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Background: Ultrasound-guided  regional anesthesia techniques for perioperative analgesia in pediatric patients scheduled for lower abdominal surgeries can be achieved either by quadratus lumborum block (QLB) or caudal block (CB). Neostigmine was co-administered with caudal bupivacaine to shorten the onset and extend the duration of analgesia., Objectives: This study aimed to compare between 2 ultrasound-guided techniques used for perioperative analgesia (QLB with bupivacaine vs. CB with bupivacaine/neostigmine) regarding the total amount of rescue analgesic (acetaminophen mg/kg) used for pain relief at 24 hours postsurgery in pediatric patients undergoing lower abdominal surgeries in a developing country and to discuss existing barriers during the implementation of both techniques., Study Design: A randomized, double-blind, prospective, single-center study., Setting: Ain-Shams University Hospitals., Methods: Eighty pediatric patients scheduled for lower abdominal surgeries under general anesthesia were randomly allocated to receive either ultrasound-guided QLB using bupivacaine or ultrasound-guided CB using a bupivacaine/neostigmine mixture. The total amount of rescue analgesic (acetaminophen mg/kg) 24 hours postsurgery was considered as the primary outcome while the time to first rescue analgesia, pain score, postoperative nausea and vomiting, bradycardia, hypotension, and urinary retention were considered as secondary outcomes., Results: In the QLB group, the time to first rescue analgesia was longer whereas the total analgesic dose (mg/kg) was lower than the CB group (P < 0.001, P = 0.007, respectively). While, on the other hand, in CB group, the time to perform the block was shorter and Parents Satisfaction Score 24 h postsurgery was lower than the QLB group (P < 0.001, P < 0.001, respectively). Side effects were infrequent and comparable between the study groups., Limitations: First, the researchers did not assess the dermatomal level before or after the operation in either group. Second, the investigators should have noticed the first voiding time to demonstrate accurately the incidence of urine retention. Third, a cost-effectiveness analysis of perioperative costs (drugs, staff, resources being used) of these regional anesthesia techniques when applied in an ambulatory setting should have been done, which would be helpful for those in resource-limited settings., Conclusions: Postoperative analgesia for pediatric patients undergoing lower abdominal surgeries can be safely and effectively achieved by QLB with bupivacaine  and a CB with a bupivacaine/neostigmine mixture with priority given to CB, especially in resource-limited settings.

Background: Regional blocks have been shown to decrease the requirement of anesthetic agents. This study was conducted to determine the optimal endtidal concentrations of desflurane for removal of Laryngeal mask airway in children in presence of caudal block., Methods: Twenty-two children of ASA status I between the age group of 2-10 year undergoing infraumbilical surgery were enrolled in the study. General anesthesia was induced with sevoflurane and oxygen given via mask and laryngeal mask airway inserted. Caudal injection of bupivacaine 0.25%, 1 ml·kg(-1) was administered according to Armitage regimen. Desflurane was used for maintenance of anesthesia. Predecided endtidal concentration of desflurane was maintained for 10 min at the end of surgery and laryngeal mask airway removed. Target concentration in the next patient was thereafter determined by the Dixon up-down method (with 0.5% as a step size). 5% endtidal concentration was kept as the starting concentration. If removal of laryngeal mask airway was not associated with any coughing, teeth clenching, gross purposeful movement, breath holding or laryngospasm, during or within 1 min after removal, it was considered as successful., Results: In the presence of caudal analgesia, endtidal concentration of desflurane required for successful laryngeal mask airway removal in 50% (ED50) children was 3.39 ± 0.38% by Dixon's method., Conclusion: Laryngeal mask airway can be successfully removed in 50% of anesthetized children without coughing, moving, or any other airway complications at an endtidal desflurane concentration of 3.4% in the presence of caudal analgesia., (© 2013 John Wiley & Sons Ltd.)

Background/Aim. Surgery for developmental dysplasia of the hip (DDH) often needs acetabuloplasty and femoral osteotomy. This type of operation is characterized by long duration, major trauma, and severe postoperative pain. The aim of the study was to compare the analgesic effects of the caudal block (CB) and epidural block (EB) on the DDH surgery in children. Methods. A total of 100 children undergoing DDH surgery in our hospital from May 2018 to December 2021 were selected and randomly divided into two groups: an ultrasound-guided CB group and an EB group (each group consisting of 50 children). The dosage of ropivacaine, changes in blood pressure, heart rate, and intraoperative dosage of fentanyl were recorded. In addition, we recorded the values of several parameters after the surgery: the modified Face, Legs, Activity, Cry, and Consolability (FLACC) scale score at 2, 4, 6, 12, 24, 36, and 48 hrs after surgery; the time point of first-time request for acetaminophen and proportion of patients using pethidine; the sedation degree within 12 hrs after the operation (assessed using the Ramsay Sedation Scale -- RSS); the incidence of nausea, vomiting, and urinary retention; the satisfaction degree of family members with the applied methods of postoperative analgesia in children. Results. The ropivacaine dosage used in the CB group exceeded that of the EB group (p < 0.05). The CB group had lower FLACC scores 12 and 24 hrs after the operation and a longer postoperative time until the first-time request for acetaminophen than the EB group (p < 0.05). No block-related complications occurred; the two groups had similar incidence rates of nausea, vomiting, and urinary retention. The RSS score within 12 hrs after operation was higher in the CB group than in the EB group, and the family members of the children in the CB group were more satisfied (p < 0.05). Conclusion. Both CB and EB can provide satisfactory intraoperative and postoperative analgesia for pediatric hip surgery. However, CB provides effective analgesia for 24 hrs after the operation and lasts longer than that accomplished by the EB. [ABSTRACT FROM AUTHOR]

Background/Aim. Surgery for developmental dysplasia of the hip (DDH) often needs acetabuloplasty and femoral osteotomy. This type of operation is characterized by long duration, major trauma, and severe postoperative pain. The aim of the study was to compare the analgesic effects of the caudal block (CB) and epidural block (EB) on the DDH surgery in children. Methods. A total of 100 children undergoing DDH surgery in our hospital from May 2018 to December 2021 were selected and randomly divided into two groups: an ultrasound-guided CB group and an EB group (each group consisting of 50 children). The dosage of ropivacaine, changes in blood pressure, heart rate, and intraoperative dosage of fentanyl were recorded. In addition, we recorded the values of several parameters after the surgery: the modified Face, Legs, Activity, Cry, and Consolability (FLACC) scale score at 2, 4, 6, 12, 24, 36, and 48 hrs after surgery; the time point of first-time request for aceta-minophen and proportion of patients using pethidine; the sedation degree within 12 hrs after the operation (assessed using the Ramsay Sedation Scale – RSS); the incidence of nausea, vomiting, and urinary retention; the satisfaction degree of family members with the applied methods of post-operative analgesia in children. Results. The ropivacaine dosage used in the CB group exceeded that of the EB group (p < 0.05). The CB group had lower FLACC scores 12 and 24 hrs after the operation and a longer postoperative time until the first-time request for acetaminophen than the EB group (p < 0.05). No block-related complications occurred; the two groups had similar incidence rates of nausea, vomiting, and urinary retention. The RSS score within 12 hrs after operation was higher in the CB group than in the EB group, and the family members of the children in the CB group were more satisfied (p < 0.05). Conclusion. Both CB and EB can provide satisfactory intraoperative and postoperative analgesia for pediatric hip surgery. However, CB pro-vides effective analgesia for 24 hrs after the operation and lasts longer than that accomplished by the EB.

Background: Pain after lumbosacral spine surgeries is due to activation of various pain mechanisms like inflammatory, nociceptive and neuropathic. Also, by handling structures like vertebrae, intervertebral disc, dura and nerve root sleeves, facet joint capsules, muscles, fascia and ligaments. Several studies have shown that caudal epidural injections are relatively safe, simple, and effective in relieving postoperative pain. Regional blockade can be prolonged by adding different adjuvants. Methodology-The study was conducted in the Anesthesiology department, at the tertiary care hospital for a period of 18 months. 40 patients selected for lumbar spine surgery were included in this study. Further the patients were divided into two groups consisting of 20 patients in each. Group 1 received 0.2% Ropivacaine and Group 2 received 0.2% Ropivacaine + 8mg Dexamethasone. Patients were further monitored for hemodynamic changes such as for Heart rate (HR), Respiratory rate (RR), Non-invasive Blood pressure (NIBP), arterial oxygen saturation (SpO2). Changes were noted and analyzed. Results- The mean of group 1 (N=25) was recorded as 80.96 ± 703 with the range between minimum 65 and maximum 95, whereas the mean of group 2 was recorded as 82.36 ± 9.92 for OPHR. OPSBP mean of group 1 (N=25) was recorded as 112.92 ± 10.27 with the range between minimum 90 and maximum 130, whereas the mean of group 2 was recorded as 118.84 ± 11.82 with the range between minimum 90 and maximum 138.Conclusion-Pre-emptive caudal block with 0.2% Ropivacaine and 8 mg Dexamethasone provides longer and better analgesia for lumbosacral spine surgeries with no hemodynamic side effects. [ABSTRACT FROM AUTHOR]

Caudal epidural blockade is one of the most frequently administered regional anesthesia techniques in children. It is a supplement during general anesthesia and for providing postoperative analgesia in pediatrics for sub-umbilical surgeries, especially for genitourinary surgeries. However, the duration of the analgesic effect is occasionally unsatisfactory. In this review, we discuss the main advantages and disadvantages of different techniques to prolong postoperative analgesia for single-injection caudal blockade in children. A literature search of the keywords “caudal”, “analgesia”, “pediatric”, and “children” was performed using PubMed and Web of Science databases. We highlight that analgesic quality correlates substantially with the local anesthetic's type, dose, the timing relationship between caudal block and surgery, caudal catheterization, and administration of epidural opioids or other adjuvant drugs.

ABSTRACTBackground We hypothesized that adding nalbuphine to bupivacaine would prolong the duration of caudal epidural anaesthesia (CEA) in pediatric patients undergoing hypospadias repair surgery.Methods 60 children scheduled for elective hypospadias surgery under general anesthesia combined with CEA were divided into two equal groups: the control group received caudal bupivacaine 0.25% 1 ml/kg plus 2 ml normal saline. The Nalbuphine group received caudal bupivacaine 0.25% 1 ml/kg plus nalbuphine 0.1 mg/kg in 2 ml normal saline. Intraoperative and postoperative rescue analgesia was managed by giving intravenous paracetamol 15 mg/kg and/or 100mcg nalbuphine. The Face, Legs, Activity, Cry, Consolability (FLACC) pain scale, and the Richmond AgitationSedation Scale (RASS) score were measured. Pre-operative and postoperative blood samples were collected for a subgroup of patients for cortisol analysis.Results The duration of postoperative analgesia was significantly longer in the nalbuphine group (p

Background: Erector spinae plane block (ESPB) is a relatively new type of regional anesthesia that has demonstrated efficacy in pain management. The study uses ultrasound (US) guidance to perform the ESPB and evaluates its efficacy and safety compared to the traditional caudal block (CB) in managing postoperative pain in children undergoing lower limb surgeries. Methods: This randomized controlled double-blind trial enrolled 50 pediatric cases aged 2-15 years planned for lower limb surgeries. Cases were classified into two equal groups that were administered 0.25% bupivacaine (0.5 ml/Kg) via CB (group C) or lumbar ESPB at the side of operation (group E). The blocks were US guided after induction of anesthesia before skin incision. Results: Heart rate and mean arterial pressure at 45, 60, and 75 min, and at the end of surgery were reduced in group C contrasted to group E (P < 0.05). Pain scores at 6 h and 8 h were reduced significantly in group E (P < 0.001 and 0.049 respectively). The time of block performance was significantly lower in group C compared to group E. The number of patients who required intraoperative fentanyl was comparable between groups. Group E had prolonged analgesia and less postoperative pethidine doses. Neither group exhibited local anesthetic toxicity or hematoma with lower incidence of postoperative nausea and vomiting (PONV) in Group E (P = 0.042). Conclusion: In pediatric cases undergoing lower limb surgeries, US-guided ESPB provided adequate analgesia (better pain score and prolonged analgesia with lower postoperative analgesic doses) with stable hemodynamic and lower incidence of PONV. [ABSTRACT FROM AUTHOR]

Background: We hypothesized that adding nalbuphine to bupivacaine would prolong the duration of caudal epidural anaesthesia (CEA) in pediatric patients undergoing hypospadias repair surgery. Methods: 60 children scheduled for elective hypospadias surgery under general anesthesia combined with CEA were divided into two equal groups: the control group received caudal bupivacaine 0.25% 1 ml/kg plus 2 ml normal saline. The Nalbuphine group received caudal bupivacaine 0.25% 1 ml/kg plus nalbuphine 0.1 mg/kg in 2 ml normal saline. Intraoperative and postoperative rescue analgesia was managed by giving intravenous paracetamol 15 mg/kg and/or 100mcg nalbuphine. The Face, Legs, Activity, Cry, Consolability (FLACC) pain scale, and the Richmond AgitationSedation Scale (RASS) score were measured. Pre-operative and postoperative blood samples were collected for a subgroup of patients for cortisol analysis. Results: The duration of postoperative analgesia was significantly longer in the nalbuphine group (p < 0.001). The number of patients who needed postoperative supplemental analgesia was significantly lower in the nalbuphine group (p < 0.001). Total paracetamol consumption was significantly higher in the control group (p < 0.001). The FLACC and RASS were significantly lower in the nalbuphine group. Postoperative cortisol levels were lower in the nalbuphine group compared to the control group. Conclusions: Adding caudal nalbuphine 0.1 mg/kg to bupivacaine 0.25% provides better postoperative pain control than bupivacaine alone in children undergoing hypospadias repair. [ABSTRACT FROM AUTHOR]

Purpose: Multiple regional nerve blocks proved no additional benefit in total laparoscopic hysterectomy in multimodal analgesia, as postoperative pain may mainly originate from the vaginal cuff. Theoretically, caudal block can relieve pain from the vaginal cuff by a sacral spinal nerve block. We aimed to verify whether a caudal block with ropivacaine and morphine can achieve an analgesic effect without additional adverse effects after a total laparoscopic hysterectomy.Patients and Methods: Forty-eight patients undergoing total laparoscopic hysterectomy were randomly allocated to receive preoperative caudal block with 20 mL of mixture including 0.25% ropivacaine and 2 mg morphine (caudal block group) or sham block (sham group). The primary outcome was the postoperative 24 h cumulative sufentanil consumption.Results: Median (IQR) sufentanil consumption in the first 24 postoperative hours of the caudal block group and the sham group was 0.00 (0.00 to 0.05) μg/kg vs 0.13 (0.04 to 0.21) μg/kg, respectively, p < 0.001. The majority of patients felt that visceral pain was more intense than incisional pain at 1, 6, 12, and 24 h post-surgery in the sham group (95.8% at 1 h, 95.8% at 6 h, 95.8% at 12 h, and 75% at 24 h post-surgery). Compared to the sham group, the caudal block reduced visceral pain scores at rest and during movement at 1 h (p < 0.001), 6 h (p < 0.001), 12 h (p < 0.001), and 24 h (p < 0.001) post-surgery. Intraoperative remifentanil consumption was significantly lower in the caudal block group than in the sham group (p = 0.004). There were no significant differences in other secondary outcomes between the two groups.Conclusion: A caudal block with ropivacaine and morphine could provide a satisfactory analgesic effect for 24 h postoperatively without additional adverse effects after total laparoscopic hysterectomy. [ABSTRACT FROM AUTHOR]

Central neuraxial blocks (CNBs), which include spinal, epidural, and combined spinal epidural injections, are indispensable techniques in the anesthesiologist's armamentarium. Indeed, in scenarios such as when dealing with the obstetric population, patients with obesity, or patients having respiratory compromise (e.g., lung disease or scoliosis), CNBs are the mainstay for anesthesia and/or analgesia. Traditionally, CNBs are performed using anatomical landmarks, which are simple, easy to master, and exceptionally successful in most cases. Nevertheless, there are notable limitations with this approach, especially in scenarios where CNBs are considered mandatory and vital. Any limitation of an anatomic landmark-based approach is an opportunity for an ultrasound-guided (USG) technique. This has become particularly true for CNBs, where recent advances in ultrasound technology and research data have addressed many of the shortcomings of the traditional anatomic landmark-based approaches. This article reviews the ultrasound imaging of the lumbosacral spine and its application for CNBs. [ABSTRACT FROM AUTHOR]

Background: The goal is to reduce or eliminate perioperative pain with as few adverse effects as possible. The mode of anaesthesia that has been proven to be safe and effective in children is regional. In addition to extending analgesia to the postoperative period with minimal sedation (2), the use of inhalational and intravenous analgesics can be reduced. In childern caudal epidural is the regional block infra-umbilical procedures. Objectives:This study was aimed at comparing Bupivacaine 0.125 % (1ml/kg) alone against Bupivacaine 0.125 % (1ml/kg) plus Fentanyl 0.5 µg/kg as a caudal block administered via single bolus in infra-umbilical procedures in children aged 1 to 8 years. Hemodynamic alterations, ie heart rate and blood pressure., and Duration of post operative analgesia after and Adverse reactions are the parameters noted Material & Methods: Study Design: A prospective, randomized, comparative study. Study area: Department of Anaesthesia and Critical care, Government Medical college, Srikakulam, AP. Study Period: 1 year. Study population: children, of both gender, posted for infraumbilical procedures of various types. Sample size: study consisted a total of 60 cases. Sampling method: Simple random method.A general, systemic examination, including the airway and spine, was done on the day of surgery also. Vital parameters such as systolic blood pressure, respiratory rate and pulse rate were noted. In addition, investigations such as blood and urine tests, bleeding and clotting times, a chest x-ray if necessary, and viral tests (HIV & HBsAg) were done. Informative and written consent was obtained from the parent. Prior to surgery, restriction was advised for solid foods for 6 hours, milk for 4-5 hours and clear fluids for 2-3 hours. All children were given 1 mg/kg of Promethazine syrup the night before the scheduled operation. Results: The mean duration of analgesia at various time intervals in both the groups was statistically significant. The mean duration of analgesia in the B group (0.125% Bupivacaine) is 5.2 ± 0.85 hrs, the mean duration of analgesia in the BF group (0.125 % Bupivacaine + 0.5 mc/kg Fenyanyl) is 10.8 ± 1.24 hrs. This duration of analgesia is statistically significant as detected by using t test (p = 0.03, <0.05) Conclusion: The present study demonstrated that caudal epidural block with Bupivacaine 0.125% (1ml/kg) plus Fentanyl (0.5 mcg/kg) resulted in analgesia of longer duration and postoperative analgesia when compared with 0.125% Bupivacaine (1ml/kg) alone, with no significant difference in the hemodynamic parameters and the occurrence of side effects. [ABSTRACT FROM AUTHOR]

Rabab SS Mahrous,1 Amin AA Ahmed,2 Aly Mahmoud Moustafa Ahmed1 1Department of Anaesthesia and Surgical Intensive Care Alexandria University Alexandria Egypt; 2Department of Orthopedic Surgery and Traumatology Alexandria University Alexandria EgyptCorrespondence: Rabab SS Mahrous, Department of Anaesthesia and Surgical Intensive Care Faculty of Medicine Alexandria University, Alexandria, Egypt, Tel +201223497339, Email roba98@hotmail.comBackground and Aim: Ultrasound (US) guided regional analgesia is a safe and effective method in providing perioperative analgesia in pediatrics with a high success rate rapid onset and fewer side effects. The aim of this study was to compare the efficacy of US-guided caudal block versus US-guided peripheral nerve blocks (femoral and sciatic nerve blocks) in providing perioperative analgesia in pediatrics undergoing unilateral lower limb surgery.Methods: Children aged 1– 12 years scheduled for unilateral lower limb surgery during the period from January 2020 to December 2021 were randomly allocated into two groups. Group C where pediatrics received US-guided caudal block, while in group P, pediatrics received US-guided femoral and sciatic nerve blocks after the induction of general anesthesia (GA). The primary aim was to compare the postoperative pain (evaluated by the COMFORT pain score) between the two groups. Secondary aims were to compare perioperative opioids used parents’ satisfaction and occurrence of side effects.Results: Pediatrics who underwent unilateral lower limb surgeries were allocated into two groups (group C and group P). There was no significant difference between patients’ baseline characteristics and the postoperative pain score at 2, 4, 16, and 20 h.’ However there was a statistical significance at 6, 8, 12, and 24 h postoperatively, frequency of analgesia as well as the total postoperative dose of opiates (nalbuphine). Time to first analgesic (nalbuphine) requirement was significantly less in group C with a mean of (9.6± 2.9 h) than in group P with a mean of (15.1± 3.5 h). Parents of children in group P were more satisfied than those in group C with no recorded complications for both techniques.Conclusion: US-guided lower limb peripheral nerve block is a simple and safe method to provide adequate and more prolonged analgesia compared to US-guided caudal block for lower limb surgeries in pediatrics.Keywords: caudal, analgesia, peripheral nerve, block, lower limb surgeries, pediatrics

Background: the control of postoperative pain is important in children, and poor pain control leads to organ dysfunction and behavioral problem. Aim of study: we compare the analgesic effect of bupivacaine by caudal block root and acetaminophen suppository on postoperative pain in pediatric inguinal hernial repair surgery. Patient and Methods: A prospective, randomized, controlled trail of 40 children, aged between (1-7 years), ASA grade I-II, scheduled for elective day case unilateral inguinal surgery. For all the patients included in this study, a standardized controlled anesthetic protocol was used. Preoperatively the patients were randomized into two groups according to the operation waiting lists. group 1 included (18) patients who received single - shot caudal block with (1ml/kg) of 25% bupivacaine preoperatively after induction of anesthesia by the anesthetist, group 2 included (22) patients who received (15-20 mg/kg) acetaminophen suppository. Results: The number of patients (who had first three hours free of pain); was significantly higher in the Caudal group than those of the other group. Patients of the Caudal group; needed significantly a longer duration of time for the first analgesic drug. Patients of the Caudal group; had significantly a lower (Face, Legs, Activity, Cry, Consolability scale) in (1/2, 1, and 2 hours) time intervals of the study. Conclusion: Caudal anesthesia with bupivacaine has better painless period postoperatively. [ABSTRACT FROM AUTHOR]

Background Caudal block is the most common regional anesthetic technique performed for analgesia for pediatric surgeries. The aim of this study was to evaluate dexamethasone through intravenous and caudal routes as adjuvants to caudal block for postoperative analgesia for pediatric patients who underwent lower abdominal surgeries. Patients and methods This prospective, randomized, double-blinded controlled study included 150 children who were divided into three equal groups. All patients received caudal analgesia with 0.125% hyperbaric bupivacaine 1 ml/kg. Group C received an intravenous injection of 10 ml normal saline, group D received 0.1 mg/kg dexamethasone added to the caudal analgesia, and 10 ml normal saline intravenous, while group IV received dexamethasone 0.1 mg/kg in 10 ml normal saline intravenous. The primary outcomes were the duration and severity of postoperative pain. The amount of rescue analgesic doses, residual motor block, and side effects such as nausea, vomiting, and hyperglycemia (secondary outcomes) were monitored. Results Dexamethasone groups (D, IV) showed a significantly prolonged duration of postoperative analgesia in comparison to the control group (C) and group D showed a longer duration of analgesia and delayed analgesic rescue when compared with the dexamethasone IV group. CHIPPS was the least in group D compared with group C and group IV at 3, 6, 12, and 24 h. Postoperative nausea and vomiting were significantly lower in group IV compared with the other two groups. Conclusions Dexamethasone either caudal or low-dose intravenous was effective for prolonging the duration of analgesia from caudal blockade with bupivacaine, while caudal dexamethasone was more effective. Intravenous dexamethasone had the upper hand in decreasing postoperative nausea and vomiting. [ABSTRACT FROM AUTHOR]

Amaç: Pediatrik ürolojik girişim uygulanmış hastalardan postoperatif ağrı tedavisinde parasetamol ya da rejyonal tekniklerden kaudal blok kullanılmış olan ve FLACC skalası ile postoperatif analjezi ölçümü yapılmış olan hastaları retrospektif olarak değerlendirmeyi amaçladık. Gereç ve Yöntem: Çalışmada yaşları 0 ile 12 arasında değişen, Nisan 2019 ile Temmuz 2019 tarihleri arasında ürolojik günübirlik cerrahi uygulanmış toplam 55 hastanın dosyaları retrospektif olarak değerlendirilmiştir. Kaudal epidural analjezi yapılan pediatrik hastalar Grup 1 olarak adlandırılırken, iv parasetamol verilen Grup 2 olarak adlandırılmıştır. FLACC skorları 10 dakika da bir olmak üzere 50 dakika boyunca uygulanmış. 10, 20, 30, 40 ve 50. dk’daki skorları hesaplanmıştır. Skor sonucuna göre ek analjezik yapılan hastalar not edilmiştir.Bulgular: Hastaların yaş ortalaması Grup 1’de 5.5±3.4 yıl iken Grup 2’de 6.2±3.6 yıl idi. Ortalama cerrahi süresi Grup 1’de 36.9±25.5, Grup 2’de ise 23.5±17.2 dakika idi. Postoperatif FLACC skorları 10, 20, 30, 40. dakikalarda grup 2’de Grup 1’e göre anlamlı derecede yüksekti ve yine 50. dakikada bile anlamlı derecede yüksek tespit edildi. Postoperatif ek analjezik ihtiyacı Grup 1’de hiçbir hastaya gerekmezken %0 , grup 2’deki 14 hastaya %50 ek analjezik olarak iv parasetamol 15 mg/kg verilmiştir.Sonuç: Çalışmamızda ağrı ortaya çıkmadan önce önleme konusunda kaudal epidural analjezi tekniğinin uygulanmasının postoperatif ağrı kontrolünü sağlamada etkin olduğunu tespit ettik. İlave olarak kaudal analjezinin postoperatif dönemde ek analjezik ihtiyacını azaltması, analjeziklerden oluşabilecek yan etkilerden sakınma ve maliyeti düşürme açısından avantajları düşünüldüğünde pediatrik grup hastalarda tercih sebebi olması gerektiğini düşünmekteyiz

Background: The usage of caudal opioids extends the length of analgesia substantially, but it often comes with a slew of adverse side effects, including fatigue, vomiting, pruritus, urinary retention, and a chance of respiratory distress later on. Objective: The aim of this analysis was to compare the effects of caudal dexmedetomidine versus morphine in conjunction with bupivacaine in pediatric infraumbilical surgeries. Patients and Methods: This randomized controlled sample involved 90 pediatric patients aged 1 to 7 years old, of American Society of Anesthesiologists (ASA) physical status I-II, of both sexes, who were scheduled for lower abdominal surgeries. Patients were allocated to three equal groups. Group D got a 0.25% bupivacaine + 1 g/kg dexmedetomidine. Group M obtained a 0.25% bupivacaine + 30 g/kg morphine mixture. Group MD: dexmedetomidine 1 g/kg and morphine 30 g/kg with bupivacaine were used in a single dose caudal epidural analgesia. Results: Intraoperative heart rate, mean arterial blood pressure at 20, 25, 30 and 45 min was significantly decreased in group MD than group D and group M while in postoperative period were insignificantly among the three groups at all times of measurement. FLACC was significantly lower in MD group at discharge, 1, 2, 3, 6, 12 and 18 hours. Ramsey sedation score (RSS) at 30 min was significantly decreased in group M than group D and in group MD than group M. Time for 1st analgesia and paracetamol dosage was significantly earlier in group M than group D and group MD. Pruritus and vomiting were significantly lower in group D than other groups. Conclusions: The addition of dexmedetomidine to caudal morphine in pediatric patients produced longer postoperative analgesia, more sedation and with better emergence from anesthesia and hemodynamic stability, with fewer side effects than morphine. [ABSTRACT FROM AUTHOR]

Introduction: This study is to compare advantages, safety and mid-term effects of fluoroscopy (FL)-guided transforaminal (TF) to caudal (CA) epidural steroid injection (ESI) for chronic pain after spinal surgery (CPSS) by assessing pain relief and improvement of functionality. Methods: Patients with radicular pain in CPSS who received FL-guided CA (n = 21) or TF (n = 28) ESI were included in this retrospective study. Complication frequencies, adverse events, treatment effects, and functional improvements for each procedure were compared at 1, 3, and 6 months following the last injection. Results: Both the Oswestry Disability Index (ODI) and verbal numeric pain scale scores (VNS) demonstrated improvement in both groups at all 1, 3, and 6 months following the last injection, without meaningful difference between groups (p < 0.05). Moreover, no meaningful difference was present between groups in terms of treatment success rate at every time point. The amount of time used for the injection procedure was shorter in CA group than in TF group (410.32 ± 25.73 seconds vs 640.65 ± 18.03 seconds, p < 0.05). Within 2 weeks of the injection treatment, the patient satisfactory scores were evaluated, with excellent being rated 85.7% (n = 18) among CA-ESI patients and 55.7% (n = 16) among TF-ESI patients (p < 0.05). Logistic regression analysis revealed that variables such as method of injection (CA or TF approach), sex, use of analgesics, pain duration, number of injections, and age were not significant variables for successful treatment results. There were no adverse complications after the procedure in both groups. Conclusion: The outcomes of FL-guided CA-ESI and TF-ESI for CPSS are similar in terms of pain reduction and functional improvements. CA-ESI is associated with lesser procedure time. In addition, compared with the TF-ESI, the patient experiences less discomfort during the injection, and the satisfaction with the injection treatment is confirmed to be better. Accordingly, both methods are effective; however, in the CA approach, patient satisfaction is higher and the procedure time is shorter. [ABSTRACT FROM AUTHOR]

Background Different additives have been reported to prolong the duration of caudal anesthesia in pediatrics. Although these drugs successfully increased the duration of the block, ketamine has been found to effectively increase the duration of caudal block in pediatrics. Aim This study aimed to assess the clinical effectiveness of ketamine after caudal or intravenous administration in pediatric patients who underwent hypospadias repair to distinguish between local and systemic analgesia. Patients and methods After induction of general anesthesia 48 patients aged 1-6 years assigned to undergo hypospadias repair received a caudal injection of bupivacaine and were randomly blinded into two groups: K1 group received 1 mg/kg S-ketamine as the caudal group and K2 group received 1 mg/kg S-ketamine as the intravenous group. Postsurgical measurements included the effectiveness of postsurgical analgesia which was assessed by using observational pain scale duration of analgesia sedation score and hemodynamic and complications. Results The caudal block was successful in all the patients included in the study. None of the patients in either groups required intraoperative rescue analgesia. All patients remained vitally stable during the procedure and intraoperative hemodynamic parameters were comparable in the two groups. The time to the administration of first analgesia was statistically longer in K1 group (11.5±4.6 h) than in the K2 group (8.7±3.1 h). Time to spontaneous leg movement and time to first micturition were statistically nonsignificant between both groups. The number of patients requested for additional analgesic drugs (acetaminophen and ibuprofen) was statistically significant being higher in the K2 group than the K1 group. Conclusion This study demonstrates that ketamine if added to caudal epidural in a dose of 1 mg/kg provided prolonged postoperative analgesia with improved quality had longer duration of analgesia decreased the supplemental acetaminophen analgesia during the first 24 h postoperatively had stable hemodynamic changes and had comparable adverse effects and complications in comparison with systemic ketamine in a dose of 1 mg/kg. [ABSTRACT FROM AUTHOR]

Background and Aims: Pre-emptive analgesia using caudal epidural technique is an underutilized technique in lumbosacral spine surgery patients. We intend to study if pre-emptive analgesia with a single caudal epidural injection of ropivacaine is an effective method of postoperative analgesia by assessing the quality and duration of pain relief and intraoperative opioid requirement. Material and Methods: Eighty patients undergoing lumbosacral spine surgeries by the posterior approach were randomized to ropivacaine (R) group (n = 40) and saline (S) group (n = 40). Patients in R group received caudal epidural injection of 20 ml of 0.2% ropivacaine for surgeries at or below L5 lumbar spine and 25 ml of 0.2% ropivacaine for surgeries between L2 and L5 lumbar spine. Patients in S group received similar amounts of normal saline. Patients were monitored in the immediate postoperative period and at 4, 8, 12, and 24 hours for pain using visual analogue scale (VAS) scale. Time to rescue analgesia and intraoperative fentanyl requirement were noted. Results: The demographics, duration of anesthesia, and hemodynamic variables were comparable in both groups. The mean intraoperative fentanyl requirement (P = 0.001) and mean VAS scores were significantly lower in the R group in the immediate postoperative period, (P < 0.001), 4 hours (P < 0.001), 8 hours (P = 0.009), 12 hours (P = 0.007), and 24 hours (P = 0.046) postoperatively. The mean time to rescue analgesia was significantly longer in the R group (P < 0.001) compared to S group. No hemodynamic or neurological side-effects were observed in the groups. Conclusion: Pre-emptive analgesia with caudal epidural injection of ropivacaine is a safe and effective method of postoperative analgesia.

Objective: The aim of this systematic review and meta-analysis is to compare the outcomes of morphine vs. clonidine use as adjuvants in caudal anaesthesia. We are specifically focused on analgesic and side effect profiles. Methods: We searched databases and trial registration sites and include here randomised controlled trials that compare the analgesic effects of caudal clonidine vs. morphine as adjuvants on postoperative pain. The risk ratio for evaluating pain scores, the need for rescue analgesia and all adverse effects were assessed. The i2 statistic was used to assess heterogeneity. We also assessed risk of bias with Cochrane's Collaboration tool. The quality of evidence was assessed with Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Results: Four randomised controlled trials (including 166 patients) that evaluated the use of clonidine vs. morphine as adjuvants in caudal block were included in this systematic review and meta-analysis. The pooled estimate for postoperative analgesia revealed no statistically significant differences between the clonidine group compared to morphine group (MD=2.90; 95% CI 4.05 to 9.85; i2 93%). Significantly less postoperative nausea and vomiting were reported among the patients that received clonidine vs. those that were treated with morphine (RR 0.57, 95% CI -0.36 to -0.90, i2 26%). There were no statistically significant differences between the two groups in assessments that included urinary retention, pain scores or need for rescue analgesia at 24 hours. Conclusion: Clonidine is just as effective as morphine when used an adjuvant to local anaesthetic for caudal block, and has a more desirable side effect profile, particularly with respect to postoperative nausea and vomiting. [ABSTRACT FROM AUTHOR]

Objective: We aimed to evaluate postoperative analgesia of intravenous paracetamol or caudal block at pediatric patients with using FLACC scale who underwent urologic intervention retrospectively. Material and Methods: The files of 55 patients aged between 0 and 12 who underwent urological surgery between April 2019 and July 2019 were evaluated retrospectively. Pediatric patients undergoing caudal epidural analgesia were referred to as Group 1, while Group 2 was given iv paracetamol. FLACC scores were administered for 50 minutes, once every 10 minutes. Scores at 10, 20, 30, 40 and 50 min were calculated. Patients who underwent additional analgesics based on the score were noted. Results: The mean age of the patients was 5.5 ± 3.4 years in Group 1 and 6.2 ± 3.6 years in Group 2. Mean duration of surgery was 36.9 ± 25.5 minutes in Group 1 and 23.5 ± 17.2 minutes in Group 2. Postoperative FLACC scores were significantly higher in group 2 at 10, 20, 30, 40 minutes compared to Group 1, and again significantly higher at 50 minutes. No additional postoperative analgesic requirement was required in Group 1 (0%), while 14 patients (50%) in group 2 received iv paracetamol 15 mg / kg as an additional analgesic. Conclusion: We found that the application of caudal epidural analgesia to prevent postoperative pain was effective. Caudal analgesia should be preferred in pediatric patients when it is considered to reduce requirement of additional analgesics in postoperative period, avoiding the side effects and reducing costs. [ABSTRACT FROM AUTHOR]

Background:Caudal block is a common technique for pediatric analgesia, but with the disadvantage of short duration of action of bupivacaine aft er single injection. Caudal ketamine could off er signifi cant analgesic benefi ts. We compared the analgesic eff ects and side eff ects of ketamine added to bupivacaine in pediatric patients under-going inguino-scrotal surgeries. Materials and Methods: 80-patients (3 to 10 years) were randomly assigned into 2-groups by lott ery method. Aft er sevofl urane in oxygen general anaesthesia induction, each patient received either a single caudal dose of bupivacaine 0.25% (1 mL/kg) with normal saline or bupivacaine 0.25% with ketamine 0.5 mg/kg. Haemodynamic variables, MOPS score, analgesia duration, use of analgesics and side eff ects were assessed during the fi rst 12 h. Results: Addition of ketamine to caudal bupivacaine signifi cantly prolonged the duration of analgesia than the use of bupivacaine alone. Th ere was statistically signifi cant diff erence between bupivacaine alone and in combination with ketamine with regards to the analgesia time (p < 0.05). No signifi cant diff erence was observed in incidence of side-eff ects. Conclusion: Addition of ketamine to caudal bupivacaine signifi cantly prolonged analgesia in children undergoinginguinoscrotalsurgeries. [ABSTRACT FROM AUTHOR]

Background: Multiple studies claim that caudal administration of ketamine causes effective postoperative analgesia. The aim of this study was to assess the clinical effectiveness of ketamine after caudal or topical administration in pediatric patients undergoing inguinal herniotomy. Patients and Methods: This randomized, comparative, double-blind study included eighty children (aged 6 months to 6 years) received either 1 ml/kg of 0.25% bupivacaine/ketamine 0.5 mg/kg for caudal analgesia (caudal group) or 0.3 ml/kg of 0.25% bupivacaine/ketamine 0.5 mg/kg sprayed by the surgeon around the spermatic cord and upon the ilioinguinal nerve before wound closure for topical analgesia (topical group). The duration of postoperative analgesia, pain scores, rescue analgesic consumption, sedation score, hemodynamic monitoring, and side-effects were evaluated 48 h postoperative. Results: Kaplan–Meier survival analysis of analgesia free time demonstrated a significant advantage of topical ketamine (TK) group over caudal ketamine (CK) group. The duration of postoperative analgesia was longer in TK group than in CK group (28.74 ± 2.88 vs. 21.43 ± 5.01 h, P < 0.000). Fewer children asked for oral analgesics in the topical group (24 of 36, 66.7%) than in the caudal one (28 of 32, 87.5%; P < 0.01). Postoperative pain scores at the 6th till 48th h were lower in topical group with comparable analgesic consumption between two groups. In the caudal group, four subjects suffered from retention of urine: Two presented with a residual motor block and two had photophobia. Conclusion: Wound instillation of bupivacaine/ketamine is a simple, noninvasive, and effective technique that could be a safe alternative to CK for postoperative analgesia in children undergoing inguinal hernia repair.

Background: Alpha-2 adenoreceptors as an adjuvant to local anesthetic during caudal analgesia in children prolongs the duration of analgesia. This study was designed to compare the analgesic efficacy and adverse effects of dexmedetomidine and clonidine when added to ropivacaine for caudal analgesia in children undergoing lower abdominal surgeries. Methods: In a prospective study, Seventy-eight children received block with either 0.2% ropivacaine 1.5 mg/kg (Group R; n = 26) or 0.2% ropivacaine 1.5 mg/kg + 1 mcg/kg clonidine (Group RC; n = 26) or 0.2% ropivacaine 1.5 mg/kg + dexmedetomidine 1 mcg/kg (Group RD; n = 26). Results: Duration of analgesia was 7.15 ± 1.00 h in Group R, 11.57 ± 1.27 h in Group R + C, and 14.73 ± 1.53 h in Group R + D (P < 0.0001). One patient in Group R + D had vomiting and 1 patient in Group R had urinary retention which was not statistically significant (P > 0.05). Conclusion: Addition of clonidine and dexmedetomidine to caudal ropivacaine significantly prolongs the duration of analgesia without adverse effects.

Caudal block is most popular regional anesthetic technique used in children. It provides excellent analgesia during surgery as well as in postoperative period in subumblical surgeries. In this study, we compared the analgesic efficacy and safety of caudal dexmedetomidine added to caudal ropivacaine for postoperative analgesia in children. 60 patients aged 1 to 8 years scheduled for subumblical surgeries were randomly allocated into two groups of 30 patients each. Group RD received 1ml/kg of 0.2% ropivacaine with dexmedetomidine 2ìg/Kg in normal saline 1 ml. Group R received 1ml/kg of 0.2% ropivacaine with normal saline 1ml. Hemodynamic parameters, duration of analgesia, pain scores using observational pain scoring (OPS), requirement of rescue analgesia, and various complications were recorded. The duration of analgesia in group R was 8.4± 1.4 hours while in group RD the duration was 10.4 ± 2 hours. Maximum OPS scores were lower in group RD compared to group R.It was concluded that caudal dexmedetomidine when added to ropivacaine as an adjuvant increases the efficacy and duration of analgesia, reducing the need of post operative rescue analgesia with no additional side effects. [ABSTRACT FROM AUTHOR]

Context: Caudal analgesia is a reliable and an easy method to provide intraoperative and postoperative analgesia for infraumbilical surgeries in pediatric population but with the disadvantage of short duration of action after single injection. Many additives were used in combination with local anesthetics in the caudal block to prolong the postoperative analgesia. Aim: We compared the analgesic effects and side effects of dexmedetomidine added to ropivacaine in pediatric patients undergoing lower abdominal surgeries. Settings and Design: Double-blinded randomized controlled trial. Materials and Methods: Sixty patients (2-10 years) were evenly and randomly assigned into two groups in a double-blinded manner. After sevoflurane in oxygen anesthesia, each patient received a single caudal dose of ropivacaine 0.25% (1 ml/kg) combined with either dexmedetomidine 2 μg/kg in normal saline 0.5 ml, or corresponding volume of normal saline according to group assignment. Hemodynamic variables, end-tidal sevoflurane, and emergence time were monitored. Postoperative analgesia, requirement of additional analgesic, sedation, and side effects were assessed during the first 24 h. Results: The duration of postoperative analgesia was significantly longer (P = 0.001) and total consumption of rescue analgesic was significantly lower in Group RD compared with Group R (P < 0.05). Group RD have better quality of sleep and prolonged duration of sedation (P = 0.001). No significant difference was observed in the incidence of hemodynamic changes or side effects. Conclusion: Addition of dexmedetomidine to caudal ropivacaine significantly prolongs analgesia in children undergoing lower abdominal surgeries without an increase in the incidence of side effects.

Background: The study was conducted to evaluate the perioperative analgesic efficacy of the two doses of caudally administered tramadol versus bupivacaine in adult hemorrhoidectomy. Patients and Methods: A total of 90 patients, aged 20-50 years, undergoing hemorrhoidectomy were randomly scheduled to receive bupivacaine 0.25% in 20 ml (Group B; n = 30), tramadol 1 mg/kg in 20 ml (Group T 1 ; n = 30), tramadol 2 mg/kg in 20 ml (Group T 2 ; n = 30) through caudal route after induction of general anesthesia. Postoperative pain was assessed every hour until the visual analog scale was 6, which is 1 st time for rescue analgesia. Postoperative sedation, hemodynamic changes, serum cortisol, and epinephrine levels and incidence of side effects were also evaluated. Results: Duration of analgesia was longer in Group T 2 (20 [1.14] h] compared with the Group B (7 [1.2] h) or Group T 1 (12 [0.75] h); all P < 0.001. There were no significant hemodynamic changes. There were not incidences of side effects. Conclusion: Caudal tramadol 2 mg/kg provided a longer duration of postoperative analgesia with rapid onset and no incidence of complications or adverse effects in adult hemorrhoidectomy.

Introduction We have designed a prospective, randomised, single blinded non-inferiority trial to determine whether using a lower concentration local anaesthetic in caudal blocks (0.125% levobupivacaine) provides non-inferior analgesia compared to IG/IH blocks with fewer side effects. Material and methods We recruited 82 patients for our study at Medway Maritime Hospital. The intervention was caudal block with 0.125% levobupivacaine with clonidine as an additive compared with USS guided IG/IH nerve blocks. Our primary outcome measure was post-operative pain and our predefined non-inferiority margin was a 15% difference in pain. Secondary outcomes included rescue analgesia, motor block, time to discharge and micturition. Results 80 patients were included in analysis (caudal n=40, IG/IH n=40). We found a 5% absolute decrease in post-operative pain after low concentration caudal blocks compared to IG/IH blocks (95% CI -19.5 to 9.5, p <0.01) demonstrating non-inferiority. There was no evidence of noninferiority for motor block, with 12.5% more patients experiencing motor block in the caudal group immediately following recovery from general anaesthetic (95% CI - 2.4 to 28.4 p=0.379 for non-inferiority). Of these, 2 patients receiving caudal blocks (5%) had remaining motor block on the ward which recovered by discharge. Conclusions Our study shows non-inferiority between low concentration local anaesthetic in caudal blocks compared with USS guided IG/IH nerve blocks for analgesic benefit and requirement for post-operative analgesia. We suggest 0.125% levobupivacaine for anaesthetists who use caudal blocks in their practice. This technique demonstrates non-inferiority compared to USS guided IG/IH blocks. [ABSTRACT FROM AUTHOR]

Background and Aims: Pre‑emptive analgesia using caudal epidural technique is an underutilized technique in lumbosacral spine surgery patients. We intend to study if pre‑emptive analgesia with a single caudal epidural injection of ropivacaine is an effective method of postoperative analgesia by assessing the quality and duration of pain relief and intraoperative opioid requirement. Material and Methods: Eighty patients undergoing lumbosacral spine surgeries by the posterior approach were randomized to ropivacaine (R) group (n = 40) and saline (S) group (n = 40). Patients in R group received caudal epidural injection of 20 ml of 0.2% ropivacaine for surgeries at or below L5 lumbar spine and 25 ml of 0.2% ropivacaine for surgeries between L2 and L5 lumbar spine. Patients in S group received similar amounts of normal saline. Patients were monitored in the immediate postoperative period and at 4, 8, 12, and 24 hours for pain using visual analogue scale (VAS) scale. Time to rescue analgesia and intraoperative fentanyl requirement were noted. Results: The demographics, duration of anesthesia, and hemodynamic variables were comparable in both groups. The mean intraoperative fentanyl requirement (P = 0.001) and mean VAS scores were significantly lower in the R group in the immediate postoperative period, (P < 0.001), 4 hours (P < 0.001), 8 hours (P = 0.009), 12 hours (P = 0.007), and 24 hours (P = 0.046) postoperatively. The mean time to rescue analgesia was significantly longer in the R group (P < 0.001) compared to S group. No hemodynamic or neurological side‑effects were observed in the groups. Conclusion: Pre‑emptive analgesia with caudal epidural injection of ropivacaine is a safe and effective method of postoperative analgesia. [ABSTRACT FROM AUTHOR]

Background: Umbilical hernia repair is a common pediatric surgical procedure. While opioid analgesics are a feasible option and have long been a mainstay in the pharmacological intervention for pain, the effort to improve care and limit opioid-related adverse effects has led to the use of alternative techniques, including regional anesthesia. The current study prospectively compares the analgesic efficacy of three techniques, including caudal epidural blockade, peripheral nerve blockade, and local wound infiltration, in a double-blinded study. Patients and methods: A total of 39 patients undergoing umbilical hernia repair were randomized to receive a caudal epidural block (CDL), ultrasound-guided bilateral rectus sheath blocks (RSB), or surgical site infiltration (SSI) with local anesthetic. Intraoperative anesthetic care was standardized, and treatment groups were otherwise blinded from the intraoperative anesthesiology team and recovery nurses. Postoperatively, the efficacy was evaluated using Hannallah pain scores, Aldrete recovery scores, the need for intravenous fentanyl, and the time to discharge. Results: Each cohort was similar in terms of age, weight, premedication dosing, length of case, intraoperative and postoperative fentanyl requirements, and time to tracheal extubation. Among the three cohorts, there were no significant differences noted in terms of pain scores or time to recovery. Conclusion: All the three techniques provided effective analgesia following umbilical hernia repair. Our findings offer effective and safe analgesic options as alternatives to the neuraxial (caudal) approach. [ABSTRACT FROM AUTHOR]

Background Caudal block has been widely used in children undergoing genitourinary surgery. However, the influence of caudal block on postoperative oliguria is unclear. Aim The aim of this study was to assess the effect of caudal block on urinary flow through the reimplanted ureter after ureteroneocystostomy and the incidence of postoperative oliguria in infants. Methods This retrospective study analyzed the medical records of 121 infants aged less than 12 months who underwent bilateral ureteroneocystostomy for vesicoureteral reflux at a tertiary medical center. In all study infants, a ureteral catheter was placed in one of the two ureters in order to relieve the clinical consequences of transient ureteral obstruction and a urethral catheter was placed at the end of the ureteroneocystostomy procedure. Urinary output was assessed separately for each catheter. Logistic regression analysis was performed to identify the risk factors for oliguria from the urethral catheter. Results Among the 121 patients, 63 (52%) received caudal block (caudal block group) and 58 (48%) did not (no caudal block group). Patient characteristics, preoperative vesicoureteral reflux grade and renal function, and intraoperative profiles were comparable between the groups. The incidence of oliguria from the urethral catheter for 8 h after the surgery was significantly higher in the caudal block group than in the no caudal block group. However, the incidence of oliguria from the ureteral catheter was comparable between the groups. In multivariate analysis, oliguria from the urethral catheter was associated with caudal block, anesthesia duration, and intraoperative dexamethasone administration. The odds for oliguria was 3.069-fold greater in patients who received caudal block than in those who did not (95% CI, 1.303-7.228, P = 0.010). On the other hand, intraoperative dexamethasone reduced the risk of oliguria. Conclusion Caudal block may be associated with postoperative oliguria in infants undergoing ureteroneocystostomy. [ABSTRACT FROM AUTHOR]

Background: Caudal block is commonly administered for postoperative analgesia in children. Although caudal block with 1.5 ml kg -1 local anaesthetic has been reported to reduce cerebral oxygenation in infants, the effect of caudal block on intracranial pressure (ICP) in children has not been well investigated. Optic nerve sheath diameter (ONSD) correlates with degree of ICP. This study aimed to estimate the effects of caudal block on ICP according to volume of local anaesthetic using ultrasonographic measurement of ONSD in children.Methods: Eighty patients, 6- to 48-months-old, were randomly allocated to the high-volume (HV) or low-volume (LV) groups for caudal block with ropivacaine 0.15%, 1.5 ml kg -1 or 1.0 ml kg -1 , respectively. Measurement of ONSD was performed before (T0), immediately after (T1), and 10 min (T2) and 30 min (T3) after caudal block.Results: The two groups exhibited significant differences in ONSD according to time ( P Group x Time =0.003). The HV group exhibited significantly greater changes in ONSD from T0 to T2 and T3 than the LV group. However, in both groups, ONSDs at T1, T2 and T3 were significantly greater compared with those at T0, with the highest values at T2.Conclusions: Caudal block with a high volume of local anaesthetic can cause a greater increase in ICP than caudal block with a low volume of local anaesthetic. However, caudal block with 1.0 ml kg -1 of local anaesthetic can also result in a significant increase in ICP.Clinical Trial Registration: NCT02768493. [ABSTRACT FROM AUTHOR]

Background: The challenge in providing analgesia for spine surgeries is to provide extended postoperative pain relief and simultaneously allow early neurological assessment and mobilization. Our study aimed to evaluate the analgesic efficacy of intravenous versus caudal dexamethasone in lumbosacral spine surgeries. Materials and Methods: In this prospective double-blind study, a total of 96 patients undergoing lumbosacral spine surgery were randomized into three groups to receive 25 ml of preemptive caudal epidural injection of either injection ropivacaine 0.2% (Group A, n = 32), a 25 ml of injection ropivacaine 0.2%, and intravenous injection dexamethasone 8 mg (Group B, n = 32) or 25 ml mixture of injection ropivacaine 0.2% with injection dexamethasone 8 mg (Group C, n = 32) under general anesthesia. Visual analog scale (VAS), heart rate, blood pressures, blood sugar levels, and time to rescue analgesia were recorded at regular intervals for the first 24 h. Time to discharge was noted. Analysis of variance has been used to find the significance of study parameters between the groups of patients. Statistical software, namely, SAS 9.2 and SPSS 15.0, have been used for the analysis of the data. Results: The mean VAS was significantly lower in the Group C for up to 24 h following the caudal block. No significant hemodynamic changes were noted in any of the groups. The intravenous dexamethasone group showed higher blood glucose levels at 24 h but was not clinically relevant Conclusion: These results suggest that injection dexamethasone is a safe adjunct to caudal ropivacaine in lumbosacral spine surgeries. [ABSTRACT FROM AUTHOR]

Background: Multiple studies claim that caudal administration of ketamine causes effective postoperative analgesia. The aim of this study was to assess the clinical effectiveness of ketamine after caudal or topical administration in pediatric patients undergoing inguinal herniotomy. Patients and Methods: This randomized, comparative, double-blind study included eighty children (aged 6 months to 6 years) received either 1 ml/kg of 0.25% bupivacaine/ketamine 0.5 mg/kg for caudal analgesia (caudal group) or 0.3 ml/kg of 0.25% bupivacaine/ketamine 0.5 mg/kg sprayed by the surgeon around the spermatic cord and upon the ilioinguinal nerve before wound closure for topical analgesia (topical group). The duration of postoperative analgesia, pain scores, rescue analgesic consumption, sedation score, hemodynamic monitoring, and side-effects were evaluated 48 h postoperative. Results: Kaplan-Meier survival analysis of analgesia free time demonstrated a significant advantage of topical ketamine (TK) group over caudal ketamine (CK) group. The duration of postoperative analgesia was longer in TK group than in CK group (28.74 ± 2.88 vs. 21.43 ± 5.01 h, P = 0.000). Fewer children asked for oral analgesics in the topical group (24 of 36, 66.7%) than in the caudal one (28 of 32, 87.5%; P < 0.01). Postoperative pain scores at the 6th till 48th h were lower in topical group with comparable analgesic consumption between two groups. In the caudal group, four subjects suffered from retention of urine: Two presented with a residual motor block and two had photophobia. Conclusion: Wound instillation of bupivacaine/ketamine is a simple, noninvasive, and effective technique that could be a safe alternative to CK for postoperative analgesia in children undergoing inguinal hernia repair. [ABSTRACT FROM AUTHOR]

Purpose: The objectives of this study were to compare the effects of caudal dexmedetomidine combined with ropivacaine to provide postoperative analgesia in children and also to establish its safety in the paediatric population. Methods: In a randomised, prospective, parallel group, double-blinded study, 60 children were recruited and allocated into two groups: Group RD (n=30) received 0.25% ropivacaine 1 ml/kg with dexmedetomidine 2 μg/kg, making the volume to 0.5 ml and Group R (n=30) received 0.25% ropivacaine 1 ml/kg + 0.5 ml normal saline. Induction of anaesthesia was achieved with 50% N 2 O and 8% sevoflurane in oxygen in spontaneous ventilation. An appropriate-sized LMA was then inserted and a caudal block performed in all patients. Behaviour during emergence was rated with a 4-point scale, sedation with Ramsay′s sedation scale, and pain assessed with face, legs, activity, cry, consolability (FLACC) pain score. Results: The duration of postoperative analgesia recorded a median of 5.5 hours in Group R compared with 14.5 hours in Group RD, with a P value of

Study Objective: We conducted this study to compare the efficacy of caudal epidural block (CEB) vs ultrasonography-guided transversus abdominis plane (TAP) block for providing postoperative pain relief in children scheduled for lower abdominal surgery. Whereas the primary objective was to compare the duration of postoperative analgesia, the secondary objectives included comparative assessment (TAP vs CEB) of quality of pain relief in the first 24hours postoperatively and rescue analgesia requirements.Design: Randomized-control, prospective, observer-blinded, 2-arm, single-center comparison.Setting: Operating room, postoperative recovery area.Patients: Eighty-children, aged 2-6years, of American Society of Anesthesiologists physical status I/II scheduled to undergo unilateral lower abdominal surgery under general anesthesia.Interventions: The recruited children were randomly allocated to receive under general anesthesia either CEB (group C, 0.75 mL/kg of 0.25% bupivacaine) or ultrasonography-guided administration of TAP block (group T, 0.5 mL/kg of 0.25% bupivacaine).Measurements: Intraoperative: heart rate and noninvasive blood pressure; postoperative: pain profile, including duration of postoperative analgesia, quality of pain relief, and rescue analgesia requirements.Main Results: The median duration of postoperative analgesia was significantly greater in children who received CEB than those who were administered TAP block (group C: 362.5 minutes [172.5-693.75] vs group T: 210 minutes [108.75-362.5]; P<.05). No difference was found in the incidence of postoperative pain up to 6 hours from the point of initiation of assessment (group C: 47.2% vs group T: 55.9%; P>.05). The children who received CEB experienced greater incidence of pain in the 6- to 24-hour postoperative interval than those administered TAP block (group C: 75% vs group T: 44.1%; P<.05). Although there was no difference in the rescue analgesia requirements, the number of children not requiring any rescue analgesia in the first 24 hours postoperatively was significantly higher in the TAP group (group C: n=2 vs group T: n=8; P<.05).Conclusions: In children undergoing lower abdominal surgery, CEB provides a significantly prolonged duration of postoperative analgesia when compared with ultrasonography-guided TAP block. [ABSTRACT FROM AUTHOR]

Background and Aims: Caudal epidural block is the most commonly used neuraxial block in children. Morphine has been used as a caudal additive for more than three decades. The aim of our study was to evaluate the efficacy and duration of analgesia of three different doses of caudal epidural morphine (CEM), and to find out the incidence of side effects. Material and Methods: This study was conducted on 75 patients of American Society of Anesthesiologists grades I and II, aged 2-12 years, undergoing lower abdominal and urogenital surgeries. Patients were randomly allocated to one of the three groups according to the dose of morphine. Group I received 30 µg/kg, group II 50 µg/kg, and group III 70 µg/kg. Heart rate, blood pressure, oxygen saturation, electrocardiogram, pain score, sedation score, duration of analgesia, and side-effects were noted. Results: The mean duration of analgesia was 8.63 h in group I, 13.36 h in group II and 19.19 h in group III. Respiratory depression was noted in three patients in group III. One patient in group I had itching. One patient each in groups I, II, and III had nausea/vomiting. Conclusion: CEM significantly prolongs the duration of analgesia, though with a higher dose the risk of respiratory depression should always be kept in mind. [ABSTRACT FROM AUTHOR]

Background: The study was conducted to evaluate the perioperative analgesic efficacy of the two doses of caudally administered tramadol versus bupivacaine in adult hemorrhoidectomy. Patients and Methods: A total of 90 patients, aged 20-50 years, undergoing hemorrhoidectomy were randomly scheduled to receive bupivacaine 0.25% in 20 ml (Group B; n = 30), tramadol 1 mg/kg in 20 ml (Group T1; n = 30), tramadol 2 mg/kg in 20 ml (Group T2; n = 30) through caudal route after induction of general anesthesia. Postoperative pain was assessed every hour until the visual analog scale was 6, which is 1st time for rescue analgesia. Postoperative sedation, hemodynamic changes, serum cortisol, and epinephrine levels and incidence of side effects were also evaluated. Results: Duration of analgesia was longer in Group T2 (20 [1.14] h] compared with the Group B (7 [1.2] h) or Group T1 (12 [0.75] h); all P < 0.001. There were no significant hemodynamic changes. There were not incidences of side effects. Conclusion: Caudal tramadol 2 mg/kg provided a longer duration of postoperative analgesia with rapid onset and no incidence of complications or adverse effects in adult hemorrhoidectomy. [ABSTRACT FROM AUTHOR]

Study Objective: Caudal block helps relieve pain after sub-umbilical surgery in pediatric patients; however, the duration for which it exerts its analgesic effect is limited. The addition of certain adjuvant agents to local anesthetics (LAs) that are used to administer caudal block can prolong postoperative analgesia. Therefore, we aimed to compare the efficiencies and side effects of caudal adjuvants in the settings of pediatric lower abdominal and urological surgeries.Design: A network meta-analysis (NMA).Patients: One hundred and twelve randomized controlled trials (RCTs) involving 6800 pediatric patients were included in the final analysis.Interventions: Different adjuvant agents, namely clonidine, dexamethasone, dexmedetomidine, fentanyl, ketamine, magnesium, midazolam, morphine, neostigmine, and tramadol.Measurements: The primary outcome was the duration of analgesia. The secondary outcomes included the requirement for additional analgesia, analgesic consumption, and postoperative complications. The effects and rankings were evaluated using NMA and the surface under the cumulative ranking curve scores, respectively.Results: Neostigmine, dexmedetomidine, and dexamethasone were found to be the three most effective adjuvants that prolong the duration of analgesia for caudal block, and these adjuvants extended this duration by 8.9 h (95% confidence interval [CI], 7.1-10.7), 7.3 h (95% CI, 6.0-8.6), and 5.9 h (95% CI, 4.0-7.7), respectively. Caudal neostigmine was associated with an increase in the incidence of postoperative nausea and vomiting, whereas dexmedetomidine and dexamethasone showed no postoperative complications.Conclusions: This NMA provided evidence and suggested that dexmedetomidine and dexamethasone may be the most beneficial adjuvant pharmaceutics adding to LAs for caudal block in children. However, given the off-label status of caudal dexmedetomidine and dexamethasone, further high-quality RCTs are still warranted, especially to determine whether delayed neurological complications will occur. [ABSTRACT FROM AUTHOR]

Background and Aims: It is well-known that neuroendocrine stress response (NESR) occurs in children and it can be modified by caudal block. However, there is paucity of literature comparing caudal fentanyl and ketamine on NESR. The present study was aimed to compare the analgesic efficacy of these caudal adjuvants and their effect on (NESR) in children undergoing infraumbilical and perineal surgery. Materials and Methods: A total of 60 children undergoing infraumbilical surgery were included in this randomized, double-blind study. Three groups of 20 each were assigned to receive caudal block with bupivacaine 0.25% 1 ml/kg along with either 0.9% normal saline (Group I) 1 µg/kg fentanyl (Group II) or 0.5 mg/kg ketamine (Group III). Modified visual analogue scale (VAS) was used for assessment of post-operative pain, and stress response was assessed by blood glucose, serum cortisol and insulin levels at various time intervals Results: VAS scores were significantly lower in the ketamine group at all-time intervals upto 4 h (P < 0.05). Patients in ketamine group required rescue analgesia significantly later (8.23 h) when compared to fentanyl (5.95 h) and bupivacaine group (4.10 h). Caudal block led to significant decrease in cortisol and insulin levels within the groups however this significance was not achieved between groups. Conclusion: Caudal ketamine in a dose of 0.5 mg/kg provides prolonged analgesia when compared to fentanyl 1 µg/kg. Blunting of the NESR was observed in all the groups though the indicators of the response were lowest with ketamine. [ABSTRACT FROM AUTHOR]

Background There is a need for an adjuvant agent of caudal block that prolongs its duration and improves the analgesic efficacy to fasten functional recovery. Magnesium is an N-methyl-D-aspartate receptor antagonist that functions as an analgesic. This study was aimed to evaluate whether magnesium as an adjuvant for caudal block in children can improve postoperative analgesia and functional recovery. Methods Eighty children, 2-6 years of age, undergoing inguinal herniorrhaphy, were included in this prospective, randomized, double-blinded study. For caudal block, Group R received ropivacaine 1.5 mg·ml−1, 1 ml·kg−1 and Group RM received the same dose of ropivacaine mixed with 50 mg of magnesium. The Parents' Postoperative Pain Measure ( PPPM) score, analgesic consumption, functional recovery, and adverse effects were evaluated at 6, 24, 48, and 72 h after surgery, as well as daily thereafter until the child showed full functional recovery. Results The PPPM score after hospital discharge was significantly lower for Group RM than for Group R at all times ( P < 0.05). Children in Group RM required less fentanyl for rescue analgesia in the recovery area (16.2% vs 39.5%, P = 0.034) and less oral analgesics after discharge (20.5% vs 52.6%, P = 0.007). The time to return of normal functional activity was shorter in Group RM ( P < 0.05). The incidence of adverse effects did not differ between groups. Conclusions As an adjuvant for caudal analgesia, 50 mg magnesium provided superior quality of analgesia and faster return of normal functional activity than local anesthetic alone in children. [ABSTRACT FROM AUTHOR]

Background and Objectives: Dexmedetomidine (D) can prolong the duration of local anesthetics, but the effect of caudal dexmedetomidine on the potency of levobupivacaine (L) for caudal block has not been investigated. This study was designed to determine the effect of caudal dexmedetomidine on levobupivacaine for caudal block in pediatric patients. Methods: Eighty-nine children scheduled for elective inguinal hernia repair or hydrocele were randomly assigned to one of the three groups: Group L (caudal levobupivacaine), Group LD1 (levobupivacaine plus 1 μg·kg-1 dexmedetomidine), or Group LD2 (levobupivacaine plus 2 μg·kg-1 dexmedetomidine). The primary endpoint was the minimum local anesthetic concentration (MLAC), which was determined using the Dixon up-and-down method. The secondary endpoints were the duration of analgesia and sedation. Results: The MLAC values (sd) of caudal levobupivacaine were 0.103 (0.01)%, 0.068 (0.02)%, and 0.055 (0.03)% in Groups L, LD1, and LD2, respectively. The values of EC50 and EC95 (95% CI) of caudal levobupivacaine from logistic regression analysis were 0.094 (0.083-0.105)% and 0.129 (0.1-0.159)%, 0.058 (0.044-0.072)% and 0.106 (0.067-0.144)%, and 0.046 (0.033-0.059)% and 0.091 (0.055-0.127)% in Groups L, LD1, and LD2, respectively. The mean durations of analgesia in the postoperative period were 141, 378, and 412 min in Groups L, LD1, and LD2, respectively (L vs LD1 or LD2, P < 0.001). The mean durations of sedation in both Groups LD1 and LD2 also were significantly prolonged, compared with Group L (P < 0.01). Conclusions: Caudal dexmedetomidine reduces the MLAC values of levobupivacaine and improves postoperative analgesia in children without any neurological side effects. [ABSTRACT FROM AUTHOR]

BACKGROUND: Caudal anesthesia is widely used as intraoperative and postoperative analgesia in children's subumbilical surgeries such as on the urogenital system, lower extremities and lower abdomen to reduce the stress response to surgery and to facilitate the general anesthesia. AIM: The purpose of this study was to compare the effects of caudally administered bupivacaine and levobupivacaine of equal volume and concentration on motor block and postoperative pain in children undergoing circumcision surgery. PATIENTS AND METHODS: The prospective, randomized, double-blind study included 60 patients with ages ranging from 1-10 years and ASA (American Society of Anesthesiologists) physical status of I-II who underwent elective circumcision surgery. The patients were divided into two groups: group B received 0.5 ml/kg of bupivacaine 0.25% caudally and group L received 0.5 ml/kg of levobupivacaine 0.25% caudally. Postoperative pain was assessed by children's and infant's postoperative pain scale and motor block was assessed by the Bromage scale. RESULTS: The mean children's and infant's postoperative pain scale of group B was significantly lower than that of group L (p < 0.001). Three patients in group B and seven patients in group L needed additional analgesia after the incision. There was no significant difference between groups in terms of Bromage scores and in both groups the residual motor block was found to be zero at the 150th minutes. CONCLUSION: According to these findings, bupivacaine has an adequate quality of analgesia than levobupivacaine. We suggest that bupivacaine for caudal block at the concentration of 0.25% (0.5 ml/kg) provides an adequate level of analgesia for outpatient circumcision surgery. [ABSTRACT FROM AUTHOR]

Background: Emergence delirium (ED) although a short-lived and self-limiting phenomenon, makes a child prone to injury in the immediate postoperative period and hence is a cause of concern not only to the pediatric anesthesiologist, surgeons, and post anesthesia care unit staff but also amongst parents. Additional medication to quieten the child offsets the potential benefits of rapid emergence and delays recovery in day care settings. There is conflicting evidence of influence of analgesia and sedation following anesthesia on emergence agitation. We hypothesized that an anesthetic technique which improves analgesia and prolongs emergence time will reduce the incidence of ED. We selected ketamine as adjuvant to caudal block for this purpose. Methods: This randomized, double blind prospective study was performed in 150 premedicated children ASA I, II, aged 2 to 8 years who were randomly assigned to either group B (caudal with bupivacaine), BK (bupivacaine and ketamine), or NC (no caudal), soon after LMA placement. Recovery characteristics and complications were recorded. Results: Emergence time, duration of pain relief, and Pediatric Anesthesia Emergence Delirium (PAED) scores were significantly higher in the NC group (P<0.05). Duration of analgesia and emergence time were significantly more in group BK than groups B and NC. However, the discharge readiness was comparable between all groups. No patient in BK group required to be given any medication to treat ED. Conclusion: Emergence time as well as duration of analgesia have significant influence on incidence of emergence delirium. Ketamine, as caudal adjuvant is a promising agent to protect against ED in children, following sevoflurane anesthesia. [ABSTRACT FROM AUTHOR]

Background: Pain in infancy is a developmental process. Due to the underdeveloped pain pathways in the spinal cord, the threshold of stimulation and sensation of pain is low at birth and has potential impacts on increasing the central effects of pain. Primary trauma during infancy can cause long term changes in structure and function of pain pathways that continue until adulthood. Lack of pain management in children can result in morbidity and mortality. Objectives: In this study we examined the duration of post-operative analgesia in children when clonidine is added to bupivacaine in caudal anesthesia. Materials and Methods: In this clinical trial, 40 children aged 1-8 years who were candidates for elective inguinal hernia repair were studied. Induction and maintenance of anesthesia were achieved using sodium thiopenthal, halothane and nitrous oxide. Children were randomly divided into 2 groups in a double-blind fashion, and were given caudal anesthesia with 0.125% bupivacaine (1ml/kg) alone or b bupivacaine plus 2 μg/kg clonidine. Blood pressure and heart rate were recorded peri-operatively. Analgesia was evaluated using objective pain scale (OPS) and sedation was assessed using Ramsay sedation scale (RSS). Acetaminophen was administered rectally for cases with OPS score greater than five. Results: Duration of analgesia was found to be significantly longer in the group given bupivacaine plus clonidine (mean 417.50 min vs. 162.00 min). Peri-operative hypotension or bradycardia, post-operative respiratory depression, nausea or vomiting were not recorded in any patient. Conclusions: We concluded that addition of clonidine to bupivacaine prolongs the duration of post-operative analgesia without any respiratory or hemodynamic side-effects. [ABSTRACT FROM AUTHOR]

Purpose: The objectives of this study were to compare the effects of caudal dexmedetomidine combined with ropivacaine to provide postoperative analgesia in children and also to establish its safety in the paediatric population. Methods: In a randomised, prospective, parallel group, double-blinded study, 60 children were recruited and allocated into two groups: Group RD (n=30) received 0.25% ropivacaine 1 ml/kg with dexmedetomidine 2 μg/kg, making the volume to 0.5 ml and Group R (n=30) received 0.25% ropivacaine 1 ml/kg + 0.5 ml normal saline. Induction of anaesthesia was achieved with 50% N2O and 8% sevoflurane in oxygen in spontaneous ventilation. An appropriate-sized LMA was then inserted and a caudal block performed in all patients. Behaviour during emergence was rated with a 4-point scale, sedation with Ramsay's sedation scale, and pain assessed with face, legs, activity, cry, consolability (FLACC) pain score. Results: The duration of postoperative analgesia recorded a median of 5.5 hours in Group R compared with 14.5 hours in Group RD, with a P value of <0.001. Group R patients achieved a statistically significant higher FLACC score compared with Group RD patients. The difference between the means of mean sedation score, emergence behaviour score, mean emergence time was statistically highly significant (P<0.001). The peri-operative haemodynamics were stable among both the groups. Conclusion: Caudal dexmedetomidine (2 μg/kg) with 0.25% ropivacaine (1 ml/kg) for paediatric lower abdominal surgeries achieved significant postoperative pain relief that resulted in a better quality of sleep and a prolonged duration of arousable sedation and produced less incidence of emergence agitation following sevoflurane anaesthesia. [ABSTRACT FROM AUTHOR]

Clonidine has the potential to significantly prolong the duration of caudal epidural anesthesia. We investigated the effect of the addition of clonidine to the MLAC of levobupivacaine in a randomized controlled dose-response trial. A group of 120 children aged <6 years of age received caudal anesthesia with levobupivacaine and 1, 2, or 3 μg·kg of clonidine. The MLAC was determined according to a Dixon-Massey protocol. The primary outcome was effective surgical anesthesia. Secondary outcomes were the duration of postoperative analgesia, postoperative pain scores, clonidine side effects, and time to hospital discharge. The MLAC of caudal levobupivacaine was 0.106%, 0.077%, and 0.035% with 1, 2, and 3 μg·kg of clonidine, respectively. There were significant dose-dependent increases in median duration of analgesia. The incidence of delayed discharge, somnolence, and PONV was significantly increased in the 3 μg·kg of clonidine group. Clonidine produces a local anesthetic sparing effect with a dose-dependent decrease in levobupivacaine MLAC for caudal anesthesia. In addition, there is a dose-dependent prolongation of postoperative analgesia following lower abdominal surgery in children. A dose of 2 μg·kg of clonidine provides the optimum balance between improved analgesia and minimal side effects. [ABSTRACT FROM AUTHOR]