scholarly journals General versus general anaesthesia combined with caudal block in laparoscopic-assisted Soave pull-through of Hirschsprung disease: a retrospective study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Zhixiong Lin ◽  
Yifan Fang ◽  
Lei Yan ◽  
Yu Lin ◽  
Mingkun Liu ◽  
...  
Keyword(s):  
Side Effects ◽  
General Anesthesia ◽  
Operation Time ◽  
Hirschsprung Disease ◽  
Caudal Block ◽  
Hemodynamic Changes ◽  
Significant Difference ◽  
Pull Through ◽  
Laparoscopic Assisted ◽  
Duration Of Operation

Abstract Background Caudal block is one of the most preferred regional anesthesia for sub-umbilical region surgeries in the pediatric population. However, few studies are available on caudal block performed in laparoscopic-assisted Soave pull-through of Hirschsprung disease (HD). We aimed to compare general anesthesia (GA) and general anesthesia combined with caudal block (GA + CA) in laparoscopic-assisted Soave pull-through of HD. Methods A retrospective review was performed in children with HD operated in our hospital between 2017 and 2020. Patients were divided into the GA and GA + CA group. The primary outcome was the duration of operation, and secondary outcomes included intraoperative hemodynamic changes, the Face, Legs, Activity, Cry, Consolability (FLACC) scale, dose of anesthetics, and incidence of side effects. Results A total of 47 children with HD were included in the study, including 20 in the GA group and 27 in the GA + CA Group. The two groups were similar in age, gender, weight and type of HD (P > 0.05). The GA + CA group had significantly shorter duration of operation (especially the transanal operation time) (median 1.20 h vs. 0.83 h, P < 0.01) and recovery time (mean 18.05 min vs. 11.89 min, P < 0.01). The mean doses of sufentanil and rocuronium bromide during the procedure and FLACC scores at 1 h and 6 h after surgery were also lower in the GA + CA group (p < 0.01). The hemodynamic changes in the GA + CA group were more stable at time of t2 (during transanal operation) and t3 (10 min after transanal operation), but there was no significant difference in the incidence of postoperative side effects between the two groups (P = 1.000). Conclusion General anesthesia combined with caudal block can shorten the duration of operation, and provide more stable intraoperative hemodynamics and better postoperative analgesia.

scholarly journals A Comparative Study between Swenson Abdominoperineal Pull-through and Transanal, Full Thickness, Swenson like Approach for Hirschsprung Disease

2017 ◽  
Vol 5 (1) ◽  
pp. 23-27
Author(s):  
Khalid Mahmud ◽  
MK Islam ◽  
M Rashedul Alam ◽  
Sabbir Karim
Keyword(s):  
Urinary Incontinence ◽  
Fecal Incontinence ◽  
Comparative Study ◽  
Operation Time ◽  
Hirschsprung Disease ◽  
Paediatric Surgery ◽  
Full Thickness ◽  
Group A ◽  
Pull Through ◽  
Group B

Background: Hirschsprung disease (HD) is a congenital developmental disorder of intrinsic component of enteric nervous system leading to severe complication which needs operative correction. There are different operative techniques existing and each technique has its advantages and disadvantages.Objective: The aim of the study was to evaluate the better outcome between Transanal full thickness swenson like pull through and Swenson abdomino-perineal pull through.Method: The Prospective comparative study had been carried out in the department of paediatric surgery, Dhaka Shishu (Children) Hospital during the period of January 2014 to July 2016. Total 56 patients with HD patients were included in the study irrespective of colostomy except major co-morbidities which can influence the general outcomes and who did not agree to close stoma within 12 weeks of pull-through operation. Patients were allocated in both groups by purposing sampling. Twenty eight patients with long segment HD were allocated in Group-A and operated by Swenson abdominoperineal pull through and 28 patients with short segment disease were allocated in group-B and operated by Transanal, full thickness, swenson like procedure.Result: Among the study population 32 (57.14%) were male and 24 (42.86%) were female with age range was 1 day- 96 months. Four patients developed urinary incontinence, 3 patients developed cuff abscess and 2 patients developed fecal incontinence. And in group-B no patient developed urinary incontinence but 4 developed cuff and anastomotic abscess and no patient developed fecal incontinence. The mean operation time 114.14 ± 13.02 in group-A and 68.36 ± 16.12 minutes in group-B. Mean hospital stay in group-A was 6.18 ± 1.83 days and 5.05 ± 0.43 days in group-B.Conclusion: The newer modification, Transanal, full thickness Swenson like procedure can be better technique in the management of HD.Bangladesh Crit Care J March 2017; 5(1): 23-27

scholarly journals Comparison of Two Different Cut-Off Values of Scoring System for Diagnosis of Hirschsprung-Associated Enterocolitis After Transanal Endorectal Pull-Through

2021 ◽  
Vol 9 ◽  
Author(s):  
Gunadi ◽  
Raedi Ardlo Luzman ◽  
Sagita Mega Sekar Kencana ◽  
Bhagas Dwi Arthana ◽  
Fauzan Ahmad ◽  
...  
Keyword(s):  
Scoring System ◽  
Maternal Education ◽  
Hirschsprung Disease ◽  
Final Analysis ◽  
Hemoglobin Level ◽  
Deficiency Anemia ◽  
Cross Sectional ◽  
Definitive Therapy ◽  
Significant Difference ◽  
Pull Through

Background: Hirschsprung-associated enterocolitis (HAEC) is a major contributor in the mortality of Hirschsprung disease (HSCR) patients that can occur both preoperatively and post-operatively. Several cut-off values of HAEC score have been used, i.e., ≥10 and ≥4. Here, we compared the HAEC frequency after transanal endorectal pull-through (TEPT) using two cut-offs of scoring system and associated them with the risk factors.Methods: Cross-sectional analysis was conducted using medical records of HSCR patients who were aged ≤18 years old and underwent TEPT at our institution, Indonesia between 2009 and 2016. HAEC was determined using the scoring system with cut-off values of ≥10 and ≥4.Results: Seventy subjects were used in the final analysis, consisting of 44 males and 26 females. There was a significant difference in one HAEC finding between the ≥10 and ≥4 cut-off groups; diarrhea with explosive stools (p = 0.002). The HAEC frequency was 5/70 (7.1%) and 49/70 (70%) patients using cut-off values of ≥10 and ≥4 (p &lt; 0.0001), respectively. We found that patients with anemia (i.e., iron deficiency anemia) had a higher risk of HAEC after TEPT than patients with normal hemoglobin level with OR of 3.77 (95% CI = 1.28–11.1; p = 0.027), while no associations were found between other variables, including sex, age at diagnosis, age at definitive therapy, albumin level, and nutritional status and HAEC following TEPT (p = 0.87, 0.15, 0.33, 0.26, and 0.60, respectively). Also, no associations were observed between maternal education level, mother's age at pregnancy and gestational age and HAEC after definitive surgery (p = 0.10, 0.46, and 0.86, respectively).Conclusions: This report is the first study comparing two different cut-off values of scoring system to evaluate the HAEC frequency after TEPT and results suggest further using cut-off of ≥4 to expand the diagnosis of HAEC. Moreover, we also show for the first time that hemoglobin level is a strong risk factor for the HAEC development after TEPT.

Why Do the Patients with Hirschsprung Disease Get Redo Pull-Through Operation?

2018 ◽  
Vol 29 (05) ◽  
pp. 431-436 ◽  
Author(s):  
Ji-Won Han ◽  
Joong Kee Youn ◽  
Chaeyoun Oh ◽  
Hyun-Young Kim ◽  
Sung-Eun Jung ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Postoperative Complications ◽  
Ganglion Cell ◽  
Transition Zone ◽  
Associated Factors ◽  
Operation Time ◽  
Hirschsprung Disease ◽  
Contrast Study ◽  
Pull Through

Introduction The treatment of Hirschsprung disease (HD) is pull-through (PT) surgery. Redo PT can be performed in 1 to 10% of patients after initial PT. In this study, we reviewed the causes and associated factors of redo PT. Materials and Methods We retrospectively reviewed medical charts of 657 patients with HD who underwent surgeries between September 1979 and January 2016. The indications for redo PT are as follows. First, there were persistent obstructive symptoms after the first operation, (1) with transition zone shown definitely on contrast study, (2) with anatomic problems, and (3) obstructive symptoms persist despite conservative or nonredo surgical treatment without (1) and (2). We analyzed the causes and associated factors of redo PT. Results A total of 49 (7.5%) patients underwent redo PT. Among them, 41 and 8 patients underwent PT twice and three times, respectively. Among 57 cases of redo, the causes of redo included pathologic problem (n = 28)—aganglionosis (n = 20), hypoganglionosis (n = 4), immature ganglion cell (n = 4)—or anatomic problem (n = 21)—stricture (n = 13), fistula and/or abscess (n = 8) at anastomosis. Comparing associated factors between the nonredo and redo groups, the redo group had longer initial PT operation time (p = 0.001), more postoperative complications (p < 0.001), and more transanal endorectal PT (TERPT) approach as initial PTs (p < 0.001). According to causes of redo, the anatomic problem group underwent more third PTs than the pathologic problem group (p = 0.010). Conclusion Approximately 7.5% of patients experienced redo PT. The cause of redo included pathologic (n = 28) or anatomic problem (n = 21). Longer operation time, more complications, and TERPT were associated with redo. The anatomic problem group underwent more third PTs than the pathologic problem group.

scholarly journals Perbandingan Efek 10 Mg dengan 12,5 Mg Levobupivacain 0,5% Isobarik terhadap Onset, Durasi, dan Hemodinamik pada Spinal Anestesi untuk Seksio Sesarea

2020 ◽  
Vol 2 (2) ◽  
pp. 71-8
Author(s):  
Rachmad Ismail ◽  
Muh Ramli Ahmad ◽  
A. Muh. Takdir Musba
Keyword(s):  
Data Analysis ◽  
Side Effects ◽  
Cesarean Section ◽  
Spinal Anesthesia ◽  
Motor Block ◽  
Sensory Block ◽  
Hemodynamic Changes ◽  
Group Data ◽  
Significant Difference ◽  
Sensory Motor

Latar Belakang: Tujuan utama spinal anestesi pada seksio sesarea adalah meminimalkan efek samping pada ibu dan bayi baru lahir. Levobupivacain memiliki mekanisme aksi yang sama dengan anestesi lokal lainnya, akan tetapi memiliki efek toksik pada jantung dan saraf yang lebih kecil. Tujuan: Membandingkan onset/durasi blok sensorik, motorik serta hemodinamik antara 10 Mg dengan 12,5 Mg Levobupivacain 0,5% Isobarik + fentanyl 25 μg pada seksio sesarea dengan anestesi spinal.Metode: Sampel terdiri dari dua kelompok, kelompok pertama menerima 10 Mg Levobupivacain 0,5% Isobarik + fentanyl 25 μg dan kelompok kedua menerima 12,5 Mg Levobupivacain 0,5% Isobarik + fentanyl 25 μg dengan sampel masing-masing kelompok 23 orang. Analisis data menggunakan uji statistik uji T independen.Hasil: Onset blok sensorik lebih cepat pada kelompok 12,5 Mg Levobupivacain (2,30 menit) dibandingkan kelompok 10 Mg Levobupivacain (3,70 menit), hal ini secara statistik menunjukkan perbedaan yang signifikan. Durasi blok sensorik kelompok 12,5 Mg Levobupivacain (187,39 menit), durasi blok motorik (194,57 menit) lebih lama dibandingkan kelompok 10 Mg Levobupivacain durasi blok sensorik (153,48 menit) dan durasi blok motorik (157,83 menit). Tidak ada perbedaan yang signifikan pada perubahan hemodinamik untuk kedua kelompokSimpulan: Onset blok sensorik kelompok 12,5 Mg Levobupivacain lebih cepat dibandingkan kelompok 10 Mg Levobupivacain, durasi blok sensorik dan blok motorik kelompok 12,5 Mg Levobupivacain lebih lama dibandingkan kelompok 10 Mg Levobupivacain. Comparison Effects 10 Mg with 12.5 Mg Levobupivacain 0.5% Isobaric Against Onset, Duration, and Hemodynamics in Spinal Anesthesia of Caesarean Section Abstract Background: The main purpose of spinal anesthesia in cesarean section is to minimize side effects on the mother and newborn baby. Levobupivacaine has the same mechanism of action as other local anesthetics, but has a smaller toxic effect on the heart and nerves.Objective: Comparing the onset / duration of sensory, motor and hemodynamic blocks between 10 Mg and 12.5 Mg Levobupivacain 0.5% Isobaric + 25 μg fentanyl in cesarean section with spinal anesthesia.Methods: The sample consisted of two groups, the first group received 10 Mg Levobupivacain 0.5% Isobaric + fentanyl 25 μg and the second group received 12.5 Mg Levobupivacain 0.5% Isobaric + fentanyl 25 μg with a sample of 23 people each group. Data analysis using independent T test statistical tests.Results: Sensory block onset was faster in the 12.5 Mg Levobupivacain group (2.30 minutes) than the 10 Mg Levobupivacain group (3.70 minutes), this statistically showed a significant difference. The sensory block duration of the 12.5 Mg Levobupivacain group (187.39 minutes), the motor block duration (194.57 minutes) is longer than the 10 Mg Levobupivacain group the duration of the sensory block (153.48 minutes) and the duration of the motor block (157.83 minutes). There were no significant differences in hemodynamic changes for the two groups.Conclusion: The onset of the 12.5 Mg Levobupivacain sensory block was faster than the 10 Mg Levobupivacain group, the duration of the sensory block and motor block of the 12.5 Mg Levobupivacain group was longer than the 10 Mg Levobupivacain group

scholarly journals Suspension sutures facilitate single-incision laparoscopic-assisted rectal pull-through for Hirschsprung disease

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Liem Thanh Nguyen ◽  
Anh Tho Nguyen ◽  
Quang Thanh Nguyen ◽  
Quynh Anh Tran ◽  
Hau Duc Bui ◽  
...  
Keyword(s):  
Abdominal Wall ◽  
Single Incision ◽  
Hirschsprung Disease ◽  
Conventional Instruments ◽  
Long Term Follow Up ◽  
Pull Through ◽  
Laparoscopic Assisted ◽  
Suspension Suture

Abstract Background To present a surgical technique of single-incision laparoscopic-assisted endorectal pull-through (SILEP) with suspension sutures using conventional instruments for Hirschsprung disease (HD) and its long-term follow-up outcomes. Methods The procedure began with a 1 cm transumbilical skin incision. Three separate punctures were made in the fascia with a 5 mm scope in the middle and 5 mm and 3 mm ports for working instruments on the left and right, respectively. The first suspension suture was placed to secure the sigmoid colon to the abdominal wall. A window was created through the rectal mesentery, and dissection around the rectum was carried out. The second suspension suture was performed to suspend the rectovesical peritoneal fold or the rectovaginal peritoneal fold to the abdominal wall. Dissection around the rectum was continued downward to approximately 1 cm below the peritoneal fold. Then, the operation was completed by a transanal approach. Results Forty patients underwent SILEP from March 2013 to April 2015. The median age was 2.7 months (ranging from 1 to 17 months). The mean operative time was 96 ± 23 min. No conversion to an open operation was required. The average hospitalization time was 4.5 ± 2 days. There were no intraoperative or perioperative complications. Long-term follow-up results were obtained from 38 patients. A frequency of defecation from every other day to twice a day was noted for 33 patients (86.8%) and more often for 5 patients (13.2%). Two patients had enterocolitis (5.2%). Conclusion Single-incision laparoscopic rectal pull-through with suspension sutures using conventional instruments is feasible and safe for HD with good long-term outcomes.

Intrathecal Nalbuphine versus Intrathecal fentanyl as adjuvant to 0.5% bupivacaine for caesarian section surgery under subarachnoid block

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Amr Essam El-Din Abdel Hameed ◽  
Noha Sayed Hussien ◽  
Marwa Mamdouh Mohamed ◽  
Abdelrahman Mostafa Mohamed El Kenawy
Keyword(s):  
Blood Pressure ◽  
Side Effects ◽  
Postoperative Analgesia ◽  
Tissue Injury ◽  
Sensory Block ◽  
Sensory Level ◽  
Significant Difference ◽  
Block Level ◽  
Duration Of Operation ◽  
Fentanyl Group

Abstract Background One of the main objectives of anesthesia is to relieve the patient’s pain and agony, by ensuring the performance of surgical procedures without any discomfort. Elimination of postoperative pain is indispensable due to the central, peripheral and immunological stress response to tissue injury. So there is a need for extended analgesia without any side effects to achieve this goal. Aim of the Work To compare the post-operative analgesic effect of intrathecal-nalbuphine and fentanyl as adjuvant to bupivacaine during cesarean delivery. The secondary aim is to compare side effects between using nalbuphine and fentanyl as adjuvants to bupivacaine. Patients and Methods After Approval is obtained from the research Medical Ethical Committee of Faculty of Medicine, Ain Shams University. The study was conducted on 60 patients that were randomly selected. Randomly divided into 2 groups 30 patients each. Group F which received fentanyl as adjuvant while group N received nalbuphine as adjuvant. Results The addition of a small dose of nalbuphine or fentanyl to bupivacaine in spinal anesthesia prolonged the time of postoperative analgesia. In this study, there was no significant difference regarding the age, height, weight, and duration of operation, maximum sensory level, and maximum motor blockade level. The duration of the postoperative analgesia was prolonged with Nalbuphine group in comparison to the fentanyl group, the results were highly significant. Conclusion We concluded that either intrathecal nalbuphine (0.8 mg) or intrathecal fentanyl (25 µg) combined with Bupivacaine improves intraoperative analgesia and prolongs early post-operative analgesia in cesarean section. There was no significant difference with regard to: Peak sensory block level, Maximum motor block level, systolic blood pressure, diastolic blood pressure, oxygen saturation, and heart rate.

scholarly journals The Safety and Efficacy of Total Laparoscopic Distal Gastrectomy With Delta-Shaped Anastomosis Compared With Laparoscopic-Assisted Distal Gastrectomy

2020 ◽  
Vol 104 (3-4) ◽  
pp. 131-137
Author(s):  
Y. B. Gao ◽  
W. D. Jin ◽  
J. Cao ◽  
Z. Y. Zhang ◽  
X. Cai ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Hospital Stay ◽  
Distal Gastrectomy ◽  
Enhanced Recovery ◽  
Operation Time ◽  
Laparoscopic Distal Gastrectomy ◽  
Short Term ◽  
Therapeutic Benefits ◽  
Significant Difference ◽  
Laparoscopic Assisted

Aim: To evaluate the safety and short-time benefits of enhanced recovery after surgery on hospital stay, recovery of gastrointestinal function and complications after total laparoscopic distal gastrectomy (TLDG) with delta-shaped anastomosis, comparing with laparoscopic-assisted distal gastrectomy (LADG). Methods: A retrospective analysis was performed in 134 patients with gastric cancer who were treated at Wuhan General Hospital of Guangzhou Military Area Command from November 2013 to August 2015. A total of 70 patients underwent TLDG, and 64 patients underwent LADG. All patients were performed elective standard D2 total gastrectomy by 1 group of experienced surgeons. The short-term therapeutic benefits, including duration of flatus and defecation, postoperative pain, duration of postoperative stay, and complications between the 2 groups were analyzed. Results: Compared with LADG, TLDG had shorter time to the first flatus (74.09 ± 11.08 h versus 84.11 ± 12.18 h, P &lt; 0.001), earlier postoperative liquid diet intake (98.83 ± 10.63 h versus 108.58 ± 13.08 h, P &lt; 0.001), less dosage of pain killers (2.01 ± 0.85 versus 2.41 ± 0.85, P = 0.009), faster recovery with a shorter postoperative hospital stay (8.14 ± 0.3.43 d versus 9.97 ± 4.53 d, P = 0.009), There were no significant difference in operation time, blood loss, the number of lymph nodes retrieved, or the incidence of postoperative complications (anastomotic bleeding or leakage, wound infection, digestive tract dysfunction, thrombosis, or death; P &gt; 0.05). Conclusions: TLDG with delta-shaped anastomosis is a safe and effective fast-tract surgical approach for earlier gastric cancer, which would probably achieve the short-term curative effect. Further studies based on larger volumes and long-term effects are required to confirm these findings.

scholarly journals The Safety and Efficacy of Total Laparoscopic Distal Gastrectomy With Delta-Shaped Anastomosis Compared With Laparoscopic-Assisted Distal Gastrectomy

2020 ◽  
Vol 104 (3-4) ◽  
pp. 116-122
Author(s):  
You-Bing Gao ◽  
Jin Wei-Dong ◽  
Cao Jun ◽  
Zhang Zhi-Yong ◽  
Cai Xun ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Hospital Stay ◽  
Distal Gastrectomy ◽  
Enhanced Recovery ◽  
Operation Time ◽  
Laparoscopic Distal Gastrectomy ◽  
Short Term ◽  
Therapeutic Benefits ◽  
Significant Difference ◽  
Laparoscopic Assisted

Aim: To evaluate the safety and short-time benefits of enhanced recovery after surgery on hospital stay, recovery of gastrointestinal function and complications after total laparoscopic distal gastrectomy (TLDG) with delta-shaped anastomosis, comparing with laparoscopic-assisted distal gastrectomy (LADG). Methods: A retrospective analysis was performed in 134 patients with gastric cancer who were treated at Wuhan General Hospital of Guangzhou Military Area Command from November 2013 to August 2015. A total of 70 patients underwent TLDG, and 64 patients underwent LADG. All patients were performed elective standard D2 total gastrectomy by 1 group of experienced surgeons. The short-term therapeutic benefits, including duration of flatus and defecation, postoperative pain, duration of postoperative stay, and complications between the 2 groups were analyzed. Results: Compared with LADG, TLDG had shorter time to the first flatus (74.09 ± 11.08 hours versus 84.11 ± 12.18 hours, P &lt; 0.001), earlier postoperative liquid diet intake (98.83 ± 10.63 hours versus 108.58 ± 13.08 hours, P &lt; 0.001), less dosage of pain killers (2.01 ± 0.85 versus 2.41 ± 0.85, P = 0.009), faster recovery with a shorter postoperative hospital stay (8.14 ± 0.3.43 days versus 9.97 ± 4.53 days, P = 0.009), There were no significant difference in operation time, blood loss, the number of lymph nodes retrieved, or the incidence of postoperative complications (anastomotic bleeding or leakage, wound infection, digestive tract dysfunction, thrombosis, or death; P &gt; 0.05). Conclusions: TLDG with delta-shaped anastomosis is a safe and effective fast-tract surgical approach for earlier gastric cancer, which would probably achieve the short-term curative effect. Further studies based on larger volumes and long-term effects are required to confirm these findings.

scholarly journals Comparative Study of Caudal Bupivacaine and Bupivacaine with Clonidine in Infra Umbilical Surgeries in Children

2020 ◽  
Vol 5 (1) ◽  
pp. 23-29
Author(s):  
Swetha J Gouda ◽  
P.V. Margi
Keyword(s):  
Side Effects ◽  
Single Shot ◽  
Age Group ◽  
Efficacy And Safety ◽  
Caudal Block ◽  
Hemodynamic Changes ◽  
Analgesic Effects ◽  
Group A ◽  
The Mean ◽  
Group B

Background: Caudal epidural analgesia is one of the most commonly performed regional blocks in paediatric anaesthesia for intra and post-operative analgesia. Addition of opioids like morphine, fentanyl is associated with side effects like respiratory depression, urinary retention, etc. Clonidine, an α2 agonist is known for its analgesic effects with lesser side effects. Hence, this study was conducted to know the efficacy and safety of addition of clonidine to bupivacaine in a single shot caudal block in children.Subjects and Methods:This study was conducted among 60 children in the age group of 5 – 10 years coming for various elective infraumbilical surgical procedures. They were divided into two groups of 30 each. Group A received caudal 0.25% bupivacaine (1ml/kg) and group B received caudal 0.25% bupivacaine (1ml/kg) with clonidine (1.5µg/kg). The various parameters studied were hemodynamic changes, duration of analgesia and incidence of side effects.Results:The groups were similar in age, sex and weight. The hemodynamic parameters like heart rate, blood pressure, respiratory rate were also similar between the two groups after administering caudal block. The mean duration of analgesia in group B (433.5 ± 60 min) was significantly longer (p< 0.05) than group A (250.33 ±41 min). Conclusion:This study showed that the addition of clonidine in the dose of 1.5µg/kg to 0.25% bupivacaine (1ml/kg) improved the analgesic duration and efficacy after a single shot caudal block with minimal side effects in children.

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