The effect of local wound infiltration vs caudal block on wound infection and healing after inguinal herniotomy in pediatrics − a double-blinded randomized study

Abstract Background: Caudal block with the use of an adequate dose of bupivacaine, and combined with a general anesthesia (GA) provides intra-operative anesthesia and postoperative analgesia. No study has examined the use of 3 mg/Kg bupivacaine for intra-abdominal surgery in pediatric patients in clinical practice. Objective: Compare the effectiveness of three mg/Kg bupivacaine administered as 1.2 mL/Kg 0.25% bupivacaine and 1.5 mL/Kg 0.2% bupivacaine for caudal block in pediatric patients undergoing intra-abdominal surgery. Methods: In a randomized, double-blinded clinical trial, patients (age: 6 months -7 years) were randomly assigned into one of two groups (n= 40) to receive a caudal block with either 1.2 mL/Kg 0.25% bupivacaine (group A) or 1.5 mL/Kg 0.2% bupivacaine (group B), with morphine 50 μg/Kg. The effectiveness of intra-operative anesthesia, complications, and requirements for post-operative analgesia were evaluated. Results: Data were available for 74 pediatric patients. There were no significant differences between the two groups in baseline characteristics. Intra-operatively, the numbers of patients who required a rescue analgesic were comparable between the groups (67% in group A and 63% in group B). The numbers of patients who required a muscle relaxant were also comparable between groups (49% in group A and 57% in group B). The time from discontinuation of the volatile anesthetic to extubation was significantly shorter in group B (9.5±1.1 minutes) than group A (14.3±0.9 minutes), p < 0.01. The time from initial caudal block to the first analgesic required in the recovery room was significantly longer in group B (202±45 minutes) than in group A (149±27 minutes). The time from the caudal block to the first analgesic required in the ward was significantly longer in group B (10.4±3.1 hours) than in group A (8.2±2.0 hours). Overall fentanyl requirements were comparable between groups, 52.5±2.0 μg in group A and 49.5±3.0 μg in group B. Conclusion: Caudal block by either 1.2 mL/Kg 0.25% bupivacaine plus morphine 50 μg/Kg or 1.5 mL/Kg 0.2% bupivacaine plus morphine 50 μg/Kg provided effectively equivalent intra-operative analgesia and surgical relaxation. However, a caudal block with 1.5 mL/Kg 0.2% bupivacaine plus morphine 50 μg/Kg provided superior prolonged analgesic advantages compared with 1.2 mL/Kg 0.25% bupivacaine plus morphine 50 μg/Kg in pediatric patients undergoing intra-abdominal surgery.

Download Full-text

Faculty of 1000 evaluation for The role of different anesthetic techniques in altering the stress response during cardiac surgery in children: a prospective, double-blinded, and randomized study.

F1000 - Post-publication peer review of the biomedical literature ◽

10.3410/f.718007742.793479149 ◽

2013 ◽

Author(s):

Gregor Theilmeier ◽

Hans-Jörg Gillmann ◽

Jan Larmann

Keyword(s):

Cardiac Surgery ◽

Stress Response ◽

Randomized Study ◽

Anesthetic Techniques ◽

Double Blinded

Download Full-text

Spontaneous Preterm Birth: Is Prevention with Aspirin Possible?

Geburtshilfe und Frauenheilkunde ◽

10.1055/a-1226-6599 ◽

2021 ◽

Author(s):

Richard Berger ◽

Ioannis Kyvernitakis ◽

Holger Maul

Keyword(s):

Preterm Birth ◽

Low Dose ◽

Randomized Study ◽

Preterm Births ◽

Spontaneous Preterm Birth ◽

Dose Aspirin ◽

Nulliparous Women ◽

Low Dose Aspirin ◽

Secondary Analyses ◽

Double Blinded

Abstract Background The rate of preterm births in Germany is 8.6%, which is very high compared to other European countries. As preterm birth contributes significantly to perinatal morbidity and mortality rates, the existing prevention strategies need to be optimized and expanded further. About ⅔ of all women with preterm birth have preterm labor or premature rupture of membranes. They are bracketed together under the term “spontaneous preterm birth” as opposed to iatrogenic preterm birth, for example as a consequence of preeclampsia or fetal growth retardation. Recent studies suggest that low-dose aspirin does not just reduce the rate of iatrogenic preterm births but can also further reduce the rate of spontaneous preterm births. This review article presents the current state of knowledge. Method A selective literature search up until April 2020 was done in PubMed, using the terms “randomized trial”, “randomized study”, “spontaneous preterm birth”, and “aspirin”. Results Secondary analyses of prospective randomized studies on the prevention of preeclampsia with low-dose aspirin show that this intervention also significantly reduced the rate of spontaneous preterm births in both high-risk and low-risk patient populations. The results of the ASPIRIN trial, a prospective, randomized, double-blinded multicenter study carried out in six developing countries, also point in this direction, with the figures showing that the daily administration of 81 mg aspirin starting before 14 weeks of gestation lowered the preterm birth rate of nulliparous women without prior medical conditions by around 11% (11.6 vs. 13.1%; RR 0.89; 95% CI: 0.81 – 0.98, p = 0.012). Conclusion Further studies on this issue are urgently needed. If these confirm the currently available results, then it would be worth discussing whether general aspirin prophylaxis for all pregnant women starting at the latest in 12 weeks of gestation is indicated.

Download Full-text

246 ASSESSMENT OF PAROXETINE IN THE PREVENTION OF DEPRESSION IN PATIENTS WITH CHRONIC HEPATITIS C TREATED BY PEG-INTERFERON-RIBAVIRIN.: A DOUBLE-BLINDED, RANDOMIZED STUDY. ANRS HC18 PAROPEG

Journal of Hepatology ◽

10.1016/s0168-8278(10)60248-6 ◽

2010 ◽

Vol 52 ◽

pp. S104 ◽

Cited By ~ 3

Author(s):

J.-P. Bronowicki ◽

V. Canva ◽

A. Tran ◽

M.-N. Hilleret ◽

S. Pol ◽

...

Keyword(s):

Chronic Hepatitis ◽

Hepatitis C ◽

Chronic Hepatitis C ◽

Randomized Study ◽

Double Blinded

Download Full-text

Efficacy and safety of Fufangkushen colon-coated capsule in the treatment of ulcerative colitis compared with mesalazine: A double-blinded and randomized study

Journal of Ethnopharmacology ◽

10.1016/j.jep.2011.08.057 ◽

2012 ◽

Vol 141 (2) ◽

pp. 592-598 ◽

Cited By ~ 21

Author(s):

Yang Gong ◽

Qinglin Zha ◽

Li Li ◽

Yan Liu ◽

Bo Yang ◽

...

Keyword(s):

Ulcerative Colitis ◽

Randomized Study ◽

Efficacy And Safety ◽

Double Blinded

Download Full-text

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

QJM ◽

10.1093/qjmed/hcab086.108 ◽

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.

Download Full-text