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Background: Ultrasound-guided Quadratus Lumborum block (QLB) has become an established modality for perioperative analgesia in lower abdominal surgeries. However, its efficacy in upper abdominal surgeries is still understudied. Objectives: The study aimed to determine QLB2 efficacy as a perioperative analgesic modality in upper abdominal surgeries, compared to caudal epidural block (CEB), regarding FLACC score, the time to the first rescue analgesia, the amount of fentanyl consumed intraoperatively, amount of rescue analgesia administered, parents' satisfaction, as well as the incidence of complications. Study design: A randomized, prospective, double-blind, and single-center study. Setting: Ain Shams University Hospitals Methods/patients/interventions/measurements: Fifty-two pediatric patients scheduled for upper abdominal surgeries under general anesthesia were assigned randomly to undergo CEB or ultrasound guided QLB 2. As assessed by FLACC, postoperative pain scores were the primary outcome. The secondary outcomes included the amount of fentanyl consumed intraoperatively, the time to first rescue analgesia, the amount of rescue analgesia given, parents' satisfaction, and the incidence of complications. Results: The QLB cohort demonstrated decreased FLACC scores than the CEB group. Total fentanyl consumption was significantly lower (33.4 ± 14.9 µg vs. 56.5 ± 17.0 µg, p-value of 0.003), time to first rescue analgesia was more prolonged (14.4 ± 1.3hrs vs. 1.8 ± 1.2 hr, p-value <0.001), and parents' satisfaction was significantly higher. Postoperative nausea incidence was significantly alleviated (11 (42.3%) vs. 22 (84.6%), p-value 0.002), whereas vomiting was substantially decreased (0 (0.0%) vs. 15 (57.7%), p-value <0.001). Conclusion: Perioperative analgesia in pediatric patients can be effectively achieved using QLB type 2. Compared to CEB, it provides more stable hemodynamics, lower FLACC scores, less need for rescue analgesia, and higher parent satisfaction. [ABSTRACT FROM AUTHOR]

Background: The drug volume to be used in caudal in pediatric patients has remained an unmet issue since long. We determined the minimum drug volume required to reach T10 level in pediatric patients using ultrasonography and compared it with the already established volume by Armitage formula. Aim: To determine the minimum effective caudal local anesthetic dose using ultrasound guidance. Methods: Study was performed at two centres and at each centre, 50 pediatric patients (Total 100 patients), aged 1 to 3 years, undergoing below umbilical surgeries were included and randomised into two groups of 25 each (Total 50) to receive ultrasound guided drug volume vs. Armitage formula based volume. The volume required to reach T10 level was assessed with ultrasound in one group. Also, maximum height achieved, cutaneous level achieved after 15 min, FLACC scores 30 min post extubation and parental satisfaction scores were noted. Results: The mean drug volume required to reach T10 level in Group U was 0.755 ± 0.053 ml/kg with a P value < 0.001. (Compared to the drug volume of 1 ml/kg using one sample t test). The highest level achieved in both groups were calculated as the mode value of T8 and T7 in Group U and Group A respectively. The highest cutaneous level achieved after 15 min was also calculated as the mode value of T4 in both groups. FLACC scores at 30 min were also comparable. Satisfaction scores were comparable in both groups. Conclusion: A volume of 0.7 ml/kg of local anaesthetic in pediatric caudal block is sufficient to achieve a target of T10 level for infraumblical surgeries. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusion Inguinal hernia repair is the most common operation in infants, with well recognized anesthetic and perioperative risks. The aim was to investigate if the combination of caudal block, high‐flow nasal oxygen insufflation and intravenous dexmedetomidine sedation is suitable for infants undergoing inguinal hernia surgery.A prospective multicenter international study was performed in three centers in Australia and New Zealand. Fifty infants less than 64 weeks post‐menstrual age undergoing inguinal hernia surgery were enrolled. Exclusion criteria were any condition that contraindicated the use of the anesthesia technique. The technique included intravenous dexmedetomidine with a loading dose of 1–2 mcg/kg over 10 min and maintenance of 0.2–3 mcg/kg/h, high‐flow nasal oxygen insufflation 2 L/kg/min with an oxygen blender, and a caudal block using 1 mL/kg 0.2% ropivacaine. The primary outcome was the successful completion of surgery without conversion to general anesthesia.Completion of surgery with the technique was successful in 41/50 (82%) infants. Care was provided by 22 anesthesiologists and 11 surgeons. Infants had a low incidence of intraoperative complications, including apnea [1 (2.4%)], bradycardia [2 (4.9%)], hypotension [2 (4.9%)], and desaturation [1 (2.4%)]. Postoperative complications included apnea [3 (7.3%)], bradycardia [3 (7.3%)], hypotension [3 (7.3%)], desaturation [4 (9.8%)]. No infants were intubated in the first 24 h postoperatively.Caudal block, high‐flow nasal oxygen insufflation and intravenous dexmedetomidine sedation is a potential alternative to general anesthesia for infant inguinal hernia surgery with a low rate of complications in this small cohort of infants. [ABSTRACT FROM AUTHOR]

Background: Postoperative pain management remains a significant challenge for patients undergoing posterior urethroplasty (PU). In a previous study, we proposed a novel technique of combined pudendal nerve (PN) and spermatic cord (SC) block to manage pain after PU. The present trial was conducted to test the hypothesis that this technique is effective for pain control after PU and provides longer-lasting analgesia than caudal epidural block (CB). Methods: Sixty patients undergoing PU were randomized into two groups: Group NB received combined PN and SC block, and Group CB received CB. General anesthesia with a laryngeal mask was performed. The primary outcome was the postoperative analgesic duration, and the secondary outcomes included the Numeric Rating Scale (NRS) scores for pain and the number of patients with different motor scores of the lower limb at 3, 6, 12, and 24 h postoperatively. Results: Two patients in Group CB were withdrawn due to block failure. The postoperative analgesic duration was statistically longer in Group NB compared with Group CB (mean difference [95% confidence interval], 115.78 min [17.80, 213.75]; P = 0.021). The NRS scores for pain at 12 and 24 h after surgery were statistically lower in Group NB compared with Group CB. Group NB had statistically more patients with motor score 0 at 3 h postoperatively than Group CB. Conclusions: PN combined with SC block is an effective technique for postoperative analgesia in PU. This technique can achieve a longer duration of analgesia and lower pain scores, especially 12 h after surgery, than a CB. Trial registration: This study was registered in the Chinese Clinical Trial Register (registration no. ChiCTR2100042971, registration date on 2/2/2021). [ABSTRACT FROM AUTHOR]

Ecological drivers of variation in the morphology of the lizard tail are understudied despite its important and varied functions in defence, locomotion, balance, climbing, and resource storage. We quantified variation in original tail shape and surface area-to-volume ratio (SA : V) in an Australian gecko clade (Oedura) and tested whether environmental variables are predictors of this variation. To use museum specimens, we developed an approach to straighten deformed preserved tails for accurate shape analysis. Tail shape varied from a relatively 'typical lizard' tail—long, tapered, and circular in cross-section—to a distinctive expanded, wide, and flat shape. Extreme versions of the latter shape seem to have evolved in parallel in two distantly related lineages. Wide tails and low SA : V ratio values occur in the Australian Monsoonal Tropics, while arid zone species all had a narrow, tapered tail with high SA : V. These data suggest expanded or bulbous tails may be analogous to succulence in plants and an adaptation for resource storage in environments with predictable peaks (wet season) and dearths (dry season) of resource availability. However, limited replicated evolution of bulbous tails precludes statistical significance in this case, and more analyses of tail anatomy in Oedura and other lizard clades are required to test this hypothesis further. [ABSTRACT FROM AUTHOR]

Background: Transforaminal and caudal epidural injections are two methods of steroid injection in lumbar radiculopathy. Using a targeted catheter with the possibility of accessing the involved spinal roots and steroid administration selectively next to them during the caudal procedure may achieve the benefits of both transforaminal and caudal procedures. The aim of this study was to investigate the clinical effects and physical examinations of transforaminal steroid injection compared to caudal through a targeted catheter in lumbar radiculopathy. Methods: Fifty patients with lumbar radiculopathy candidates for epidural steroid injection were divided into transforaminal (T) and caudal (C) groups. Steroid injection under fluoroscopic guidance was performed in group T with the transforaminal method and in group C with the caudal method using a targeted catheter for each involved spinal nerve root. Pain intensity visual analog scale (VAS), Oswestry Disability Index (ODI), daily analgesic consumption, and physical examinations on four follow‐ups (before injection, second week, first and third month) were evaluated. Results: Pain score (VAS) and functional disability index (ODI) were similar in both groups, and there was no significant difference between the two groups (p > 0.05). The positive Lasègue test was significantly higher in the caudal group than in the transforaminal group only in the third month (p < 0.05). Other physical examinations in both groups did not have significant differences in all the follow‐ups. Moreover, there was no difference in the amount of analgesic consumption in the two groups. No complications were observed in both groups. Conclusion: This study showed that transforaminal and caudal steroid injection (with a targeted catheter) in patients with lumbar radiculopathy had similar effects in controlling pain and improving functional disability of patients in the short term. Cases of recurrence of positive Lasègue test in physical examinations in the long term (third month) in the caudal group may indicate the preference of the transforaminal approach. Trial Registration: Iranian Registry of Clinical Trials (IRCT) number: IRCT20111102007984N31 [ABSTRACT FROM AUTHOR]

Abstract Background The drug volume to be used in caudal in pediatric patients has remained an unmet issue since long. We determined the minimum drug volume required to reach T10 level in pediatric patients using ultrasonography and compared it with the already established volume by Armitage formula. Aim To determine the minimum effective caudal local anesthetic dose using ultrasound guidance. Methods Study was performed at two centres and at each centre, 50 pediatric patients (Total 100 patients), aged 1 to 3 years, undergoing below umbilical surgeries were included and randomised into two groups of 25 each (Total 50) to receive ultrasound guided drug volume vs. Armitage formula based volume. The volume required to reach T10 level was assessed with ultrasound in one group. Also, maximum height achieved, cutaneous level achieved after 15 min, FLACC scores 30 min post extubation and parental satisfaction scores were noted. Results The mean drug volume required to reach T10 level in Group U was 0.755 ± 0.053 ml/kg with a P value

Abstract Background Postoperative pain management remains a significant challenge for patients undergoing posterior urethroplasty (PU). In a previous study, we proposed a novel technique of combined pudendal nerve (PN) and spermatic cord (SC) block to manage pain after PU. The present trial was conducted to test the hypothesis that this technique is effective for pain control after PU and provides longer-lasting analgesia than caudal epidural block (CB). Methods Sixty patients undergoing PU were randomized into two groups: Group NB received combined PN and SC block, and Group CB received CB. General anesthesia with a laryngeal mask was performed. The primary outcome was the postoperative analgesic duration, and the secondary outcomes included the Numeric Rating Scale (NRS) scores for pain and the number of patients with different motor scores of the lower limb at 3, 6, 12, and 24 h postoperatively. Results Two patients in Group CB were withdrawn due to block failure. The postoperative analgesic duration was statistically longer in Group NB compared with Group CB (mean difference [95% confidence interval], 115.78 min [17.80, 213.75]; P = 0.021). The NRS scores for pain at 12 and 24 h after surgery were statistically lower in Group NB compared with Group CB. Group NB had statistically more patients with motor score 0 at 3 h postoperatively than Group CB. Conclusions PN combined with SC block is an effective technique for postoperative analgesia in PU. This technique can achieve a longer duration of analgesia and lower pain scores, especially 12 h after surgery, than a CB. Trial registration This study was registered in the Chinese Clinical Trial Register (registration no. ChiCTR2100042971, registration date on 2/2/2021).

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]

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ABSTRACT Background Transforaminal and caudal epidural injections are two methods of steroid injection in lumbar radiculopathy. Using a targeted catheter with the possibility of accessing the involved spinal roots and steroid administration selectively next to them during the caudal procedure may achieve the benefits of both transforaminal and caudal procedures. The aim of this study was to investigate the clinical effects and physical examinations of transforaminal steroid injection compared to caudal through a targeted catheter in lumbar radiculopathy. Methods Fifty patients with lumbar radiculopathy candidates for epidural steroid injection were divided into transforaminal (T) and caudal (C) groups. Steroid injection under fluoroscopic guidance was performed in group T with the transforaminal method and in group C with the caudal method using a targeted catheter for each involved spinal nerve root. Pain intensity visual analog scale (VAS), Oswestry Disability Index (ODI), daily analgesic consumption, and physical examinations on four follow‐ups (before injection, second week, first and third month) were evaluated. Results Pain score (VAS) and functional disability index (ODI) were similar in both groups, and there was no significant difference between the two groups (p > 0.05). The positive Lasègue test was significantly higher in the caudal group than in the transforaminal group only in the third month (p

El estudio se enfoca en el desarrollo de un micro generador hidroeléctrico mediante el empleo de una turbina de flujo cruzado de admisión inferior que aprovecha el potencial hidráulico de los canales de riego. La metodología utilizada es cuantitativa y experimental, y se basa en un diagrama de flujo que describe las etapas desde la creación hasta la implementación del prototipo. Se tomaron en cuenta variables como la altura y el caudal del agua, así como las dimensiones del canal de riego, las cuales no podían modificarse debido a las actividades agrícolas que se llevan a cabo en el lugar. Los resultados obtenidos de la implementación en campo del prototipo diseñado demuestran que el generador tiene la capacidad de alcanzar un valor de potencia de 93 W con un porcentaje de eficiencia del 11.3% el mismo que produce energía de manera sostenible en áreas remotas. En conclusión, el estudio resalta la necesidad de explorar nuevas fuentes de energía renovales y sostenibles en respuesta a la crisis energética actual que afecta a la sociedad; se enfatiza la imprescindibilidad por adoptar alternativas energéticas más limpias que limite la dependencia por los recursos no renovables a la par de controlar los efectos negativos del cambio climático.

Pediatric burns affect approximately 15-20 patients per 100 000 hospital admissions, but unfortunately there is a lack of evidence to guide optimal strategies for acute pain control. The aim of this study was to evaluate whether caudal analgesia with single injection of local anesthetics reduced pain medication consumption in pediatric patients who required surgical intervention for burn injuries. Retrospective data from patients

Background & Aim: Caudal block has been commonly used by the anaesthesiologists in pediatric surgery to relieve postoperative pain. This study compared the use of bupivacaine alone with bupivacaine plus tramadol for a single shot caudal block to find out whether tramadol can be an effective adjuvant to bupivacaine for providing better postoperative analgesia in children undergoing lower extremity surgery. Material and methods: A total of 60 children undergoing lower extremity surgery were randomly allocated into two groups; 30 children in group BT were treated with bupivacainewith tramadol, and 30 patients in Group B were treated with bupivacaine only. Caudal epidural block was performed immediately after induction of anaesthesia. Study outcomes were monitored in terms of duration of analgesia and total rescue analgesia (paracetamol) required in 1st 24 hrs. Results: Mean duration of analgesia was significantly high in group BT compared to group B and total rescue analgesia required was more in group B compared to group BT which was statistically significant. Conclusion: Tramadol when administered caudally with bupivacaine provided prolonged analgesia without any side effects in children undergoing lower extremity surgery. [ABSTRACT FROM AUTHOR]

Background and Objectives: This study aimed to evaluate the mid-term effectiveness and safety of a combined ultrasound (US) and fluoroscopy (FL)-guided approach in comparison to US-guided and FL-guided caudal epidural steroid injections (CESI) for treating unilateral lower lumbar radicular pain. Materials and Methods: A total of 154 patients who underwent CESI between 2018 and 2022 were included. Patients were categorized into three groups based on the guidance method: combined US and FL (n = 51), US-guided (n = 51), and FL-guided (n = 52). The study design was retrospective case-controlled, utilizing patient charts and standardized forms to assess clinical outcomes, adverse events, complications during the procedures. Results: In all groups, Oswestry Disability Index and Verbal Numeric Scale scores improved at 1, 3, and 6 months after the last injection, with no significant differences between groups (p < 0.05). The treatment success rate at all time points was also similar among the groups. Logistic regression analysis showed that injection method, cause, sex, age, number of injections, and pain duration did not independently predict treatment success. Blood was aspirated before injection in 2% (n = 1), 13.5% (n = 7), and 4% (n = 2) of patients in the combined US and FL groups, FL-guided groups, and US-guided groups, respectively. Intravascular contrast spread was detected in one patient in the combined method groups and seven in the FL-guided groups. Conclusions: When comparing pain reduction and functional improvement, there was no significant difference between the three methods. The combined method took less time compared to using FL alone. The combined approach also showed a lower occurrence of intravascular injection compared to using FL alone. Moreover, blood vessels at the injection site can be identified with an ultrasound using the combined method. Given these advantages, it might be advisable to prioritize the combined US- and FL-guided therapy when administering CESI for patients with unilateral lumbar radicular pain. [ABSTRACT FROM AUTHOR]

Background and Objectives: The aim of this narrative review is to evaluate the literature describing the use of caudal anesthetic‐based techniques in premature and ex‐premature infants undergoing lower abdominal surgery. Methods: All available literature from inception to August 2023 was retrieved according to Preferred Reporting Items for Systematic Reviews and Meta‐Analysis guidelines from Medline, PubMed, Embase, and the Cochrane Library. Two authors reviewed all references for eligibility, abstracted data, and appraised quality. Results: Of the 211 articles identified, 45 met our inclusion criteria yielding 1548 cases with awake caudal anesthesia. The review included 558 (36.0%) cases of awake caudal anesthesia, 837 cases (54.1%) of "awake" caudal anesthesia with sedation, and 153 cases (9.9%) of combined spinal caudal epidural anesthesia without sedation. The overall anesthetic failure rate was 7.2% (71.9:1000 caudals). Failure rates were highest for CSEA (13.7%, 7.7–18.4), intermediate for awake caudal (6.6%, 5.26–9.51), and lowest for sedated caudal anesthesia (5.85%, 4.48–7.82). The incidence (range) of perioperative apnea was highest for sedated caudal anesthesia (8.16, 0%–24%), intermediate for awake caudal (7.62%, 0%–60%), and lowest for CSEA (5.53%, 0%–14.3%). High spinal anesthesia occurred in 0.84%, or 8.35:1000 caudals overall. The incidence was highest in awake caudal anesthesia cases (1.97% or 19.7:1000 caudals), intermediate with caudal with sedation (1.07% or 10.7:1000 caudals), and lowest in CSEA (0.7% or 6.6:1000 caudals). Our review was confounded by incomplete data reporting and small sample sizes as most were case reports. There were no high‐quality randomized controlled trials, and the eight single‐center retrospective data reviews lacked sufficient data to perform meta‐analysis. Conclusions: There is insufficient evidence to validate or refute the benefits of the use of "awake" caudal anesthesia in premature and ex‐premature infants. The high doses of local anesthetics used, the high failure rate, and the increased incidence of high spinal anesthesia would suggest that the techniques offer no real advantages over awake spinal anesthesia or general anesthesia with a regional block. [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: Low back pain (LBP) and lumbosacral radiculopathy are frequent disorders that cause nerve root injury, resulting in a variety of symptoms ranging from loss of sensation to loss of motor function depending on the degree of nerve compression. Objectives: The goal of this study was to investigate the effectiveness of various epidural injection procedures in adult LBP patients. Study Design: Systematic review and network meta‐analysis. Setting: Egypt. Methods: PubMed, Scopus, Web of Science, Cochrane Database, and Embase were used to conduct an electronic literature search. We included RCTs, cohorts, case controls, patients 30 years old with a clinical presentation of low back pain, and comprehensive data on the effects of the intervention on patients with lumbosacral radicular pain who got epidural steroid injections via various techniques. Only papers written in English were eligible. Results: Our analysis showed that parasagittal intralaminar (PIL) was the most effective approach in decreasing VAS (0–10) in the short term (< 6 months) (MD = −1.16 [95% CI −2.04, −0.28]). The next significant approach was transforaminal (TF) (MD = −0.37 [95% CI −1.14, −0.32]) in the long term; TF was the most effective approach (MD = −0.56 [95% CI −1, −0.13]). According to VAS (0–100) in the short term (< 6 months), our analysis showed an insignificant difference among the injection approaches and in the long term; TF was the most effective approach (MD = −24.20 [95% CI −43.80, −4.60]) and the next significant approach was PIL (MD = −23.89 [95% CI −45.78, −1.99]). Limitations: The main limitations are the heterogeneity encountered in some of our analyses in addition to studies assessed as high risk of bias in some domains. Conclusion: TF was the most effective steroid injection approach. In decreasing VAS for short‐term PIL and TF were the most significant approaches, but TF was the most effective approach in decreasing VAS for the long term. Also, TF was the most effective approach in decreasing ODI for the long term. [ABSTRACT FROM AUTHOR]

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]

The study was carried out at the Tío Pedro farm in the municipality of Venezuela, in the province of Ciego de Ávila, with the objective of proposing mathematical models to estimate the hydraulic parameters of a pumping system using the furrow irrigation technique for the cultivation of black bean. The results showed expected fluctuations in hydraulic parameters such as flow rate, head, hydraulic power, pumping time, and pumped volume. Functional relationships were found between flow and pumping head, as well as between hydraulic power, flow and pumping head. These ratios can improve pump system performance, save energy, and increase pump efficiency. In addition, functions were developed to predict the characteristic curves of the load, the efficiency of the pump and the system in general. These results can improve energy efficiency and water management in agriculture. [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

Yifan Qin, Huiyu She, Wenrui Peng, Xiaofeng Zhou, Yiting Wang, Peng Jiang, Jin Wu Department of Anesthesiology, Affiliated Hospital of Jiangsu University, Zhenjiang, People’s Republic of ChinaCorrespondence: Jin Wu, Department of Anesthesiology, Affiliated Hospital of Jiangsu University, 438 Jie Fang Road, Zhenjiang, Jiangsu, 212001, People’s Republic of China, Email wujin914@hotmail.comPurpose: 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.Keywords: anesthesia, caudal, visceral pain, hysterectomy, pain, postoperative, postoperative nausea and vomiting, gynecologic surgical procedures

Caudal epidural block is a simple and safe technique with a low complication rate commonly used for pediatric anesthesia and treatment of chronic lumbosacral pain. However, it is not exempt from some risks that, although infrequent, should be known. We describe the case of a 48-year-old female with chronic lumbosacral radicular pain who underwent caudal epidural infiltration. During the withdrawal of the catheter, accidental breakage and retention of a fragment at the level of the anterior epidural space of the sacrum occurred. We choose to have an expectant management with regular controls and a radiological lumbosacral computed tomography (CT) scan. Since the catheter was placed under sterile conditions, no prophylactic antibiotic treatment was considered. The patient showed no adverse events during the 6 months following catheter rupture. To our knowledge, there are no reports of epidural catheter breakage at the caudal level in adults. This is why there is no standardized protocol on how to proceed in these cases, and the handling of this situation must be individualized. [ABSTRACT FROM AUTHOR]

El conocimiento global de las consecuencias del cambio de vegetación y uso de suelo en las fases del ciclo hidrológico y la calidad del suelo aún está en ciernes. Esta tarea es particularmente desafiante en las regiones tropicales donde las tasas de deforestación alcanzan los niveles máximos reportados y el monitoreo es limitado. Tal es el caso de México, donde el cambio de cobertura y la erosión hídrica afectan a más de la mitad del territorio nacional. En este contexto, se usó el modelo SWAT para estudiar la erosión hídrica asociada con las variaciones en el caudal condicionadas por la trayectoria de cambio de la cobertura vegetal en seis periodos entre 1986 y 2018 en dos subcuencas del río Papaloapan. Basados en la evaluación combinada de tres estadísticos de eficiencia y dos de incertidumbre, 6 de los 10 periodos calibrados mostraron buenos ajustes en la simulación de la descarga con KGE > 0.70 y P-factor > 0.70. Los resultados mostraron a mediano plazo una disminución en la producción de sedimentos en las dos subcuencas estudiadas, posiblemente relacionada con la recuperación de los bosques en las cabeceras de las cuencas. A pesar de los buenos resultados de las simulaciones, el análisis detallado de las fuentes de incertidumbre en regiones con monitoreo limitado es tan importante como la validación con datos medidos de buena calidad para mejorar el desempeño y la confianza de los modelos y soportar de forma adecuada la toma de decisiones.

El presente artículo, tiene por objetivo principal realizar un análisis comparativo entre diversos métodos hidrológicos para estimar el Caudal Ecológico en la Bocatoma El Brazo en la Cuenca del Rio Camaná-Majes-Colca, Perú, en este caso se trata de un rio que nace de los Andes peruanos y discurre hasta desembocar en la Hoya Hidrográfica del Pacífico. Para estimar el Caudal Ecológico para el tramo en estudio se analizaron diversos métodos hidrológicos empleando una serie histórica de 20 años de datos de caudales en el rio. La fuente de información fue la Estación Hidrológica de Huatiapa. La especie indicadora para estimar el Caudal Ecológico es el Camarón de Rio cuyo nombre científico es el Cryphiops caementarius, que presenta importancia económica debido a que se distribuye en grandes poblaciones en la cuenca. Finalmente, es de resaltar, que la importancia de este artículo radica en que la metodología y resultados alcanzados aportará directrices de fácil manejo y aplicación; la cual pueda servir de guía para determinar el Caudal Ecológico en otros tramos en la cuenca y en cuencas con similares características geomorfológicas en el Perú.

Introduction: Caudal anesthesia is a standard procedure in pediatric anesthesia because of its excellent safety and success rate. Usually, it is administered after general anesthesia, but in selected neonatal populations, awake caudal anesthesia is a method of choice. Prematurely born, low birth weight neonates are more prone to complications from general anesthesia than term neonates, even after simple surgery. Among these complications, post-operative apnea is the most common. Caudal epidural anesthesia in awake neonates is a recognized technique that enables the avoidance of general anesthesia and the complications associated with it. In skilled hands, it is also theoretically easier to perform consistent caudal anesthesia than an awake subarachnoid block. In our case, we report a successful awake caudal anesthesia in an ex-premature baby in the emergency setting for incarcerated inguinal hernia repair. To our knowledge, this case report on this topic has yet to be published in Armenia. Conclusion: Neuraxial (spinal, epidural, caudal) awake anesthesia is the method of choice for lower abdominal surgery in preterm infants. Both spinal and caudal anesthesia are effective methods; awake caudal anesthesia is a method of choice because of the success rate and lower analgesic requirements in the post-operative period.

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]

Pain relief in lumbar disc hernias is a challenging condition. This study retrospectively compared particulate steroids, methylprednisolone acetate (mid-term effective), against betamethasone acetate (long-term effective) on ultrasound-guided caudal epidural injection for lumbar disc herniation. A total of 40 patients with L4-5 and/or L5-S1 disc herniation were treated with ultrasound-guided caudal epidural injection between September 2021 and June 2022. Nineteen patients who were given methylprednisolone acetate (group A) as a steroid and a total of 21 patients who were used betamethasone acetate (Group B) were retrospectively collected, and their pain levels and functional improvement were compared retrospectively before, immediately after, and 3 weeks after the injection in terms of the visual analog scale (VAS) and Oswestry Disability Index (ODI) as the efficacy value. There was no statistically significant difference between the groups regarding age, gender, and body mass index (P > 0.05). In group A, preop VAS was 8.84 ± 0.76, immediate postop period 3.10 ± 1.37, and postop third week was 4.73 ± 2.32. In group B, the preop VAS was 8.76 ± 0.76, the postop early period was 3.14 ± 1.27, and the postop third week was 3.12 ± 1.30. In group A preop ODI was 49.84 ± 9.11 and postop third week was 22.84 ± 6.44. In group B, the preop ODI was 46.71 ± 16.15 and postop third week was 30.80 ± 17.65. Significant changes were observed in the reduction of VAS values after the procedure in both groups during the early postoperative period and the third week (P value < 0.05). However, a significant difference was not found between the changes in VAS values between the groups (P value > 0.005). Similarly, significant changes were observed in the decrease of ODI values after the procedure in both groups during the early postoperative period and the third week (P value < 0.05). However, no significant difference was observed in the ODI scores between the two groups. No significant difference was observed between betamethasone and methylprednisolone. Both steroid groups showed a substantial improvement in the preoperative pain scores of the patients. [ABSTRACT FROM AUTHOR]

La cuenca del río Ayuquila-Armería se clasifica como cuenca hidrográfica prioritaria de México por su alta diversidad y también por la presión ecosistémica a la que es sometida. El objetivo de este estudio fue determinar las concentraciones de metales pesados (As, Cd, Cr, Hg, Pb y Zn) en agua y macroinvertebrados acuáticos, además de parámetros físicos y químicos (pH, C.E y caudal) en las subcuencas tributarias y el cauce principal. La presente investigación se llevó a cabo con muestreos en la temporada lluviosa en 2015, y en la temporada seca en 2016, en 18 sitios de la cuenca. En cada sitio de muestreo se realizaron determinaciones de metales pesados, parámetros físicos y químicos, colecta de macroinvertebrados acuáticos y estimación del caudal de los afluentes. En el agua superficial solo el Hg y el Pb superaron los límites permisibles para aguas naturales (0.02 y 0.0015 mg L-1 respectivamente) en el 60% de los sitios, en cuanto a las concentraciones en macroinvertebrados los seis metales superaron los límites permisibles en el 65% de los sitios con concentraciones de 0.33 a 7.07 mg kg-1, de estos el Hg (7.07 mg kg-1) y el metaloide As (5.19 mg kg-1) fueron los que presentaron las mayores concentraciones.

Background and Objectives: This study aimed to evaluate the mid-term effectiveness and safety of a combined ultrasound (US) and fluoroscopy (FL)-guided approach in comparison to US-guided and FL-guided caudal epidural steroid injections (CESI) for treating unilateral lower lumbar radicular pain. Materials and Methods: A total of 154 patients who underwent CESI between 2018 and 2022 were included. Patients were categorized into three groups based on the guidance method: combined US and FL (n = 51), US-guided (n = 51), and FL-guided (n = 52). The study design was retrospective case-controlled, utilizing patient charts and standardized forms to assess clinical outcomes, adverse events, complications during the procedures. Results: In all groups, Oswestry Disability Index and Verbal Numeric Scale scores improved at 1, 3, and 6 months after the last injection, with no significant differences between groups (p < 0.05). The treatment success rate at all time points was also similar among the groups. Logistic regression analysis showed that injection method, cause, sex, age, number of injections, and pain duration did not independently predict treatment success. Blood was aspirated before injection in 2% (n = 1), 13.5% (n = 7), and 4% (n = 2) of patients in the combined US and FL groups, FL-guided groups, and US-guided groups, respectively. Intravascular contrast spread was detected in one patient in the combined method groups and seven in the FL-guided groups. Conclusions: When comparing pain reduction and functional improvement, there was no significant difference between the three methods. The combined method took less time compared to using FL alone. The combined approach also showed a lower occurrence of intravascular injection compared to using FL alone. Moreover, blood vessels at the injection site can be identified with an ultrasound using the combined method. Given these advantages, it might be advisable to prioritize the combined US- and FL-guided therapy when administering CESI for patients with unilateral lumbar radicular pain.

Background: The use of local anesthetics as part of multimodal analgesia is an attractive concept in pediatric patients, since the evaluation and management of pain is a challenge in children under 7 years of age. Despite having guidelines and multiple studies on volume calculation, no safe and effective recommendation has been issued. Objective: To demonstrate that ultrasound-guided caudal block with a dose of 0.75 mL/kg of 0.2% ropivacaine has the same analgesic effect as a dose of 1.2 mL/kg. Material and methods: Randomized, prospective, longitudinal, comparative equivalence clinical trial. One hundred patients 0-7 years of age scheduled for elective or emergency infraumbilical surgery were enrolled between April 2021 and January 2022. Children were randomized 1:1 to be assigned to ultrasound-guided caudal block. Results: 100 patients divided into two groups with 0.2% ropivacaine volumes (0.75 mL vs. 1.2 mL). Both groups demonstrated the trans-anesthetic and post-anesthetic sedoanalgesia variables without significant differences for both groups on the FLACC pain scale after surgery and in recovery (p > 0.5), in the pain reassessment on the FLACC scale in the office called chronic pain (p > 0.5) in both groups. No complications were reported in the follow-up consultations and no arrhythmias were reported in both groups during surgery. Conclusions: The results of both groups did not show differences between a volume of 0.75 mL and 1.2 mL, the administration of 0.2% ropivacaine is favored with the use of ultrasound, which allows effective administration of lower doses of local anesthetic with reduced risk of complications. [ABSTRACT FROM AUTHOR]

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Objectives: Despite the various approaches currently available to treat CSD, this issue still needs to be resolved. Different methods and techniques to manage caudal septal dislocation with good results and according to each patient. This article reviewed the other surgical modalities for correcting caudal septum dislocation with the effectiveness of currently practiced modalities. Searching strategy: We reviewed relevant literature and used PubMed and Google Scholar. Published articles in English were included in the search. The unique and compound keywords used were caudal septum dislocation. The primary search resulted in many reports from all databases and search engines, followed by the exclusion of irrelevant articles. Findings: Different surgical modalities for correcting caudal septum dislocation have been described to correct caudal septum dislocations. Several techniques and maneuvers for surgical correction of caudal septal displacement are mentioned in the literature; nevertheless, there are different opinions and preferences regarding which approach to use. Conclusion and recommendations: An ideal caudal septoplasty should be minimally invasive and improve nasal obstruction. Surgical correction of a deviated septum can be performed using the traditional open endonasal approach, the endoscopic approach, or the open septorhinoplasty approach. In Saudi Arabia, many patients are seeking caudal septal deviation correction. However, there is a need for more trained surgeons, and it is recommended that all levels of training be considered. [ABSTRACT FROM AUTHOR]

Abstract Pediatric burns affect approximately 15–20 patients per 100 000 hospital admissions, but unfortunately there is a lack of evidence to guide optimal strategies for acute pain control. The aim of this study was to evaluate whether caudal analgesia with single injection of local anesthetics reduced pain medication consumption in pediatric patients who required surgical intervention for burn injuries. Retrospective data from patients

Background and Aims: Caudal block provides good perioperative analgesia for pediatric infraumbilical surgeries but has a short duration of action after a single injection. To overcome this limitation, we evaluated the effect of magnesium sulfate added to caudal bupivacaine on postoperative analgesia in pediatric patients undergoing infraumbilical surgeries. Materials and Methods: In this prospective randomized double-blind comparative study, 60 American Society of Anesthesiologists Grade I, II children aged 1–5 years, of either gender, undergoing infraumbilical elective surgeries were randomly divided into 2 Groups (Group M [Magnesium sulfate] and Group C [control]) and received caudal block with magnesium sulfate 50 mg (upto 1 ml with saline) and 1 ml saline, respectively, added to 1 ml/kg of 0.25% bupivacaine. Hemodynamic parameters were recorded at predefined time intervals. Postoperative pain by Face, Legs, Activity, Cry and Consolability (FLACC) scale and level of sedation by Ramsay Sedation Score was assessed postoperatively. Duration of analgesia and number of rescue analgesic doses received in 24 h were recorded. Quantitative and qualitative variables were analyzed using Mann–Whitney U test, Chi-Square test, and Kruskal–Wallis test where deemed appropriate. P ≤ 0.05 was considered statistically significant. Results: The mean duration of analgesia was significantly higher in Group M with reduced requirement of rescue analgesic doses. FLACC scores were higher in control Group C at all time intervals. Patients in the magnesium group were sedated for a longer period. Both groups had comparable hemodynamic parameters throughout the study. Conclusion: Magnesium sulfate as an adjuvant to bupivacaine in caudal block prolongs the duration of analgesia with a reduction of postoperative rescue analgesic requirement in pediatric patients.

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]

Objective: Lumbar spinal stenosis (LSS) is a narrowing of the canal diameter due to degenerative changes, particularly in elderly individuals. This narrowing sometimes accompanies foraminal stenosis. The aim of this study was to investigate the efficacy of caudal and combined caudal/transforaminal adhesiolysis for treating symptomatic LSS patients. Materials and Methods: Patients between the ages of 48-74, whose diagnosis was confirmed by magnetic resonance imaging were included in the study. The gender distribution was kept the same in both groups. The procedure was initially performed through the caudal way in all patients. Patients, with no evidence of foraminal passage in epidurography were categorized in group 2 as a combined caudal and transforaminal adhesiolysis groups. A total of 80 patients (40 patients in each group) were included in this study. Pain relief was evaluated using the walking distance, visual analog scale (VAS), and Oswestry Disability Index (ODI) before the procedure (baseline) and at the second week, the third and the sixth months after the procedure. Results: Baseline VAS values were found to be at least 5 and higher in the patients without foraminal passage by epidurography. These values were present in 35% of the patients in the caudal group. The increase in walking distance was similar in both groups (72.5% in the caudal group and 75% in the combined group). The improvement in VAS was significant in the combined group, and was observed in 39 of 40 patients. The improvement in ODI was 97.5% in both groups. No complications were encountered during and after the procedures. Conclusion: Caudal neuroplasty adhesiolysis is an effective method for treating chronic low back pain due to symptomatic LSS and its effectiveness is increased when adding a transforaminal procedures in cases with no foraminal passage in epidurography. [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

BackgroundThe caudal block and transversus abdominis plane block (TAP) are commonly used in combination with general anesthesia for pediatric lower abdominal, inguinal, and genitourinary surgeries. There is limited data directly comparing the impact of these techniques on recovery. In this meta-analysis, we compare the duration of postoperative analgesia between these two techniques.ObjectiveThis review examined the duration of analgesia in pediatric patients (age 0–18 years) undergoing surgery who received caudal or TAP block after induction of general anesthesia. The primary outcome was duration of analgesia, defined as the time to first rescue analgesic dose. Secondary outcomes included number of rescue analgesic doses, acetaminophen usage within 24 h postoperatively, 24 h pain score area under the curve, and postoperative nausea and vomiting.Evidence reviewWe systematically searched Pubmed, Central, EMBASE, CINAHL, Google Scholar, Web of Science citation index, the US clinical trials register, and abstracts from prominent 2020–2022 anesthesia conferences for randomized controlled trials that compared these blocks and reported analgesia duration.FindingsTwelve RCTs inclusive of 825 patients were identified. TAP block was associated with longer analgesia duration (Mean difference = 1.76 h, 95% CI: 0.70–2.81, p = 0.001) and reduced doses of rescue analgesic within 24 h (Mean difference = 0.50 doses, 95% CI: 0.02–0.98, p = 0.04). No statistically significant differences were detected in other outcomes.ConclusionThis meta-analysis suggests that TAP block provides greater duration of analgesia than caudal block after pediatric surgeries. TAP block was also associated with fewer rescue analgesic doses in the first 24 h without increased pain scores.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=380876, identifier: CRD42022380876.