Rectal puncture during caudal anaesthesia

Varghese, Nita; Joseph, Nandhini; Kandavar, Siri

doi:10.4103/0019-5049.181618

Cited by 4 publications

(3 citation statements)

References 4 publications

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“…4,5 Spinal anesthesia techniques are generally suitable for surgical procedures involving the lower abdomen, perineum, and lower extremities. [6][7][8] A local anesthetic solution injected into the intrathecal space prevents the conduction of impulses along motor, sensory, and autonomic nerves. Optimal anesthesia will provide satisfactory operating conditions, fast recovery, early discharge from treatment, no postoperative side effects, and high patient satisfaction, apart from the high quality and low cost of anesthetic services.…”

Section: Introductionmentioning

confidence: 99%

Spinal Anesthesia Ambulation Time of Cervical Cancer Brachytherapy Outpatient Clinic: Comparison of 5 mg Hyperbaric Bupivacaine Fentanyl with 2,5 mg Hyperbaric Bupivacaine and 25 mcg Fentanyl

DM,

Mafiana R,

Zainal R

et al. 2023

JACR

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Introduction: Regional anesthetic techniques and local anesthesia have proven to be more effective than general anesthesia in the practice of ambulatory anesthesia. Spinal anesthesia is the technique of choice for ambulatory anesthesia in cervical cancer brachytherapy patients. Low-dose local anesthetics can speed up the ambulation time. This study aims to compare the ambulation time of low-dose spinal anesthesia with conventional doses. Fast ambulation time can speed up recovery time for patients, thereby reducing the patient's length of stay. Methods: This study was a double-blind, randomized controlled trial conducted in August – September 2022 at the Radiotherapy Installation of Dr. Mohammad Hoesin General Hospital (RSMH) Palembang. All cervical cancer patients undergoing brachytherapy in adults with ASA I-II physical status were included in the study sample. Samples will be randomized into two groups, namely a combination of hyperbaric bupivacaine 5 mg and fentanyl 25 mcg and a group of bupivacaine 2.5 mg and fentanyl 25 mcg. Patients with allergies, impaired motor function, spinal failure, block level not achieved, shock, apnea, respiratory depression, and experiencing pain during the procedure were excluded from the study. Results: Ambulation time in the hyperbaric bupivacaine 5 mg and 25 mcg fentanyl group was longer than the hyperbaric bupivacaine 2.5 mg and 25 mcg fentanyl (155.22 + 10.68 minutes versus 98.69 + 7.13 minutes) with a significance level of p<0.001. Spinal anesthetic drugs work in a dose-dependent manner. Increasing the dose will increase the duration of action of the spinal anesthetic. The only side effects found were hypotension and pruritus. Conclusion: Spinal anesthesia with hyperbaric bupivacaine 2.5 mg and fentanyl 25 mcg can accelerate the ambulation time of cervical cancer patients undergoing brachytherapy.

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Section: Introductionmentioning

confidence: 99%

Spinal Anesthesia Ambulation Time of Cervical Cancer Brachytherapy Outpatient Clinic: Comparison of 5 mg Hyperbaric Bupivacaine Fentanyl with 2,5 mg Hyperbaric Bupivacaine and 25 mcg Fentanyl

DM,

Mafiana R,

Zainal R

et al. 2023

JACR

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show abstract

“…However, this safe technique can still become unsafe and result in unanticipated morbidity and at times, mortality. Published in this issue of IJA are reports of complications attributed to CNBs, ranging from post-dural puncture headache (PDPH) to pneumocephalus, arachnoiditis, epidural haematoma, rectal perforation and aphonia[ 2 3 4 5 6 7 ] clearly indicating their occurrence, despite the professed improvements in the field. This reinforces the need for adopting meticulous measures while performing these simple procedures.…”

mentioning

confidence: 99%

“…The six reports[ 2 3 4 5 6 7 ] published in this issue highlight the various possible complications that can follow the ‘simple’ procedure of spinal anaesthesia. Hence, it is prudent that every anaesthesiologist adheres to strict protocols, follows the guidelines, incorporates aseptic principles, follows-up the patients in the post-operative period, detects the complications early and treats them aggressively and appropriately.…”

mentioning

confidence: 99%

Central neuraxial blocks: Complacency begets complications

Balavenkatasubramanian

2016

Indian J Anaesth

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Risk of rectal puncture due to needle entry into the presacral space

Kwon

Lee

et al. 2020

Medicine

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During ganglion impar block, the needle may approach the presacral space and the sacrum may be penetrated during caudal anesthesia. Because the rectum is in front of the sacrococcyx and is thus at risk for puncture, it is important to determine the distance between the sacrococcyx and rectum, as well as the thickness of the sacrococcyx. Computed tomography was used to measure the distance between the rectum and sacrococcyx, as well as the thickness of the sacrococcyx. The distances between the coccyx and rectum, sacrococcygeal joint and rectum, sacral level 5 (‘sacrum 5’) and rectum, and ‘sacrum 4 to 5 junction’ and rectum were measured. The results were compared based on the presence or absence of stools in the rectum. The thickness of the sacrococcyx was measured at the sacrum 4 to 5 junction and sacrococcygeal joint. In total, 1264 patients were included in this study. All distances were less than 1 mm in both males and females, with the exception of the distance between the coccyx and rectum in males. In both males and females, there was no significant difference in distance between the sacrococcyx and rectum according to the presence or absence of feces in the rectum, but there was a difference in the distance between sacrum 5 and the rectum in males ( P = .048). Several male and female patients showed thicknesses of less than 5 mm at the sacrococcygeal joint. Some patients have a distance of less than 1 mm between the sacrum and rectum. Practitioners should exercise caution when applying a needle to the presacral space. If the sacrum is accidentally penetrated during caudal block, rectum puncture cannot be ruled out. Excretion of feces does not influence the distance between the sacrococcyx and rectum in females.

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Rectal puncture during caudal anaesthesia

Cited by 4 publications

References 4 publications

Spinal Anesthesia Ambulation Time of Cervical Cancer Brachytherapy Outpatient Clinic: Comparison of 5 mg Hyperbaric Bupivacaine Fentanyl with 2,5 mg Hyperbaric Bupivacaine and 25 mcg Fentanyl

Spinal Anesthesia Ambulation Time of Cervical Cancer Brachytherapy Outpatient Clinic: Comparison of 5 mg Hyperbaric Bupivacaine Fentanyl with 2,5 mg Hyperbaric Bupivacaine and 25 mcg Fentanyl

Central neuraxial blocks: Complacency begets complications

Risk of rectal puncture due to needle entry into the presacral space

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