Caudal epidural block in children and infants: retrospective analysis of 2088 cases

Regional anesthesia is usually preferred as caudal block via the epidural space. However, the number of large-scale studies including pediatric caudal blocks is small. The objective of this study was to evaluate complications and side effects of local anesthetics and adjuvant drugs. Retrospective, descriptive study of cases occurring during the period December 2007 to October 2009. Of 4815 medical records were screened, 2088 pediatric cases were identified and included in this study. As a local anesthetic, we preferred mostly levobupivacaine in 1669 [79.9%] patients and bupivacaine in 419 [20.1%] patients. As adjuvant drug, we preferred mostly morphine [41 patients], fentanyl [7 patients] and adrenaline [6 patients] in 54 [2.5%] patients. For general anesthesia induction, we preferred mostly propofol [1996 patients, 94.2%]; for maintenance, sevoflurane [1 773 patients, 84.9%]. For airway control, we preferred mostly the ProSeal laryngeal mask [PLMA], in 1008 [48.2%] patients. One thousand six hundred five [76.9%] patients were from outpatient clinics and 483 [23.1%] patients were from inpatient clinics. No permanent complication was encountered after caudal blocks. We conclude that caudal epidural blocks are a safe and effective method for subumbilical daycase pediatric surgeries when performed by anesthetists

A Case of Pneumothorax after Phrenic Nerve Block with Guidance of a Nerve Stimulator

Hiccups have more than 100 etiologies. The most common etiology has gastrointestinal origins, related mainly to gastric distention and gastroesophageal reflux disease. Intractable hiccups are rare but may present as a severe symptom of various diseases. Hiccups are mostly treated with non-invasive or pharmacological therapies. If these therapies fail, invasive methods should be used. Here, we present a patient on whom we performed a blockage of the phrenic nerve with the guidance of a nerve stimulator. The patient also had pneumothorax as a complication. Three hours after intervention, a tube thoracostomy was performed. One week later, the patient was cured and discharged from the hospital. In conclusion, a stimulator provides the benefit of localizing the phrenic nerve, which leads to diaphragmatic contractions. Patients with thin necks have more risk of pneumothorax during phrenic nerve location.