Caudal Epidural Anesthesia

2021 ◽  
pp. 131-146
Author(s):  
Jared R. E. Hylton ◽  
Jorge A. Pineda
Keyword(s):  
Postoperative Pain ◽  
General Anesthesia ◽  
Epidural Anesthesia ◽  
Postoperative Analgesia ◽  
Pain Control ◽  
Injection Technique ◽  
Surgical Incision ◽  
Relative Safety ◽  
Caudal Approach ◽  
Caudal Epidural

Caudal epidural anesthesia in pediatric patients was first described in 1933 as a replacement for general anesthesia in 83 children undergoing transurethral surgery, and since that time it has been shown to be useful in a variety of surgeries. The popularity of this block stems from its efficacy, simplicity, speed, and relative safety. The caudal approach to the epidural space can be used for the administration of local anesthetic and adjunct medications for either surgical anesthesia or postoperative analgesia. This technique is most commonly applied to surgical procedures occurring below the umbilicus and is frequently used as a single injection technique to be performed after induction of general anesthesia and before surgical incision for augmentation of general anesthesia and postoperative pain control. For longer procedures, a catheter can be placed to facilitate repeat dosing at the conclusion of surgery. Alternatively, more cephalad dermatomes can be anesthetized with an epidural catheter threaded to the desired level. The benefits of caudal epidural anesthesia extend beyond postoperative analgesia and include decreased intraoperative anesthetic requirements and a reduction in the neuroendocrine stress response to surgery.

scholarly journals Right Breast Mastectomy and Reconstruction with Tissue Expander under Thoracic Paravertebral Blocks in a 12-Week Parturient

2015 ◽  
Vol 2015 ◽  
pp. 1-3 ◽  
Author(s):  
Christopher Allen-John Webb ◽  
Paul David Weyker ◽  
Shara Cohn ◽  
Amanda Wheeler ◽  
Jennifer Lee
Keyword(s):  
Breast Cancer ◽  
Postoperative Pain ◽  
General Anesthesia ◽  
Pain Control ◽  
Breast Surgery ◽  
Anesthetic Management ◽  
Healthy Woman ◽  
Tissue Expander ◽  
Postoperative Pain Control ◽  
Tissue Expanders

Paravertebral blocks are becoming increasingly utilized for breast surgery with studies showing improved postoperative pain control, decreased need for opioids, and less nausea and vomiting. We describe the anesthetic management of an otherwise healthy woman who was 12 weeks pregnant presenting for treatment of her breast cancer. For patients undergoing breast mastectomy and reconstruction with tissue expanders, paravertebral blocks offer an anesthetic alternative when general anesthesia is not desired.

scholarly journals Dexmedetomidine and Fentanyl for Postoperative Analgesia in Patients Undergoing Abdominal Surgery: Randomised Controlled Trial

2021 ◽  
Author(s):  
Prashant Sachan ◽  
Prem Raj Singh ◽  
Sateesh Verma ◽  
Brij Bihari Kushwaha
Keyword(s):  
Postoperative Pain ◽  
Randomised Controlled Trial ◽  
Abdominal Surgery ◽  
Postoperative Analgesia ◽  
Pain Control ◽  
Controlled Trial ◽  
Haemodynamic Stability ◽  
Group A ◽  
Group B ◽  
Randomised Controlled

Introduction: Pain control is an important factor for postoperative recovery. Many drugs have been studied for effectiveness of postoperative analgesia. Fentanyl is a conventional drug and dexmedetomidine is one of the emerging drugs used for analgesia and postoperative pain control. Aim: To compare the effect of fentanyl and dexmedetomidine on pain control and haemodynamic stability. Materials and Methods: A randomised controlled trial was conducted on 60 patients (30 each group) undergoing for abdominal surgery, between January 2019 to January 2020. Group A received fentanyl loading dose 2 μg/kg I.V. followed by 0.5 μg/kg/hr infusion and group B received dexmedetomidine loading 1 μg/kg over 10 minutes followed by maintenance 0.5 μg/kg/hr infusion. Infusion was continued up to four hours during surgery and till eight hours of postoperative in both groups. Haemodynamic parameters {Heart Rate (HR), Mean Arterial Pressure (MAP)} were recorded after start of study drug infusion, after intubation, then every 15 minutes till 1 hour, then every 30 minutes till end of surgery and after extubation. In postoperative period, HR and MAP were recorded at interval of one hour till eight hours after extubation and postoperative analgesia was assessed by Visual Analogue Scale (VAS) at interval of one hour till eight hours. Present study used descriptive statistical analysis for data analysis. Analysis of variance (ANOVA) was used to compare data between two groups. Chi-square test was used to find the significance of difference on categorical scale between two groups. Results: This study showed that group-B had significantly less VAS score most of time in recovery period as compared to group-A (1.97±0.18 vs 2.10±0.31 at eight hours postoperative). HR, MAP was found significantly less all the time during surgery and most of the time postoperatively in group-B (p-value <0.05). Conclusion: Intravenous infusion of dexmedetomidine can be better for controlling postoperative pain and perioperative haemodynamic stability as compared to infusion of fentanyl in patients undergoing abdominal surgeries.

scholarly journals Circumcision in children: postoperative analgesic efficiency of transversus abdominis plan block vs caudal epidural block: a prospective observational study

2021 ◽  
pp. 1
Keyword(s):  
Postoperative Pain ◽  
Observational Study ◽  
Postoperative Analgesia ◽  
Prospective Observational Study ◽  
Transversus Abdominis ◽  
Tap Block ◽  
Rescue Analgesia ◽  
Pain Scores ◽  
Significant Difference ◽  
Caudal Epidural

Background and objective: Circumcision is one of the most common operations and can cause postoperative pain, fear, and anxiety for children. This study aims to compare the effects of transversus abdominis plane (TAP) block and caudal epidural (CE) anesthesia on postoperative analgesia after circumcision in providing postoperative pain control. Methods: Eighty boys aged 1 to 14 years who underwent elective circumcision surgery under general anesthesia either with USG-guided TAP block or with CE block for postoperative analgesia were enrolled consecutively to this prospective observational study equally in each group. Postoperative pain scores and need for rescue analgesia were recorded and compared between the two groups. Results: There was no statistically significant difference between the groups in mean age and Aldrete scores (p > 0.05). Body mass index (BMI) of the caudal block group was statistically lower than the TAP group (p < 0.05). While there was no statistically significant difference between the groups in 30th-minute VAS values (p > 0.05), the CE block group's 1st, 2nd, 4th, 8th, 12th, 18th, and 24th hour VAS values were statistically lower than the TAP block group's (p < 0.05). Conclusion: USG-guided TAB block under general anesthesia was not associated with lower postoperative pain scores and delayed rescue analgesia need compared with CE block in patients who underwent elective circumcision surgery. CE block provided superior analgesia than the USG-guided TAP block after elective circumcision surgery in this study.

scholarly journals Comparison of continuous femoral nerve block, caudal epidural block, and intravenous patient-controlled analgesia in pain control after total hip arthroplasty: a prospective randomized study

2014 ◽  
Vol 6 (1) ◽  
Author(s):  
Shoji Nishio ◽  
Shigeo Fukunishi ◽  
Miura Juichi ◽  
Koyanagi Sahoko ◽  
Yuki Fujihara ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Total Hip Arthroplasty ◽  
Pain Control ◽  
Femoral Nerve Block ◽  
Femoral Nerve ◽  
Epidural Block ◽  
Patient Controlled Analgesia ◽  
Continuous Femoral Nerve Block ◽  
Caudal Epidural Block ◽  
Caudal Epidural

Thirty-six patients who underwent primary unilateral total hip arthroplasty (THA) were randomly allocated to 4 groups with different pain control protocols; continuous femoral nerve block (FNB group), single-shot caudal epidural block with morphine (EB group), intravenous patient-controlled analgesia with fentanyl (IV-PCA group), and systemic administration of nonsteroidal anti-inflammatory drugs (NSAIDs group). Postoperative pain was assessed using the numerical rating scale (NRS) scores and the analgesic effect was compared among the groups. The NRS upon arrival at the recovery room and 6 hours after surgery in the FNB, EB, and IV-PCA groups were significantly lower than that in the NSAIDs group. The amount of additional analgesics requested by the patient was smaller in the FNB, EB, and IV-PCA groups as compared to the NSAIDs group. Regarding the complications related to the analgesia, 5 of the 9 patients in the IV-PCA group complained nausea and vomiting and received antiemetic drugs. Delay in the rehabilitation process due to drowsiness was encountered in 3 patients in this group, while no patient in the FNB and EB groups suffered from delayed rehabilitation. Considering both the analgesic effect and the potential risk of complications, continuous femoral nerve blocks and caudal epidural blocks for are recommended for postoperative pain control after THA procedure.

Double-masked Randomized Trial Comparing Alternate Combinations of Intraoperative Anesthesia and Postoperative Analgesia in Abdominal Aortic Surgery

2001 ◽  
Vol 95 (5) ◽  
pp. 1054-1067 ◽  
Author(s):  
Edward J. Norris ◽  
Charles Beattie ◽  
Bruce A. Perler ◽  
Elizabeth A. Martinez ◽  
Curtis L. Meinert ◽  
...  
Keyword(s):  
Length Of Stay ◽  
General Anesthesia ◽  
Abdominal Aorta ◽  
Epidural Anesthesia ◽  
Postoperative Analgesia ◽  
Postoperative Outcomes ◽  
Patient Controlled Analgesia ◽  
Treatment Groups ◽  
Thoracic Epidural ◽  
Direct Medical Costs

Background Improvement in patient outcome and reduced use of medical resources may result from using epidural anesthesia and analgesia as compared with general anesthesia and intravenous opioids, although the relative importance of intraoperative versus postoperative technique has not been studied. This prospective, double-masked, randomized clinical trial was designed to compare alternate combinations of intraoperative anesthesia and postoperative analgesia with respect to postoperative outcomes in patients undergoing surgery of the abdominal aorta. Methods One hundred sixty-eight patients undergoing surgery of the abdominal aorta were randomly assigned to receive either thoracic epidural anesthesia combined with a light general anesthesia or general anesthesia alone intraoperatively and either intravenous or epidural patient-controlled analgesia postoperatively (four treatment groups). Patient-controlled analgesia was continued for at least 72 h. Protocols were used to standardize perioperative medical management and to preserve masking intraoperatively and postoperatively. A uniform surveillance strategy was used for the identification of prospectively defined postoperative complications. Outcome evaluation included postoperative hospital length of stay, direct medical costs, selected postoperative morbidities, and postoperative recovery milestones. Results Length of stay and direct medical costs for patients surviving to discharge were similar among the four treatment groups. Postoperative outcomes were similar among the four treatment groups with respect to death, myocardial infarction, myocardial ischemia, reoperation, pneumonia, and renal failure. Epidural patient-controlled analgesia was associated with a significantly shorter time to extubation (P = 0.002). Times to intensive care unit discharge, ward admission, first bowel sounds, first flatus, tolerating clear liquids, tolerating regular diet, and independent ambulation were similar among the four treatment groups. Postoperative pain scores were also similar among the four treatment groups. Conclusions In patients undergoing surgery of the abdominal aorta, thoracic epidural anesthesia combined with a light general anesthesia and followed by either intravenous or epidural patient-controlled analgesia, offers no major advantage or disadvantage when compared with general anesthesia alone followed by either intravenous or epidural patient-controlled analgesia.

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