A comparative study of caudal anesthesia with bupivacaine v/s bupivacaine with dexmedetomidine in lower abdominal surgeries in pediatric age group

Background: caudal anaesthesia has short­term effect. Alpha­2 adenoreceptors when used as adjuvant to local anaesthetic in children prolongs analgesic duration. The study is aimed to assess the efficacy of addition of dexme­detomidine with Bupivacaine in caudal block for extending postoperative analgesia and its safety profile in pediatric infra­umbilical surgeries.Method: the prospective interventional longitudinal double blinded study was conducted on 60 patients randomly divided into two groups by simple lottery method: group B who received (0.25 %) bupivacaine 1 ml/kg plus 1 ml nor­mal saline (NS), and those in group BD who received (0.25 %) bupivacaine 1 ml/kg plus 0.5 μg/kg dexmedetomidine in 1 ml NS. Post­surgery, both groups were compared in R studio v1.2.5001. Association between the adverse effect and other variables (age, gender, type of surgery, groups) were assessed by Multiple linear regression.Results: in group BD, duration of analgesia prolonged significantly (P < 0.05). In group BD, FLACC score at initial four hours and at 12th hour was significantly less (P < 0.05). Group B was more likely to receive high number of rescue analgesia (P = 0.0005; OR = 11.769). No significant difference was observed concerning hemodynamics, respiratory parameters and adverse effect between both groups (P > 0.05). Conclusion: in children, dexmedetomidine when used along with bupivacaine prolongs postoperative analgesia du­ration, without any significant side effects.

Comparison of Midazolam with Bupivacaine and Fentanyl with Bupivacaine in Caudal Epidural Analgesia for Efficacy and Duration of Post­ Operative Analgesia in Children Undergoing Infra Umblical Surgeries

Caudal anaesthesia is a useful adjunct to general anaesthesia for infra umbilical surgeries in children as it provides post-operative analgesia and reduces pen­ operative narcotic requirements There is prolongation o. f duration of analgesia by mean duration of 318.20±24.49 minutes with addition Fentanyl to Bupivacaine. When comparing the efficacy of two differential drugs fentanyl I µg/kg and midazolam 5 0µg/kg in combination with Bupivacaine 0.2 5%, lml/kg. Duration of analgesia was found significantly more in group using Fentanyl with mean duration of 318.20 ± 24.49 minutes compared to Midazolam with mean duration of 247.25 ±12.19 minutes.

Continuous Caudal Catheters in Neonatal Population: A Focussed Review

Caudal epidural block is one of the most commonly administered blocks in paediatric population. Continuous caudal technique offers several advantages like its ability to cater to long duration surgeries, higher thoracic procedures and to deliver extended, titratable post-operative pain relief. Current advances in this technique like use of fluoroscopy, electrical stimulation and Ultrasound to secure continuous caudal catheters facilitate enhanced accuracy and safety and should be adopted wherever feasible. An understanding of local anaesthetic dosages for infusion and their fine tuning is a prerequisite. The potential benefits and risks should be assessed on a case-to-case bases Keywords: Caudal anaesthesia, Post-operative pain, Neonatal regional anaesthesia

The Successful Awake Caudal Anesthesia for Bilateral Inguinal Hernia Repair in Triple Premature Infants: Case report and Review of Literature

Introduction: Inguinal hernia is a more frequent problem in male infants with an increased incidence in twin ones. Prematurity is considered as a risk factor. During open surgery of hernia under general anesthesia, there is a high incidence of apnea especially in the preterm infants. Caudal anesthesia could been a more effective approach for induction of anesthesia and analgesia. Case presentation: Here, we presented three two-months-old infants (3.5-3.9 kg) for inguinal hernia repair, simultaneously who were born at 35 weeks’ gestation al age. They were undergone bilateral inguinal hernia repair with single shot awake caudal anaesthesia. Conclusion: Although herrniorraphy is a common procedure in preterm infants, the induction of simultaneous caudal anesthesia for this procedure is rare event. On the other hand, the complications of anestethic techniques such as apnea are important.Indeed, triple infants with based same genetic background didn’t show any undesirable events after anaesthesia.