A COMPARATIVE STUDY BETWEEN CAUDAL ROPIVACAINE AND ROPIVACAINE PLUS DEXAMETHASONE FOR INFRAUMBILICAL SURGERY IN PEDIATRIC PATIENTS

Background: Caudal block is one of the most popular regional block in children with high success rate for infra-umbilical surgeries. Among local anaesthetics ropivacaine provides a greater margin of safety, less motor blockade, less neurological and cardiac toxicity and similar duration of analgesia compared to bupivacaine. Addition of dexamethasone as an additive to local anesthesia decreases the postoperative rescue analgesia consumption.This study was designed to compare the effectiveness of intra-operative and postoperative analgesia on adding dexamethasone to 0.15% ropivacaine with 0.15%ropvacaine given alone. A prospective double blinded Materials: randomised controlled study was conducted consisting of 60 patients undergoing infra-umbilical surgeries under general anesthesia with Caudal block. Patients were randomised into two groups. Group A received 0.15% Inj.ropivacaine 1.5ml/kg with 1ml normal saline and Group B received 0.15% Inj.Ropivacaine 1.5ml/kg with 0.1mg/kg Inj.dexamethasone in caudal block Mean FLACC pain score was comparable and statistically not signi?cant (P=0.083) in both groups upto 30min Results: postoperatively. At 60min mean pain score in group A was 0.30 ± 0.54 and in group B was 0 (P=0.005) which was statistically signi?cant. In group A 40%(12) patients required rescue analgesia whereas in group B only 10%(3) patients required analgesia(P= 0.007) Patients remained hemodynamically stable throughout the procedure. After 60min Conclusion: postoperatively FLACC score was signi?cantly higher in group A as compared to group B. It concludes that addition of dexamethasone signi?cantly reduced postoperative pain and need for rescue analgesia without any side effects.

Manejo anestésico en neonatos con tumoraciones pulmonares / Anesthetic management in neonates with lung tumors

Resumen: Introducción: Los tumores pulmonares congénitos son patologías poco frecuentes; asimismo, cuando requieren intervención quirúrgica, el médico anestesiólogo se enfrenta a un reto en el manejo de estos pacientes. Presentación del caso: En este artículo describimos el caso y el manejo anestésico de un recién nacido de 37.5 semanas de gestación (SDG) y 26 días de vida extrauterina, programado para toracotomía posterolateral izquierda más lobectomía inferior izquierda y colocación de catéter venoso central bajo anestesia combinada (anestesia general balanceada más bloqueo caudal con bupivacaína y morfina). Conclusiones: Las consideraciones anestésicas para los procedimientos quirúrgicos en neonatos y/o pacientes pediátricos se convierten en un reto para el anestesiólogo, debido a la inmadurez de algunos de los sistemas, se considera que la técnica anestésica idónea para el adecuado manejo de los pacientes neonatales sigue siendo la técnica combinada. El anestesiólogo debe mantener en mente dicha técnica así como los eventos y/o efectos secundarios que se puedan derivar de la misma y de este modo instaurar de manera oportuna el tratamiento pertinente.

Abstract: Introduction: Congenital lung tumors are rare pathologies, likewise when surgical intervention is required, the anesthesiologist faces a challenge in the anesthetic management of these patients. Presentation of the case: The following article describes the case of a 26-day-old newborn child scheduled for left posterolateral thoracotomy plus lower left lobectomy and central venous catheter placement under combined anesthesia (balanced general anesthesia plus caudal block with bupivacaine and morphine). Conclusions: Anesthetic considerations for surgical procedures in neonates and/or pediatric patients become a challenge for the anesthesiologist, due to the immaturity of some of the systems, thus considering that the ideal anesthetic technique for the proper management of in neonatal patients, the combined technique continues, with epidural blocks for the management of peri- and postoperative pain. The anesthesiologist must keep in mind this technique as well as the events and/or side effects that may derive from it, thus establishing the pertinent treatment in a timely manner.

Effects of caudal block in pediatric surgical patients: a randomized clinical trial / Efeitos do bloqueio peridural caudal em pacientes cirúrgicos pediátricos: estudo randomizado

Abstract Background: Surgery generates a neuroendocrine stress response, resulting in undesirable hemodynamic instability, alterations in metabolic response and malfunctioning of the immune system. Objectives: The aim of this research was to determine the effectiveness of caudal blocks in intra- and postoperative pain management and in reducing the stress response in children during the same periods. Methods: This prospective, randomized clinical trial included 60 patients scheduled for elective herniorrhaphy. One group (n = 30) received general anesthesia and the other (n = 30) received general anesthesia with a caudal block. Hemodynamic parameters, drug consumption and pain intensity were measured. Blood samples for serum glucose and cortisol level were taken before anesthesia induction and after awakening the patient. Results: Children who received a caudal block had significantly lower serum glucose (p < 0.01), cortisol concentrations (p < 0.01) and pain scores 3 h (p = 0.002) and 6 h (p = 0.003) after the operation, greater hemodynamic stability and lower drug consumption. Also, there were no side effects or complications identified in that group. Conclusions: The combination of caudal block with general anesthesia is a safe method that leads to less stress, greater hemodynamic stability, lower pain scores and lower consumption of medication.

Resumo Justificativa: O estresse cirúrgico causa resposta neuroendócrina, resultando em instabilidade hemodinâmica indesejável, modificações na resposta metabólica e disfunção no sistema imune. Objetivos: O objetivo deste estudo foi avaliar, em pacientes pediátricos, a eficácia do bloqueio peridural caudal no controle da dor intra e pós-operatória e na redução da resposta ao estresse nesses períodos. Métodos: Estudo clínico prospectivo randomizado que incluiu 60 pacientes submetidos à herniorrafia eletiva. Um grupo (n = 30) recebeu anestesia geral e o outro (n = 30), anestesia geral combinada a bloqueio caudal. Foram medidos os parâmetros hemodinâmicos, o consumo de medicamentos e a intensidade da dor. Amostras de sangue para medir glicemia e cortisol plasmático foram obtidas antes da indução e após o despertar dos pacientes. Resultados: As crianças que receberam bloqueio peridural caudal apresentaram valores significantemente mais baixos para glicemia (p < 0,01), concentração de cortisol (p < 0,01) e escores de dor de 3 horas (p = 0,002) e 6 horas (p = 0,003) após a cirurgia, maior estabilidade hemodinâmica e menor consumo de medicamentos. Além disso, não foram observados efeitos colaterais ou complicações nesse grupo. Conclusões: O bloqueio peridural caudal combinado à anestesia geral é uma técnica segura e que se associa a menor estresse, maior estabilidade hemodinâmica, redução nos escores de dor e baixo consumo de medicamentos.

Comparison of two analgesic block techniques for circumcision: dorsal penile nerve block and caudal block

Background: Circumcision is most common and oldest surgery but also could be frightening for children because of postoperative pain. Authors aim to evaluate postoperative pain conditions of patients by using the visual pain scale (VPS).Methods: Between 2016 and 2018, 168 children undergone circumcision. The patients were splitted into three groups depend on their anesthetic care; the dorsal penile block (DPNB), caudal block (CB) and combine block.Results: The mean age were 95.3±20.9 (65-186) months. There was no significant difference between the CB and combine block in VPS at 1st, 3rd hours and second days (p=0.19, p=0.39 and p=0.9 respectively). The VPS significantly higher in the DPNB arm when compared with caudal and combine block arm at 1st and 3rd hours (p<0.01 and p<0.01 respectively) but there was no significant difference between the DPNB and caudal block at second days (p=0.9). There was no significant difference between groups for analgesic requirements (p=0.07). Incidences of nausea and vomiting were seen rarely especially in the DPNB arm and the difference was not statistically significant among the groups (p=0.9).Conclusions: CB and DPNB are effective techniques for pain relief following penile surgery. CB has superior to DPNB at 1st and 3rd hours but no difference at follow up. Both techniques are appropriate methods for postoperative pain relief.

Effects of Ketamine and Midazolam on Emergence Agitation after Sevoflurane Anaesthesia in Children Receiving Caudal Block: A Randomized Trial

Introduction: Emergence agitation is a common postanaesthetic complication in children after sevofluraneanaesthesia. We aimed to compare the effects of ketamineand midazolam administered intravenously, before the endof surgery, for prevention of emergence agitation in childrenwho received caudal block for pain relief under sevofluraneanaesthesia.Material and Methods: 100 American Society ofAnaesthesiologists status I children aged 4-11 years scheduledfor inguinal hernia repair, circumcision or orchidopexywere enrolled to the study. Anaesthesia was induced withsevoflurane 8% in a mixture of 50% oxygen and nitrous oxide.After adequate depth of anaesthesia, a laryngeal mask wasplaced and caudal block was performed with 0.5 mL kg−1,0.125% bupivacaine. At the end of the surgery, ketamine0.25 mg kg−1 or midazolam 0.03 mg kg− were given to theirrespective groups. Agitation was assessed using PaediatricAnaesthesia Emergence Delirium scale and postoperative painwas evaluated with modified Children's Hospital of EasternOntario Pain Scale.Results and conclusion: modified Children's Hospital ofEastern Ontario Pain Scale scores were found higher inmidazolam group as compared to ketamine group at 0 minutesand 5 minutes while after 10 minutes, the scores becameinsignificant. Paediatric Anaesthesia Emergence Deliriumscores were found to be higher in midazolam group at 0, 5 and10 minutes as compared to ketamine group, but at 30 minutes,the delirium scores became comparable. Thus, ketaminewas able to prevent Emergence Delirium as well as decreasepain scores better than midazolam following sevofluraneanaesthesia in children with caudal block

Comparison of Caudal Anesthesia and Ilioinguinal Block for Pediatric Inguinal Surgeries and Postoperative Analgesia

Background and Objective: Infants and children undergo a variety of groin procedures that can cause a significant degree ofdiscomfort postoperatively. We aim to compare the caudal block and ilioinguinal/iliohypogastric block using the combination ofropivacaine and dexmedetomidine with regard to efficacy, quality, and duration of post-operative analgesia.Methods: This study included two groups and 60 patients of the age group of 3–12 years. After induction of anesthesia, GroupAreceived caudal block using 1 ml/kg 0.2% ropivacaine + dexmedetomidine 0.3 μg/kg up to maximum of 20 ml. Group B receivednerve locator guided ilioinguinal/iliohypogastric block using 0.75 ml/kg 0.2% ropivacaine + dexmedetomidine 0.3 μg/kg up tomaximum of 20 ml. Postoperatively, patients were monitored for up to 24 h for primary objective of measurement of pain score,duration of analgesia, and number of rescue analgesia required. Statistical analysis performed using independent t-test andChi-square test. P < 0.05 was considered statistically significant.Results: The highest pain score in Group A was 5.93 ± 1.53 and in Group B was 4.93 ± 1.64 (P < 0.05). The average durationof analgesia in Group A and Group B was 372 min and 680 min, respectively (P < 0.05). The mean number of rescue analgesiagiven in Group A was 1.47 and in Group B was 0.96 (P < 0.05).Conclusion: Both caudal block and ilioinguinal block are effective measure of post-operative pain relief in pediatric inguinalsurgeries, but ilioinguinal block is better in terms of efficacy, duration of analgesia, lesser dose of local anesthetic required, andlesser need of rescue analgesia required.

Caudal Epidural Injection with a Catheter in Patients with Failure of Conventional Epidural Blocks / 대한척추외과학회지

STUDY DESIGN: Retrospective study. OBJECTIVES: The purpose of this study was to analyze and report the results of caudal epidural injections using a catheter in patients in whom conventional epidural block had failed. SUMMARY OF LITERATURE REVIEW: Epidural nerve block is often used to treat chronic back pain and radicular pain in degenerative lumbar disease, and percutaneous epidural neuroplasty or surgery may be an alternative if it fails. MATERIALS AND METHODS: In total, 146 patients who were treated with caudal epidural block using a catheter were recruited for this study from January 1, 2015 to June 30, 2019. Forty-five patients who had not undergone any epidural block in the past were excluded from the study. Among patients who did not have a fracture and were followed up for at least 1 month, the medical records of 61 patients with degenerative disc herniation, spondylosis, and stenosis were reviewed retrospectively. Visual analogue scale (VAS) scores were evaluated before and after the procedure. RESULTS: Of the 61 patients who had undergone epidural block through a transforaminal caudal approach with no pain control effect, there were 18 males and 43 females. Their mean age was 66.3 years and the average follow-up period was 2.64 months. There were 46 cases of spinal stenosis, 33 cases of spondylosis, 2 cases of spondylolisthesis, 9 cases of disc herniation and 1 case of ankylosing spondylitis. The mean number of epidural blocks was 5.85 (times) before the procedure. The mean initial VAS score was 5.34 and the final follow-up VAS score was 2.70. There was a significant difference between before and after the procedure (p<0.05). The mean duration of effect after the procedure was 1.84 months and the mean number of procedures was 2.30. After the procedure, there were 4 cases of surgical treatment, 2 cases of neuroplasty, and 3 cases of epidural block using other methods over more than 1 year of follow-up. CONCLUSIONS: The result of this clinical study suggests that caudal epidural injections using a catheter may be effective for patients with low back pain who have not responded to previous epidural blocks before surgical treatment.

Sedative effect of non-intravenous administration dexmedetomidine in pediatric patients underwent lower abdomen and limb surgery / 吉林大学学报(医学版)

Objective:To investigate the application of non-intravenous dexmedetomidine(DEX)in the pediatric patients underwent lower abdomen and limb surgery,and to observe the sedative effect of DEX in this procedure. Methods:Sixty patients undergoing the general anesthesia for lower abdomen and limb surgery were selected and randomly devided into ropivacaine sacral block(RS)group,intranasal DEX+ ropivacaine sacral block(ID)group, ropivacaine + DEX sacral block(DS)group,20 cases in each group.The children in ID group received intranasal DEX 1 μg·kg-130 min before operation and the children in RS and DS groups received physiological saline. 1 mL·kg-1propofol was infused intravenously in the children who could not smoothly enter into the operating room as well as the intolerance to oxygen mask or sevoflurane inhalation while induction.The children in RS and ID groups received 0.25% ropivacaine 1 mL·kg-1,and the children in DS group received the same dose of ropivacaine mixed with 1 μg·kg-1DEX,and the total volume of drugs was 20 mL.The general information of each child was recorded;the sedation status when separated from their parents and induction period mask and sevoflurane acceptance scores were assessed;the satisfaction of separation with parents,oxygen mask and sevoflurane inhalation were recorded;the time of operation,induction,extraction of laryngeal mask and anesthesia awake were recorded;delayed awakening,laryngismus and awakening period agitation score were recorded.The scores of anesthesia recovery and the dosage of propofol were recorded;the sedation scores 4,8,12,16,20,and 24 h after operation were recorded.Results:Compared with RS and DS groups,the sedation scores of the children when they were separated from their parents and mask induction and sevoflurane inhalation acceptance,the satisfaction degree of separation,mask and sevoflurane acceptance in ID group were increased(P<0.05);the dosage of propofol in ID group were decreased(P<0.05).The time of operation,extraction of laryngeal mask and anesthesia awake had no significant differences between three groups(P>0.05),the induction time of children in ID group was shorter than those in RS and DS groups(P<0.05).There was no delayed awakening in three groups,and the laryngismus and the awakening period agitation score in RS group were higher than those in ID and DS groups(P<0.05).There was no differences in the consciousness,respiration,activity scores and the scores of anethesia recovery between three groups(P>0.05).The sedation scores in the three groups were less than 3 points 4 h after operation. Compared with RS group,the sedation scores in ID and DS groups were decreased 8 h after operation(P<0.05). Compared with RS and ID groups,the sedation scores in DS group 12,16 and 20h after operation were decreased (P<0.05).There were no significant differences in the sedation scores between three groups 24 h after operation (P>0.05).Conclusion:When non-intravenous DEX is used in the pediatric patients underwent lower abdomen and limb surgery,the children can quietly and co-operationly enter into the operating room and quickly and smoothly complete the induction process;the incidence of revival restlessness is significantly reduced,and it can play a role in the early postoperative sedation.

Sedative effect of non-intravenous administration dexmedetomidine in pediatric patients underwent lower abdomen and limb surgery / 吉林大学学报(医学版)

Objective: To investigate the application of non-intravenous dexmedetomidine (DEX) in the pediatric patients underwent lower abdomen and limb surgery, and to observe the sedative effect of DEX in this procedure. Methods: Sixty patients undergoing the general anesthesia for lower abdomen and limb surgery were selected and randomly devided into ropivacaine sacral block (RS) group, intranasal DEX + ropivacaine sacral block (ID) group, ropivacaine + DEX sacral block (DS) group, 20 cases in each group. The children in ID group received intranasal DEX 1 μg · kg-1 30 min before operation and the children in RS and DS groups received physiological saline. 1 mL · kg-1 propofol was infused intravenously in the children who could not smoothly enter into the operating room as well as the intolerance to oxygen mask or sevoflurane inhalation while induction. The children in RS and ID groups received 0.25% ropivacaine 1 mL · kg-1, and the children in DS group received the same dose of ropivacaine mixed with 1 μg · kg-1 DEX, and the total volume of drugs was 20 mL. The general information of each child was recorded; the sedation status when separated from their parents and induction period mask and sevoflurane acceptance scores were assessed; the satisfaction of separation with parents, oxygen mask and sevoflurane inhalation were recorded; the time of operation, induction, extraction of laryngeal mask and anesthesia awake were recorded; delayed awakening, laryngismus and awakening period agitation score were recorded. The scores of anesthesia recovery and the dosage of propofol were recorded; the sedation scores 4, 8, 12, 16, 20, and 24 h after operation were recorded. Results: Compared with RS and DS groups, the sedation scores of the children when they were separated from their parents and mask induction and sevoflurane inhalation acceptance, the satisfaction degree of separation, mask and sevoflurane acceptance in ID group were increased (P0.05), the induction time of children in ID group was shorter than those in RS and DS groups (P0.05). The sedation scores in the three groups were less than 3 points 4 h after operation. Compared with RS group, the sedation scores in ID and DS groups were decreased 8 h after operation (P0.05). Conclusion: When non-intravenous DEX is used in the pediatric patients underwent lower abdomen and limb surgery, the children can quietly and co-operationly enter into the operating room and quickly and smoothly complete the induction process; the incidence of revival restlessness is significantly reduced, and it can play a role in the early postoperative sedation.

Ultrasound guided nerve block versus caudal block for post-operative analgesia in children undergoing unilateral groin surgery

Background: Pain is an unpleasant subjective sensation which can only be experienced and not expressed, especially in children. The primary reason to treat or prevent pain is humanitarian. Aim and objectives: To assess Ultrasound Guided Ilioinguinal / Iliohypogastric nerve block versus Caudal block for post-operative analgesia in children undergoing unilateral groin surgery in ASA grade I and II children. Materials and methods: Sixty patients aged between 3-12 years undergoing unilateral groin surgery were included. The objectives of this study were to compare the effects of caudal block and ultrasound guided Ilioinguinal/ Iliohypogstric nerve block in terms of duration of analgesia, quality of analgesia and hemodynamic. Results: The mean age of two groups was comparable with Mean ± SD 4.67 ± 1.4 for B group and Mean ± SD 4.7 ± 1.34 for C group, which was statistically not significant. In the present study, major number of cases came for herniotomy being 47% of total cases in both groups followed by high ligation 27% in US II/IH nerve block,23% in cauadal group, and orchidopexy 27% in II/IH nerve block group and 30% in caudal group. Mean duration of surgery of B group was 28.17±8.56 minutes, and for C group was 29.67±8.60 minutes. The difference between the means was statistically not significant (P>0.05). The baseline, intra operative heart rate changes between two groups were comparable and were statistically not significant and therapeutic interventions were not T. Ravi, N. Dheeraj Kumar, Bhrungi Shireesh Kumar. Ultrasound guided nerve block versus caudal block for post-operative analgesia in children undergoing unilateral groin surgery. IAIM, 2016; 3(9): 115-125. Page 116 required. There was no significant difference in quality of analgesia in both groups with P-Value >0.05. Duration of Postoperative analgesia is comparable in both the groups with Mean±SD values being 4.95±0.51 for B group and 4.78±0.49 for C group which is statistically not significant with PValue being >0.05. Conclusion: Ultrasound guided Ilioinguinal / Iliohypogastric nerve blocks is an ideal procedure for unilateral groin surgeries in children, regarding quality of analgesia with less pain scores and duration of analgesia is comparable with that of caudal block, with lower volume of local anesthetic.

Comparison of postoperative analgesia between transversus abdominis plane block and caudal block for Hirschsprung??s disease / 临床麻醉学杂志

Objective To compare the analgesia effect of transversus abdominis plane(TAP) block and caudal block after radical surgery of Hirschsprung’s disease.Methods Sixty pediatric pa-tients,52 males,8 females,aged 1-3 yr,of ASA physical status Ⅰ or Ⅱ,scheduled for elective rad-ical surgery on Hirschsprung’s disease,were equally randomized into TAP block group(group TAP) and caudal block group (group CA).0.2% ropivacaine 1 ml/kg was used in both blocks.FLAAC scores were measured at 6,12,18 and 24 h after surgery.The requirement of sufentanil every 6 h, the first passage of flatus,the time of removing urine tube and the incidence of nausea and vomiting within 24 hours were recorded.Results Compared with group TAP,FLAAC scores and the require-ment of sufentanil were significantly decreased at 6 h after operation in group CA(P <0.05).FLAAC scores and the requirement of sufentanil were similar at 12,18 and 24 h in the two groups.The first passage of flatus,the time of removing urine tube in group TAP were significantly shorter than group CA(P < 0.05 ).The incidence of nausea and vomiting were not significantly different in the two groups.Conclusion Although both TAP block and caudal block can provide effective analgesia for the pediatric patients after radical surgery on Hirschsprung’s disease,caudal block provided superior anal-gesia at early stage after operation,however,TAP block is more beneficial for earlier recovery of bowl function.

Efficacy and safety of ropivacaine combined with lidocaine in caudal block for pediatric laparoscopic hernia surgery / 中国生化药物杂志

Objective To evaluate the anesthetic effect and safety of ropivacaine combined with lidocaine caudal block in the treatment of pediatric laparoscopic hernia surgery.Methods A total of 70 cases with pediatric hernia surgery in Ningbo Women and Children’s Hospital from May 2014 to October 2015 in this study were divided into control group and experimental group with 35 cases in each group.The patients in the both groups were given routine examination, preoperative anesthesia induction, adopted 7 scalp injection needles to prick into the hiatus sacralis,patients in control group were treated by 1% lidocaine hydrochloride injection mixed liquid 1 mL/kg;patients in the experimental group were treated by 0.25%lidocaine hydrochloride injection and 0.25% ropivacaine hydrochloric injection mixed liquid 1 mL/kg; pediatric hernia surgery, intraoperative continuous pumped into propofol injection 4-6 mL/kg and maintain the mask to the oxygen.The visual analog pain scored( VAS) , visual satisfaction scored ( VSS) and adverse reactions were compared at the end of operation, after operation 0 h,0.5 h,1 h,2 h,4 h,8 h and 24 h.Results The sensory and motor block effective time in the experimental group were later than the control group, the sensory and motor block duration time were shorter than the control group (P<0.05).VAS score of the experimental group was significant lower than control group after operation 2 h ( P<0.05 ) . After operation, postoperative 0.5 h, postoperative 1 h, the VSS score of the experimental group was significant lower than control group ( P<0.05 ) .Lower limbs numbness discomfort duration time of the experimental group was significant lower than control group after operation ( P<0.05 ) . Postoperative agitation rate of the experimental group 8.57% was significant lower than the control group 34.29% (P<0.05).The incidence of adverse reactions of experimental group 5.71% was significant lower than the control group 25.71% ( P<0.05 ) .Conclusion Ropivacaine combined with lidocaine caudal block in the treatment of pediatric hernia surgery has the remarkable effect, with high safety.

Effects of ketamine and midazolam on emergence agitation after sevoflurane anaesthesia in children receiving caudal block: a randomized trial / Efeitos de cetamina e midazolam sobre a incidência de agitação pós-anestesia com sevoflurano em crianças submetidas ao bloqueio caudal: estudo randomizado / Efectos de la ketamina y el midazolam sobre la incidencia de agitación postanestesia con sevoflurano en niños sometidos al bloqueo caudal: estudio aleatorizado

Background and objectives: Emergence agitation is a common postanaesthetic problem in children after sevoflurane anaesthesia. We aimed to compare the effects of ketamine and midazolam administered intravenously, before the end of surgery, for prevention of emergence agitation in children who received caudal block for pain relief under sevoflurane anaesthesia. Methods: 62 American Society of Anesthesiologists patient classification status I children, aged 2–7 years, scheduled for inguinal hernia repair, circumcision or orchidopexy were enrolled to the study. Anaesthesia was induced with sevoflurane 8% in a mixture of 50% oxygen and nitrous oxide. After achieving adequate depth of anaesthesia, a laryngeal mask was placed and then caudal block was performed with 0.75 mL kg−1, 0.25% bupivacaine. At the end of the surgery, ketamine 0.25 mg kg−1, midazolam 0.03 mg kg−1 and saline were given to ketamine, midazolam and control groups, respectively. Agitation was assessed using Paediatric Anaesthesia Emergence Delirium scale and postoperative pain was evaluated with modified Children's Hospital of Eastern Ontario Pain Scale. Results and conclusions: Modified Children's Hospital of Eastern Ontario Pain Scale scores were found higher in control group than in ketamine and midazolam groups. Paediatric Anaesthesia Emergence Delirium scores were similar between groups. Modified Children's Hospital of Eastern Ontario Pain Scale and Paediatric Anaesthesia Emergence Delirium scores showed a significant decrease by time in all groups during follow-up in postanaesthesia care unit. The present study resulted in satisfactory Paediatric Anaesthesia Emergence Delirium scores which are below 10 in all groups. As a conclusion, neither ketamine nor midazolam added to caudal block under sevoflurane anaesthesia did show further effect on emergence agitation. In addition, pain relief still seems to be the major factor in preventing emergence ...

Justificativa e objetivos: A incidência de agitação é um problema pós-anestésico comum em crianças após a anestesia com sevoflurano. Nosso objetivo foi comparar os efeitos de cetamina e midazolam administrados por via intravenosa, antes do término da cirurgia, para prevenir a incidência de agitação em crianças submetidas ao bloqueio caudal para alívio da dor sob anestesia com sevoflurano. Métodos: Foram inscritos no estudo 62 pacientes pediátricos, entre 2-7 anos, estado físico classificado de acordo com a Sociedade Americana de Anestesiologistas (ASA: I), programados para correção de hérnia inguinal, circuncisão ou orquidopexia. A anestesia foi induzida com sevoflurano a 8% em uma mistura de oxigênio (50%) e óxido nitroso (50%). Depois de atingir a profundidade adequada da anestesia, uma máscara laríngea foi colocada e, em seguida, o bloqueio caudal foi feito com bupivacaína a 0,25% (0,75 mL kg−1). No fim da cirurgia, cetamina (0,25 mg kg−1), midazolam (0,03 mg kg−1) e solução salina foram administrados aos grupos cetamina, midazolam e controle, respectivamente. A incidência de agitaçio foi avaliada com a escala Paediatric Anaesthesia Emergence Delirium (PAED) e a dor no período pós-operatório avaliada com a escala modificada Children's Hospital of Eastern Ontario Pain Scale (mCHEOPS). Resultados e conclusões: Os escores de dor da escala modificada mCHEOPS foram maiores no grupo controle do que nos grupos cetamina e midazolam. Os escores PAED foram semelhantes entre os grupos. Os escores dessas duas escalas mostraram uma diminuição significativa do tempo em todos os grupos durante o acompanhamento em sala de recuperação pós-anestesia. O presente estudo resultou em escores satisfatórios da escala PAED, que ficaram abaixo ...

Introducción y objetivos La incidencia de agitación es un problema postanestésico frecuente en niños después de la anestesia con sevoflurano. Nuestro objetivo fue comparar los efectos de la ketamina y del midazolam administrados por vía intravenosa antes del término de la cirugía para prevenir la incidencia de agitación en niños sometidos al bloqueo caudal para alivio del dolor bajo anestesia con sevoflurano. Métodos 62 pacientes pediátricos, con edades entre 2 y 7 años, estado físico clasificado de acuerdo con la Sociedad Norteamericana de Anestesiólogos (ASA I), programados para la corrección de hernia inguinal, circuncisión o orquidopexia fueron inscritos en el estudio. La anestesia se indujo con sevoflurano al 8% en una mezcla de oxígeno al 50% y óxido nitroso al 50%. Después de alcanzar la profundidad adecuada de la anestesia, una mascarilla laríngea se colocó y enseguida el bloqueo caudal se realizó con bupivacaína al 0,25% (0,75 ml kg−1). Al final de la cirugía, la ketamina (0,25 mg kg−1), el midazolam (0,03 mg kg−1) y la solución salina fueron administrados a los grupos ketamina, midazolam y control, respectivamente. La incidencia de agitación se evaluó usando la escala Paediatric Anaesthesia Emergence Delirium y el dolor en el período postoperatorio se calculó con la escala modificada Children's Hospital of Eastern Ontario Pain Scale. Resultados y conclusiones Las puntuaciones de dolor de la escala modificada Children's Hospital of Eastern Ontario Pain Scale fueron más elevadas en el grupo control que en los grupos ketamina y midazolam. Las puntuaciones de la Paediatric Anaesthesia Emergence Delirium fueron parecidas entre los grupos. Las puntuaciones de esas 2 escalas arrojaron una reducción significativa del tiempo en todos los grupos durante el ...

Classification and analysis of fifth pair of sacral foramina in indian dry sacra / Clasificación y análisis del quinto par de forámenes en huesos sacros secos de indios

A sacrum with five pairs of foramina is an anatomical variant resulting from sacralisation of lumbar vertebra at cranial end or sacralisation of coccyx vertebra at caudal end. An unusual gross variation nurtures interest of anatomists and causes concern for clinicians when it mimics pathology. A sacrum with fifth anomalous pair of sacral foramina has been observed which prompted the author to examine the available sacra in the osteology lab of Department of Anatomy KG Medical University Lucknow, UP, India. Of the total sixty six observed sacra, those with five pairs of sacral foramina due to sacralisation of lumbar vertebra were found in eleven cases (16.6%) while those due to sacralisation of coccygeal vertebra were observed in nine cases (13.6%). These sacralisations were classified in five categories to systematise the anatomical study, causes and clinical complications. Sacralisation of lumbar vertebra may compress the fifth sacral nerve causing sciatica and back pain. It may also cause herniation of disc above sacralisation. Sacralisation of coccygeal vertebra may influence the caudal block anaesthesia in surgical procedures and also results in prolonged second stage of labor and perineal tears.

Un sacro con cinco pares de forámenes es una variante anatómica que resulta de la sacralización de la vértebra lumbar al extremo craneal o sacralización de la vértebra coxis al extremo caudal. Esta variación inusual es de interés para los anatomistas como también motivo de preocupación para los médicos al asemejar una patología. Un sacro con un quinto par anómalo de forámenes fue observado, por lo que se examinaron otros sacros del laboratorio de osteología del Departamento de Anatomía Médica de la Universidad de Lucknow, India. De un total de 66 sacros estudiados, en 11 casos (16,6%) se observaron cinco pares de forámenes sacros, debido a la sacralización de la vértebra lumbar; mientras que en 9 casos (13,6%), se observó la sacralización de la vértebra caudal. Estos fueron clasificados en cinco categorías para sistematizar el estudio anatómico, sus causas y complicaciones clínicas. La sacralización de la vértebra lumbar puede comprimir el quinto nervio, causando ciática sacra y dolor de espalda. También puede causar una hernia discal superior a la sacralización. La sacralización de la vértebra caudal, puede influir en la anestesia de bloqueo caudal en procedimientos quirúrgicos y también dar lugar a una prolongada etapa del trabajo de parto y desgarros perineales.

Clinical effect of sufentanil and levobupivacaine on postoperative analgesia in pediatric caudal block anesthesia / 国际儿科学杂志

Objective To invetigate the effect and safety of sufentanil mixed levobupivacaine on postoperative analgesia in pediatric caudal block anesthesia.Method Sixty pediatric patients (2 ～ 6 years old) who were undergoing elective abdominal surgery,such as repair hernia of high ligation,were randomly divided into three groups with 20 cases each.after intravenous induction,0.25％ levobupivacaine was injected in sacrum tube in group Ⅰ,0.5 μg/ml sufentanil mixed 0.25％ levobupivacaine and 1.0 μg/ml sufentanil mixed 0.25％ levobupivacaine were injected in sacrum tube in group Ⅱ and group Ⅲ respectively.The analgesia effect,the analgesia time,recover time and adverse reaction were observed and recorded 2,4,8,12,16,24 hours after the surgery.Results The analgesia effect in group Ⅱ、Ⅲ were significantly better than the group Ⅰ when 4、8、12 hours after the operation(P ＜0.05),and the analgesia effect in groupⅢ were significantly better than the group Ⅱ when 8 hours after the operation (P ＜ 0.05).There were no significant differences in three groups when 2、16、24 hours after the operation(P ＞0.05),the analgesia time in group Ⅱ、Ⅲ were significantly longer than the group Ⅰ (P ＜ 0.05),and the analgesia time in group Ⅲ were significantly longer than the group Ⅱ (P ＜ 0.05).There were no differences in the recovery time of three groups (P ＞ 0.05).There were no adverse reactions in three groups.Conclusions 0.5 μg/ml and 1.0 μg/ml sufentanil mixed 0.25％ levobupivacaine may be used on postoperative analgesia in pediatric caudal block anesthesia safely and analgesia effect and time were more better and longer than 0.25％ levobupivacaine singly.The analgesia effect in group with 1.0μg/ml sufentanil mixed 0.25％ levobupivacaine was the best in three groups with the fewest side effects.

Inadvertent Dural Puncture during Caudal Approach by the Introducer Needle for Epidural Adhesiolysis Caused by Anatomical Variation

There have been reports of abnormalities in the lumbosacral region involving a lower-than-normal termination of the dural sac, which is caused by disease or anatomical variation. Inadvertent dural puncture or other unexpected complications can occur during caudal epidural block or adhesiolysis in patients with these variations, but only a small number of case reports have described this issue. We report a case of dural puncture by the introducer needle before attempting caudal epidural adhesiolysis, which occurred even though the needle was not advanced upward after penetrating the sacrococcygeal ligament. Dural puncture was caused by a morphological abnormality in the lumbosacral region, with no pathological condition; the dural sac terminal was located more distally than normal. However, dural puncture could have been prevented if we had checked for such an abnormality in the magnetic resonance imaging (MRI) taken before the procedure.

The Correlation between Caudal Epidurogram and Low Back Pain

BACKGROUND: The common causes of lower back pain with or without leg pain includes disk disease and spinal stenosis. A definitive diagnosis is usually made by means of magnetic resonance imaging (MRI), but treatment is often difficult because the MRI findings are not consistent with the symptoms of the patient in many cases. The objective of this study was to observe the correlation between the patterns of epidurography performed in patients having lower back pain with or without leg pain and the position or severity of the pain as subjectively described by the patients. METHODS: The subjects of this study were 69 outpatients with lower back pain with or without leg pain who visited our clinic and complained of predominant pain on one side. We performed caudal epidural block using an image intensifier. A mixture of the therapeutic drug and the contrast agent (10 ml) was injected to observe the contrast flow pattern. The patients who complained of predominant pain on one side were divided into the left side group and the right side group. A judgment of inconsistency was made if the contrast agent flowed to the side of the pain, while a judgment of consistency was made if the contrast agent flowed to the opposite side of the pain. The degree of the drug distribution was evaluated by counting the number of cells to which the contrast agent's flowed for evaluating the correlation between the contrasted cell and the severity of pain (one group or = VAS 8) the degree of the contrast agent's contrast was evaluated by dividing and counting an image into 15 cells (the left, right, and middle sections at each level of L4, L5, S1, S2, and S3). RESULTS: Thirty out of the 69 patients who had laterality in pain, that is, those who complained of predominant pain on one side, showed that the laterality of the pain and the contrast agent flow was consistent, while 39 patients showed that the laterality was inconsistent (P: 0.137). The evaluation of the correlation between the pain and the contrast agent flow showed that the mean number of contrasted cells was 9.0 +/- 2.2 for the 46 patients in the group with a VAS of 7 or lower and 6.5 +/- 2.0 for the 23 patients in the group with a VAS of 8 or higher, indicating that the former group showed a significantly greater number of contrasted cells (P < 0.001). CONCLUSIONS: This study, conducted with patients having lower back pain with or without leg pain, showed that the contrast flow pattern of caudal epidurography had a significant correlation with the severity of the pain but not with the laterality of the pain.

Comparison of Postoperative Analgesic Efficacy of Caudal Block versus Dorsal Penile Nerve Block with Levobupivacaine for Circumcision in Children / 대한통증학회지

BACKGROUND: Circumcision is a painful intervention frequently performed in pediatric surgery. We aim to compare the efficacy of caudal block versus dorsal penile block (DPNB) under general anesthesia for children undergoing circumcision. METHODS: This study was performed between July 1, 2009 and October 16, 2009. Fifty male children American Society of Anesthesiolgists physical status classification I, aged between 3 and 12 were included in this randomized, prospective, comparative study. Anesthetic techniques were standardized for all children. Patients were randomized into 2 groups. Using 0.25% 0.5 ml/kg levobupivacain, we performed DPNB for Group 1 and caudal block for Group 2. Postoperative analgesia was evaluated for six hours with the Flacc Pain Scale for five categories; (F) Face, (L) Legs, (A) Activity, (C) Cry, and (C) Consolability. For every child, supplemental analgesic amounts, times, and probable local or systemic complications were recorded. RESULTS: No significant difference between the groups (P > 0.05) was found in mean age, body weight, anesthesia duration, FLACC pain, and sedation scores (P > 0.05). However, on subsequent measurements, a significant decrease of pain and sedation scores was noted in both the DPNB group and the caudal block group (P < 0.001). No major complication was found when using either technique. CONCLUSIONS: DPNB and caudal block provided similar postoperative analgesic effects without major complications for children under general anesthesia.

Comparison of Postoperative Analgesic Efficacy of Caudal Block versus Dorsal Penile Nerve Block with Levobupivacaine for Circumcision in Children

BACKGROUND: Circumcision is a painful intervention frequently performed in pediatric surgery. We aim to compare the efficacy of caudal block versus dorsal penile block (DPNB) under general anesthesia for children undergoing circumcision. METHODS: This study was performed between July 1, 2009 and October 16, 2009. Fifty male children American Society of Anesthesiolgists physical status classification I, aged between 3 and 12 were included in this randomized, prospective, comparative study. Anesthetic techniques were standardized for all children. Patients were randomized into 2 groups. Using 0.25% 0.5 ml/kg levobupivacain, we performed DPNB for Group 1 and caudal block for Group 2. Postoperative analgesia was evaluated for six hours with the Flacc Pain Scale for five categories; (F) Face, (L) Legs, (A) Activity, (C) Cry, and (C) Consolability. For every child, supplemental analgesic amounts, times, and probable local or systemic complications were recorded. RESULTS: No significant difference between the groups (P > 0.05) was found in mean age, body weight, anesthesia duration, FLACC pain, and sedation scores (P > 0.05). However, on subsequent measurements, a significant decrease of pain and sedation scores was noted in both the DPNB group and the caudal block group (P < 0.001). No major complication was found when using either technique. CONCLUSIONS: DPNB and caudal block provided similar postoperative analgesic effects without major complications for children under general anesthesia.

A comparison between caudal block versus splash block for postoperative analgesia following inguinal herniorrhaphy in children / 대한마취과학회지

BACKGROUND: We wanted to determine the postoperative analgesic efficacy of preincisional caudal epidural block versus instillation (splash block) following inguinal herniorrhaphy in children. METHODS: Thirty children (age range: 1-7 years) who were scheduled to undergo inguinal herniorrhaphy were divided into 2 groups: the caudal block group and the splash block group with 15 children in each group. Tracheal intubation was performed. Fifteen children received caudal block with 1.0 ml/kg of 0.25% ropivacaine (Group 1). Caudal block was performed using the loss of resistance method via the sacral hiatus. Fifteen children in Group 2 received local instillation (splash block) in the surgical site with up to 0.4 ml/kg of 0.25% ropivacaine. The patients were observed for 90 minutes in the postanesthesia care unit and then they were transferred to the ward. The pain scores were taken 4 times. We assessed pain using the Faces pain scores. RESULTS: There were no significant differences between the groups regarding the pain scores at 10, 30 and 60 minutes upon entering the postanesthesia care unit. The pain scores of Group 1 were slightly lower at the last evaluation point when compared to that of Group 2. One patient in Group 1 required supplemental postoperative intravenous (IV) tramadol, while all the other patients in both groups did not require supplemental IV tramadol. The intraoperative requirement for sevoflurane was decreased in Group 1 as compared to that of Group 2. There were no major complications related to either type of block. CONCLUSIONS: We conclude that a splash block can have a similar analgesic effect as that of a caudal block for the postoperative herniorrhaphy pain of children.