scholarly journals Caudal block versus penile block for postoperative analgesia in children undergoing hypospadias repair

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
H G Salama ◽  
M H Elsersi ◽  
T S Shabana ◽  
J M Mahanna
Keyword(s):  
Postoperative Analgesia ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Randomized Study ◽  
Hypospadias Repair ◽  
Caudal Block ◽  
Analgesic Requirement ◽  
Analgesic Regimen ◽  
Significant Difference ◽  
Penile Block

Abstract Background Hypospadias repair is one of the most frequently performed surgical procedures in the pediatric population. Using optimal analgesic regimen provides safe and effective analgesia, reduce postoperative stress response and accelerate recovery from surgery. Aim of the Work The aim of this work is to evaluate the success rate and the effectiveness of penile block for hypospadias repair in pediatric patients in comparison with caudal block. Patients and Methods This prospective randomized study was conducted in Ain Shams University Hospitals; Pediatric Surgery Unit. It included 80 ASA I or II patients undergoing hypospadias (distal penile and mid penile) repair. They were divided into two groups: Group P: Group P penile block (n = 40) received dorsal penile nerve block by using the subpubic approach technique. Group C: Group C caudal block (n = 40) received caudal epidural block using a 22-G needle in the lateral decubitus position. Results There was no statistically significant difference between two groups regarding haemodynamics including MBP (P < 0.05) and HR (P < 0.05). FLACC pain scores were significantly lower in group C compared with group P (P< 0.01). Also, the time to first need for analgesia was significantly lower in group C compared with group P (P< 0.001) .The total rescue analgesic requirement was also significantly lower (P< 0.001) in group C compared with group P.Postoperative time of ambulation was also significantly lower (P< 0.05) in group P compared with group C. Conclusion the current study revealed that caudal block provided significantly prolonged postoperative analgesia, reduced the postoperative analgesic requirements and prolonged time of ambulation as compared with penile block in pediatric patients undergoing hypospadias repair.

Comparative Study Between Caudal Block And Local Wound Infiltration In Inguinal Hernia Repair In Pediatric Patients

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Azza Mohamed Shafeek Abdel Mageed ◽  
Wael Reda Hussaein ◽  
Rania Hassan Abdel Hafiez ◽  
Tarek Atef Abdullah Hammouda
Keyword(s):  
Inguinal Hernia ◽  
Hernia Repair ◽  
Pain Score ◽  
Inguinal Hernia Repair ◽  
Postoperative Analgesia ◽  
Pediatric Patients ◽  
Caudal Block ◽  
Wound Infiltration ◽  
Unilateral Inguinal Hernia ◽  
Significant Difference

Abstract Background Postoperative analgesia can be provided by a multimodal approach includes opioids, nonsteroidal anti-inflammatory drugs, paracetamol infusion and regional anesthetic techniques such as local infiltration or nerve blocks. In contrast to opioids, local anesthetics can be administered safely and in recent guidelines regional anesthesia is accepted as the cornerstone of postoperative pain relief in the pediatric patients. Objective Compare the postoperative analgesic effectiveness of local wound infiltration of bupivacaine against bupivacaine administered caudally in pediatric patients undergoing unilateral inguinal hernia repair. Patients and methods This study was carried out in Ain Shams University hospitals on 40 pediatric patients of both sexes aged from 6 months to 7 years belonging to ASA I or II undergoing elective unilateral inguinal hernia repair. They were randomly allocated into two groups: group C receiving caudal block, group L receiving local wound infiltration. Hemodynamic changes, postoperative pain score using FLACC pain score, postoperative analgesia and complications were recorded. Results There was no significant difference between the two groups as regard demographic data or hemodynamic variables. Pain score shows no statically significant differences between two groups in the first hour. But statistically significant decrease in FLACC score after (1, 2 and 3 hours) in group C in comparison with group L.decreased significantly in group C after 1 hour postoperative. Duration of analgesia longer in group C with no significant difference in total amount of postoperative analgesia. There was significant increase in incidence in complications in group C than group L Conclusion Caudal block provides better and longer analgesia but requires experience and may lead to complications. In contrast, wound infiltration is simple without significant side effects. Therefore, local wound infiltration may be a preferred technique for producing postoperative analgesia in pediatric inguinal hernia repair.

scholarly journals Comparison of Analgesic Efficacy of Caudal Dexamethasone versus Intravenous Dexamethasone as an Adjuvant to Caudal Block in Pediatric Patients Undergoing Lower limb orthopedic Surgeries

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
G S Mohamed ◽  
A A Abdelatif ◽  
M Menshawey ◽  
A A S Mansour
Keyword(s):  
Postoperative Pain ◽  
Surgical Procedures ◽  
Postoperative Analgesia ◽  
Lower Limb ◽  
Pediatric Population ◽  
Anesthetic Techniques ◽  
Caudal Block ◽  
Caudal Anesthesia ◽  
Analgesic Regimen ◽  
Better Than

Abstract Background Lower limb orthopedic surguries are one of the most frequently performed surgical procedures in the pediatric population. Using optimal analgesic regimen provide safe and effective analgesia, reduce postoperative stress response and accelerate recovery from surgery. Regional anesthetic techniques are commonly used to facilitate pain control in pediatric surgical procedures. The most commonly used techniques in pediatrics is caudal block. Aim of the Work This study is conducted to evaluate the analgesic effect of dexamethasone when given systemically versus caudally as an adjuvant to caudal block for children undergoing lower limb orthopedic surgeries. Patients and Methods The study was conducted on 50 randomly chosen patients in Ain Shams University Hospitals after approval of the medical ethical committee. Patients were divided randomly into two groups, each group consisted of 25 patients. Results The results of the study revealed that dexamethasone 0.1 mg/kg, when used as an adjuvant to caudal anesthesia, can significantly prolong the duration of postoperative analgesia. It is better than IV dexamethasone at similar doses in controlling postoperative pain. Conclusion From our study, we can conclude that dexamethasone 0.1 mg/kg, when used as an adjuvant to caudal anesthesia, can significantly prolong the duration of postoperative analgesia. It is better than IV dexamethasone at similar doses in controlling postoperative pain.

A Comparative Study between Caudal and Penile Blockade in Pediatric Patients Undergoing Hypospadias Repair

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mona Ismail Mohammed Fadl Eldemirdash ◽  
Raouf Ramzy Gadalla ◽  
Neveen Gerges Fahmy ◽  
Yahia Mamdouh Hassan Maky
Keyword(s):  
Pain Score ◽  
Postoperative Analgesia ◽  
Pediatric Patients ◽  
Epidural Block ◽  
Hypospadias Repair ◽  
Success Rates ◽  
University Hospitals ◽  
Analgesic Requirement ◽  
Rescue Analgesia ◽  
Randomized Clinical Study

Abstract Background Regional anesthesia, in combination with general anesthesia, is frequently used for children undergoing surgical procedures. Aim of the Work to compare postoperative analgesia between caudal block and penile block with bupivacaine in elective hypospadias repair cases in pediatric patients. Patients and Methods This study is a randomized clinical study conducted in the operating theaters of pediatric surgery unit in Ain shams university hospitals. The study was performed after ethical committee approval and informed consent from the parents after full explanation of the procedure, possible side effects and complications. This study was done in the period between March 2019 and August 2019.it included sixty male children undergoing hypospadias repair. Results Postoperative pain was evaluated by FLACC pain score at PACU, 2, 4 and 8, 12, 16 and 24 hrs. There was a significant increase in the pain score in group C starting from the fourth hour postoperativly and thereafter every hour, while the lowest pain scores were recorded in group P (P < 0.05). Also, the time to first need for rescue analgesia was significantly shorter in group C (240 +/-105 min) compared with group P (720 +/-301) (P>0.01).The total rescue analgesic requirement was significantly lower in group P (168.26 +/22.69) than group C (573.8+/- 124.1) (P < 0.01).Postoperative time of ambulation was significantly lower in group C (6.95+/- 3.22) compared with group P (5.28+/-1.99) (P < 0.01). Conclusion Dorsal penile nerve block in children undergoing penile surgery provides effective and a longer duration of postoperative analgesia and decreased postoperative analgesic requirements with more hemodynamic stability both intraoperatively and postoperatively, as it is safer and easier to perform, with higher success rates than caudal epidural block, which is invasive and shows some difficulty in practice.

scholarly journals Caudal block versus Penile block for postoperative ‎analgesia in children undergoing hypospadias repair

2020 ◽  
Vol 0 (0) ◽  
pp. 0-0 ◽  
Author(s):  
Mohamed Al-Metwally ◽  
Ezzat Al-Saudi ◽  
Ahmed Abo El Ata ◽  
Medhat Allam
Keyword(s):  
Postoperative Analgesia ◽  
Hypospadias Repair ◽  
Caudal Block ◽  
Penile Block

scholarly journals Opioid Use and the Risk of Respiratory Depression and Death in the Pediatric Population

2013 ◽  
Vol 18 (4) ◽  
pp. 269-276 ◽  
Author(s):  
Marianne R. Whittaker
Keyword(s):  
Clinical Trials ◽  
Adverse Effects ◽  
Respiratory Depression ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Opioid Use ◽  
Randomized Controlled ◽  
Randomized Controlled Studies ◽  
Increased Risk ◽  
Significant Difference

BACKGROUND Pediatric patients may be at an increased risk of adverse effects from various medications. Recently, there have been a number of serious adverse events, including several pediatric patients experiencing severe respiratory depression and death as a result of the use of codeine for pain control following tonsillectomy and adenoidectomy. OBJECTIVE To assess the safety of opioid agonists in pediatric patients undergoing operative procedures or have experienced trauma and to evaluate the risk of respiratory depression and death among this population. METHODS PubMed and Medline were searched to identify randomized controlled studies from 1994 to 2012 addressing postsurgery/trauma opioid use in pediatric patients. Relative risks and confidence intervals (CIs) were calculated using data available in clinical trials. RESULTS A total of 16 clinical trials were evaluated for this review. Randomized controlled trials included studies comparing opioids versus non-opioids for a variety of painful conditions. The relative risk of respiratory depression associated with opioid use in 1 trial was 1.63 (95% CI: 0.64–6.13). The remaining 15 trials reviewed described no significant difference in respiratory depression or adverse effects associated with treatment. No deaths were attributed to opioid use in any of these studies. CONCLUSION Opioid-associated respiratory depression was very rare and no deaths were reported in the reviewed studies. These findings under the well-defined conditions of controlled studies may not be the best means of determining overall opioid-associated side effects in pediatric patients.

scholarly journals Comparison of quadratus lumborum block and caudal block for postoperative analgesia in pediatric patients undergoing inguinal hernia repair and orchiopexy surgeries: a randomized controlled trial

2020 ◽  
Vol 45 (3) ◽  
pp. 187-191 ◽  
Author(s):  
Gözen Öksüz ◽  
Mahmut Arslan ◽  
Aykut Urfalıoğlu ◽  
Ahmet Gökhan Güler ◽  
Şeyma Tekşen ◽  
...  
Keyword(s):  
Inguinal Hernia ◽  
Hernia Repair ◽  
Inguinal Hernia Repair ◽  
Postoperative Analgesia ◽  
Pediatric Patients ◽  
Demographic Data ◽  
Parent Satisfaction ◽  
Caudal Block ◽  
Double Blind ◽  
Quadratus Lumborum

Background and objectivesCaudal epidural anesthesia is a widely used popular technique for postoperative analgesia but it has potential side effects and duration of analgesia is short. Quadratus lumborum block (QLB) was found to be an effective method for postoperative analgesia in lower abdominal surgeries. In this double-blind prospective randomized trial, we aimed to compare the postoperative analgesic efficacies of QLB and the caudal block in pediatric patients undergoing inguinal hernia repair and orchiopexy surgeries under general anesthesia.Materials and methodsAfter approval was obtained from the ethics committee, in this prospective randomized double-blind trial, 53 patients under general anesthesia undergoing inguinal hernia repair and orchiopexy surgeries randomly received caudal block or QLB. Demographic data, postoperative analgesic requirement, Face, Legs, Activity, Cry, and Consolability (FLACC) scores at 30 min, 1, 2, 4, 6, 12 and 24 hours, parent satisfaction scores and complications were recorded.ResultsThe study included 52 patients, after excluding one patient because of a failed caudal block. There were no significant differences between the groups based on demographic data (p>0.05). The number of patients who required analgesics in the first 24 hours was significantly lower in QLB group (p=0.001). Postoperative 4, 6, 12 hours FLACC scores were significantly lower in the QLB group (p<0.001, p=0.001 and p<0.001, respectively). Parent satisfaction scores were higher in the QLB group (p=0.014).ConclusionAccording to the results of this study, QLB can provide much more effective analgesia than caudal block without adjuvants in multimodal analgesia management of children undergoing inguinal hernia repair and orchiopexy surgeries.Trial registration numberNCT03294291.

scholarly journals Safety and Tolerability of Lidocaine Infusions as a Component of Multimodal Postoperative Analgesia in Children

2019 ◽  
Vol 24 (1) ◽  
pp. 34-38 ◽  
Author(s):  
Katherine Lemming ◽  
Gary Fang ◽  
Marcia L. Buck
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Adverse Effects ◽  
Dose Reduction ◽  
Postoperative Analgesia ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Postoperative Pain Management ◽  
Nuss Procedure ◽  
The Mean

OBJECTIVES Use of lidocaine as part of a multimodal approach to postoperative pain management has increased in adults; however, limited information is available regarding safety and tolerability in pediatrics. This study's primary objective was to evaluate the incidence of adverse effects related to lidocaine infusions in a sample of pediatric patients. METHODS A retrospective analysis was conducted in pediatric patients receiving lidocaine infusion for the management of postoperative analgesia at the University of Virginia Health System. RESULTS A total of 50 patients with 51 infusions were included in the final analysis. The median patient age was 14 years (range, 2–17 years). The most frequent surgeries were spinal fusion (30%), Nuss procedure for pectus excavatum (16%), and nephrectomy (6%). The mean ± SD starting rate was 13.6 ± 6.5 mcg/kg/min. The mean infusion rate during administration was 15.2 ± 6.3 mcg/kg/min, with 14.4 ± 6.2 mcg/kg/min at discontinuation. The mean length of therapy was 30.6 ± 22 hours. A total of 12 infusions (24%) were associated with adverse effects, primarily neurologic ones, including paresthesias in the upper extremities (10%) and visual disturbances (4%). The average time to onset was 16.2 ± 15.2 hours. Seven infusions were discontinued, whereas the remaining infusions resulted in either dose reduction or continuation without further incident. No patients experienced toxicity requiring treatment with lipid emulsion. CONCLUSIONS In this sample, lidocaine was a well-tolerated addition to multimodal postoperative pain management in the pediatric population. Although adverse effects were common, they were mild and resolved with either dose reduction or discontinuation.

scholarly journals Effect Intravenous Dexamethasone as an Adjuvant to Caudal Block on post operative analgesia:  Prospective Cohort study design

2020 ◽  
Author(s):  
Mohammed Suleiman Obsa ◽  
Meron ABrar Awol ◽  
Timsel Girma Simie
Keyword(s):  
Postoperative Analgesia ◽  
Categorical Variables ◽  
P Value ◽  
Anesthetic Techniques ◽  
Caudal Block ◽  
Chi Square ◽  
Analgesic Requirement ◽  
Duration Of Action ◽  
Dexamethasone Group ◽  
American Society

Abstract Introduction Caudal block is by far the most commonly employed regional anesthetic techniques to maintain postoperative analgesia in pediatric urogenital surgeries. However, its short duration of action can be prolonged by adding Adjuvants. The aim of this study was to compare the efficacy of dexamethasone administered through intravenous on post-operative analgesia in pediatric patients who underwent infra umbilical surgeries. Method In this prospective study, sixty American Society of Anesthesiologists Physical Status I and II patients aged 1–7 years were randomly allocated into two groups of thirty each. Both groups were compared for the duration of postoperative analgesia and analgesic requirement. Severity of postoperative pain was measured by FLACC score. Mann –Whitney U test was used to compare the pain severity and total analgesic consumption. Independent sample t test was used for analgesia duration as well as Chi-square test was used to analyze independent categorical variables between two groups and a p-value of less than 0.05 was considered as statistically significant. Result Analgesia duration was significantly prolonged in caudal block with IV dexamethasone group than caudal block with bupivacaine alone group ( P < 0.001). Total analgesia consumption was significantly lower ( P < 0.001) in caudal block with IV dexamethasone compared to with bupivacaine alone group. Postoperative severity of pain was significantly lower in caudal block with IV dexamethasone group at 4 th , 6 th and 12 th hours (P<0.001, P<0.001 and P<0.003) respectively. Conclusion Addition of intravenous dexamethasone as an adjuvant to caudal block with 0.25% Bupivacaine significantly reduced the intensity of post-operative pain and prolonged the duration of post-operative analgesia.

scholarly journals A PROSPECTIVE STUDY OF COMPARISON OF EPIDURAL BUPIVACAINE, FENTANYLAND THEIR COMBINATION FOR POSTOPERATIVE ANALGESIA IN LOWER ABDOMINALAND LOWER EXTREMITY SURGERY

2021 ◽  
pp. 1-4
Author(s):  
Chandeshwar Choudhary ◽  
Praveen Kumar Singh ◽  
Debarshi Jana
Keyword(s):  
Adverse Effects ◽  
Lower Extremity ◽  
Postoperative Analgesia ◽  
Good Control ◽  
Local Anaesthetics ◽  
Analgesic Requirement ◽  
Vas Score ◽  
Epidural Bupivacaine ◽  
Significant Difference ◽  
Clinically Significant

BACKGROUND Epidural analgesia with local anaesthetics and opioids provide good control of postoperative pain in lower abdominal and lower extremity surgery. AIM To evaluate and compare the analgesic action and adverse effects of epidural bupivacaine, fentanyl and their combination in postoperative period. METHODS 75 patients undergoing elective infraumbilical surgery were allocated in three groups in a randomized double blinded fashion. Postoperative analgesia was maintained with continuous infusion of epidural drug in the following manner: Group B: Injection Bupivacaine 0.125% @ 0.1mL/kg/hr through epidural route; Group F: Injection Fentanyl 4µg/mL @ 0.1mL/kg/hr through epidural route; Group BF: Injection Bupivacaine 0.0625% and Fentanyl 2µ/mL @ 0.1mL/kg/hr through epidural route. RESULTS VAS score were almost similar in all three groups at 00, 04, 08hrs and not clinically significant at that point of time. VAS score showed significant difference at 12, 20 and 24 hrs, being persistently lower in Gr BF than Gr B and Gr F. According to VRS Scale Score at 04 hrs majority of patients of all three groups had mild-to-moderate pain (p=0.278). At 08 hrs, 24% (p=0.082), 12 hrs 60% (<0.001), 16 hrs 68% (<0.001), 20 hrs 88% (<0.001) and 24 hrs 84% (<0.001) of Gr BF patients were pain free which are clinically significant. At the end of 08, 12, 16, 20, 24 postoperative hours, no patients of any groups had residual motor paralysis. Rescue analgesic needed in Gr BF patients were significantly less than other two groups. CONCLUSION Combined bupivacaine and fentanyl infusion through an epidural route provides better analgesia in comparison to bupivacaine and fentanyl alone. Total drug, rescue analgesic requirement and adverse effects are much lower in combined group.

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