Kaudalanästhesie

Abstract

Caudal anaesthesia is the most frequently used regional technique in paediatric anaesthesia. Caudal in combination with general anaesthesia is usually performed in healthy children (i.e. for herniotomy or hypospadias). Therefore every complication of this method is a catastrophe, even when the incidence of these complications is very low. Some of the documented complications of caudal anaesthesia in children are caused by the local anaesthetic solutions and/or by additives. Thus, the choice of substances for paediatric caudal blocks should minimize the risk associated with the substances used for this indication. Over the last decades the standard was bupivacaine but because of serious cardiovascular and central-nervous toxicity following inadvertent intravascular injection of bupivacaine during caudal puncture, the less toxic ropivacaine should be favoured for this indication. A huge number of clinical studies have proven the clinical effectiveness and safety of ropivacaine also for this indication. In addition, levobupivacaine, the L-enantiomere of bupivacaine, will also be an interesting local anaesthetic in the future for paediatric caudal anaesthesia. By using additives to local anaesthetics better analgesic properties should be obtained. Following an exact review of the literature, only clonidine and S(+)-ketamine are useful additives to local anaesthetics in paediatric caudal anaesthesia.

Perioperative pain management at the Department of Orthopaedic Surgery of the Vienna Medical School

“…Neben analgetischen Substanzen wie Paracetamol sowie Metamizol und der Klasse der NSAR werden regelmäßig Opioide eingesetzt. In Bedarfsfällen werden mit der Universitäts-klinik für Anästhesie perioperative Konzepte [5,6] zur Schmerztherapie unter Verwendung von Caudalblöcken [7], PCA [8] Bei zu erwartenden lang andauernden starken postoperativen Schmerzen (z. B. nach Amputationen) wird das kontinuierliche Verfahren verwendet.…”

“…Hinsichtlich der regionalen Verfahren dominiert an der unteren Extremität die Spinalanästhesie [5,6,7], aber alternative Techniken, besonders periphere Blockaden gewinnen immer mehr an Bedeutung. Wenn Verweilkatether (epidural oder femural) gesetzt werden, erfolgt die regelmäßige Kontrolle, auch später auf der Station durch den betreuenden Anästhesisten.…”

“…Revisionseingriffen werden Femoralisblockaden als single-shot [6,7] oder als kontinuierliches Verfahren [13] …”

“…Bei Operationen an der unteren Extremität basiert das Schmerzmanagement auf dem Caudalblock [7] kombiniert mit Paracetamol [15]. Der Block wird in Narkose gestochen.…”

Prospective randomized controlled comparison of caudal bupivacaine and ropivacaine in pediatric patients

“…[1] Bupivacaine has proven its efficacy in producing adequate analgesia, when given caudally. [2] Unfortunately, motor blockade resulting from it may be a cause of distress in the post-operative period and may lead to delayed hospital discharge.…”