Evidence-based clinical update: Which local anesthetic drug for pediatric caudal block provides optimal efficacy with the fewest side effects?

Dobereiner, Elisabeth F. A.; Cox, Robin G.; Ewen, Alastair; Lardner, David

doi:10.1007/s12630-010-9386-1

Cited by 50 publications

(39 citation statements)

References 30 publications

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“…Depending on the concentration of the local anesthetic and evaluation time, motor block may be observed after caudal block. 13,20,21 None of our patients presented motor block when examined before transfer from PACU to the ward, otherwise reported in the literature. None of the patients had defecation problems caused by the anal sphincter motor insufficiency after the pudendal nerve block.…”

Section: Discussionmentioning

confidence: 58%

Pudendal Versus Caudal Block in Children Undergoing Hypospadias Surgery

Kendigelen¹,

Tütüncü

Emre

et al. 2016

Regional Anesthesia and Pain Medicine

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Section: Discussionmentioning

confidence: 58%

Pudendal Versus Caudal Block in Children Undergoing Hypospadias Surgery

Kendigelen¹,

Tütüncü

Emre

et al. 2016

Regional Anesthesia and Pain Medicine

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“…Similarly, another weakness worth mentioning is the significant heterogeneity we encountered. The local anesthetics all varied, although ropivacaine, bupivacaine, and levobupivacaine were found to be equivalent in terms of efficacy37; the concentrations of the local anesthetic were different, which could have influenced the analgesic effects and side effects. Additionally, the included studies measured pain on different scales, and pain evaluation was subjective, especially for children.…”

Section: Discussionmentioning

confidence: 98%

Analgesic efficacy and impact of caudal block on surgical complications of hypospadias repair: a systematic review and meta-analysis

Zhu

Rong

Tong

et al. 2019

Regional Anesthesia &Amp; Pain Medicine

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Background and objectivesis commonly used for children undergoing hypospadias repair. However, the safety of caudal block for hypospadias repair in children is controversial in terms of surgical complications such as urethrocutaneous fistula and glans dehiscence. We sought to perform a meta-analysis to estimate the analgesic efficacy and relative complications of caudal block for hypospadias repair in children.MethodsWe identified comparative studies of caudal block versus peripheral nerve block or no caudal block; studies were published or presented through 1 January 2018, and reports of analgesic efficacy or surgical complications of hypospadias repair in children were identified. Peripheral nerve block includes dorsal nerve penile block and pudendal nerve block. Data were abstracted from studies comparing caudal block with peripheral nerve block or no caudal block; original source data were used when available. We prespecified separate assessments of randomized controlled trials (RCTs) and observational studies given the inherent differences between types of study designs. Data from 298 patients in four RCTs and from 1726 patients in seven observational studies were included. RCT and observational data were analyzed separately.ResultsIn RCTs, caudal blocks (compared with peripheral nerve blocks) showed no detectable differences in terms of need for additional analgesia within 24 hours after the surgery (OR 10.49; 95% CI 0.32 to 343.24; p=0.19), but limited data showed lower pain scores 24 hours after the surgery (standardized mean difference (SMD) 1.57; 95% CI 0.29 to 2.84; p=0.02), a significantly shorter duration of analgesia (SMD −3.33; 95% CI −4.18 to −2.48; p<0.0001) and analgesics consumption. No significant differences were observed in terms of postoperative nausea and vomiting (OR 3.08; 95% CI 0.12 to 77.80; p=0.50) or motor weakness (OR 0.01; 95% CI −0.03 to 0.05; p=0.56). Only one randomized study showed that caudal blocks (compared with peripheral nerve blocks) were associated with detectable differences in urethrocutaneous fistula rate (OR 25.27; 95% CI 1.37 to 465.01; p=0.03) and parental satisfaction rate (OR 0.07; 95% CI 0.02 to 0.21; p<0.00001). In observational studies, caudal block was not associated with surgical complications in all types of primary hypospadias repair (OR 1.83; 95% CI 0.80 to 4.16; p=0.15). To adjust for confounding factors and to eliminate potential selection bias involving caudal block indication, we performed subgroup analysis including only patients with distal hypospadias. This analysis revealed similar complication rates in children who received a caudal block and in children not receiving caudal block (OR 1.02; 95% CI, 0.39 to 2.65; p=0.96). This result further confirmed that caudal block was not a risk factor for surgical complications in hypospadias repair. The direction of outcomes in all the other subgroup analyses did not change, suggesting stability of our results.ConclusionsIn RCTs, only limited data showed peripheral nerve blocks providing better analgesic qua...

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“…But in our study, we used two different concentrations of levobupivacaine combined with same dose of ketamine (0.5 mg/kg) which enable us to determine the effect of ketamine when combined with caudal levobupivacaine. Our opinion is supported by Dobereiner et al, as they showed in their studies that if the local anesthetic agents are used in high doses, there will be no difference in postoperative analgesic efficacy [29].…”

Section: Discussionmentioning

confidence: 60%

Efficacy of Caudal Ketamine with Different Concentrations of Levobupivacaine for Postoperative Analgesia in Paediatric Subumblical Surgeries

Mogahed¹,

Salama²

2017

J Anesth Clin Res

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Evidence-based clinical update: Which local anesthetic drug for pediatric caudal block provides optimal efficacy with the fewest side effects?

Abstract: Purpose The purpose of this evidence-based clinical update is to identify the best evidence when selecting a long-acting local anesthetic agent for single-shot pediatric caudal anesthesia in children.

Cited by 50 publications

References 30 publications

Pudendal Versus Caudal Block in Children Undergoing Hypospadias Surgery

Pudendal Versus Caudal Block in Children Undergoing Hypospadias Surgery

Analgesic efficacy and impact of caudal block on surgical complications of hypospadias repair: a systematic review and meta-analysis

Efficacy of Caudal Ketamine with Different Concentrations of Levobupivacaine for Postoperative Analgesia in Paediatric Subumblical Surgeries

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