia-related complications were analyzed.Results: A total of 973 patients underwent caudal block. The effective rate was 95.38% (928 cases). However, there were still 38 (3.91%) cases with insufficient block and 7 (0.72%) cases with no block. The major anesthesia-related complications were local anesthetic systemic toxicity (9, 0.92%), cauda equine syndrome (1, 0.10%), transient neurological symptoms (3, 0.31%) and localized pain at the caudal insertion site (30, 3.08%). The identified risk factor for local anesthetic systemic toxicity was multiple attempts locating the caudal space (OR= 5.30; 1.21-23.29). The identified risk factor for localized pain at the caudal insertion site was multiple attempts locating the caudal space (OR= 10.57; 4.89-22.86).Conclusion: The main complications of caudal block are transient neurological symptoms, cauda equine syndrome, serious local anesthetic systemic toxicity and localized pain at the caudal insertion site. Localized pain at the caudal insertion site is an easily overlooked complication. Multiple punctures during the block procedure was an independent influencing factor for both local anesthetic systemic toxicity and localized pain at the caudal insertion site. It is worth avoiding multiple attempts to locate the caudal space. Caudal block is still a safe and reliable method for anesthesia in adult anorectal surgery.

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“…The optimal anesthesia method for anal surgery is a controversial issue. Shon et al [1] evaluated the influence of caudal blockade, saddle blockade, and lumbar epidural blockade in patients undergoing anorectal surgery. They have found out the lumbar epidural block to be a better choice than the caudal block in cases where saddle block cannot be applied.…”

Section: Discussionmentioning

confidence: 99%

“…Both caudal block and saddle block are frequently used and the cost ratio is low. [1] Regional anesthesia is preferred for anorectal surgeries to avoid the risks of general anesthesia. Besides, providing effective post-operative analgesia, regional techniques reduce the opioid use.…”

Section: Introductionmentioning

confidence: 99%

Regional anesthesia for anorectal Surgeries: what is the best solution?

Şimşek¹

2021

South Clin Ist Euras

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Objective: Different regional anesthesia techniques are used in anorectal surgeries. The ideal anesthetic method should provide adequate analgesia, patient comfort and safety, and enable early mobilization. The aim of this study was to compare the effects of caudal block and saddle block techniques on post-operative analgesic consumption, number of patients requiring analgesic agent, and initial analgesic requirement. Methods:The current study included 71 patients undergoing elective anorectal surgery. In the saddle block group, we inserted 25 G Quincke spinal needle by the ultrasonography guidance into the intrathecal space at L4-L5 level and administered 7.0 mg hyperbaric bupivacaine. In the caudal block group, we inserted 20 G caudal needle by ultrasound guidance into the epidural space at S4-S5 level and administered 25 ml bupivacaine at a concentration of 0.5%. Results:In group caudal, post-operative analgesic consumption and number of patients requiring analgesic agent were significantly lower than group saddle (p<0.05). In group saddle, first analgesic requirement time was significantly lower than group caudal (p<0.05). Conclusion:In this study, significantly better results were obtained in group caudal regarding post-operative analgesic consumption, number of patients requiring analgesic agent, and initial analgesic requirements time. We concluded that caudal block can be more efficient for anorectal surgery in clinical practice.

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Comparison of saddle, lumbar epidural and caudal blocks on anal sphincter tone: A prospective, randomized study

Cited by 15 publications

References 30 publications

General versus general anaesthesia combined with caudal block in laparoscopic-assisted Soave pull-through of Hirschsprung disease: a retrospective study

General versus general anaesthesia combined with caudal block in laparoscopic-assisted Soave pull-through of Hirschsprung disease: a retrospective study

Major complications of caudal block: a prospective survey of 973 cases in adult anorectal surgery

Regional anesthesia for anorectal Surgeries: what is the best solution?

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