Comparison of Postoperative Pain and Analgesic Requirements Between Laparoscopic and Open Hernia Repair in Children

Background This study analyses the impact of anaesthetic blockade and intraperitoneal local anaesthetic infiltration on paediatric laparoscopic inguinal hernia repair. Method A retrospective review of paediatric laparoscopic hernia repairs versus open repairs. Anaesthetic blockade, analgesic consumption and postoperative pain scores were compared between groups. Results 155 children underwent laparoscopic repair, 150 underwent open repairs. Median age was 7.2 months (16 days–14 years) in the laparoscopic group, 6 months (17 days–13 years) in the open group. Anaesthetic blockade varied significantly; 62.7% of open cases had caudal blockade compared to 21.6% laparoscopic (p < 0.001). A subset of laparoscopic patients had peritoneal local anaesthetic infiltration. 10.1% of laparoscopic cases required recovery analgesia, compared to 1.3% of open cases (p = 0.001). Postoperative analgesic consumption was significantly higher in the laparoscopic group. Peritoneal infiltration reduced analgesic consumption in the laparoscopic group (p = 0.038). Age < 2 was associated with use of caudal (p < 0.001), which reduced analgesic consumption. Conclusions Laparoscopy was associated with increased use of recovery analgesia. Caudal reduced the need for rescue and postoperative analgesia. Intraperitoneal infiltration of local anaesthetic is associated with reduced postoperative analgesia in laparoscopy. In suitable patients undergoing laparoscopic surgery, combination caudal and peritoneal infiltration may prove a useful adjunctive analgesic strategy.

Efficiency and safety of an anesthetic technique in surgical correction of congenital malformations of the lower parts of the urogenital system in children

Objective: to assess the efficiency and safety of an anesthetic technique in surgical correction of congenital malformations of the lower parts of the urogenital system in children by means of the performance of the comparative analysis of perioperative adverse events and complications, consumption of the inhalation anesthetic sevoflurane and the cost of anesthesia, and also the course of the early postoperative period. Material and methods. Depending on the type of anesthesia, all patients (127 boys) were divided into 3 clinical groups: those operated under multicomponent balanced inhalation anesthesia (group 1, n = 37), under general laryngeal mask anesthesia in combination with caudal blockade with 0.25% bupivacaine solution (group 2, n = 45), under general laryngeal mask anesthesia with caudal blockade with the combination of 0.25% bupivacaine solution and adjuvant (group 3, n = 45). Results. The performed analysis has not revealed any statistically significant distinctions in the assessment of anesthesia complications but it has found some significant distinctions in the consumption of sevoflurane, depth of anesthesia and its cost, as well as the necessity for postoperative anesthesia and introduction of analgesics, which testifies to the efficiency and safety of combined anesthesia and its economic benefit. Conclusion. The most effective, safe, and economically reasonable is the technique of combined anesthesia with the application of caudal blockade with local anesthetic solution and 0.1% adjuvant of morphine solution during surgical correction of congenital malformations of the lower parts of the urogenital system in children.

Role of Caudal Blockade in the Modulation of Stress Response in the Surgical Correction of Congenital Malformations of the Lower Parts of the Urogenital System in Children

Objective: to assess the efficiency and safety of an anesthetic technique during the surgical correction of congenital malformations of the lower departments of the urogenital system in children by means of the comparative analysis of laboratory and hemodynamic indices, as well as the course of the early postoperative period, development of adverse effects during the anesthesia.Material and methods. Depending on the type of anesthesia, all patients (127 boys) were divided into 3 clinical groups: those operated under multicomponent balanced inhalation anesthesia (group 1, n = 37), under general laryngeal mask anesthesia in combination with caudal blockade with a local anesthetic solution (group 2, n = 45), under general laryngeal mask anesthesia with caudal blockade with the combination of a local anesthetic solution and adjuvant (group 3, n = 45).Results. The performed analysis of the parameters of hemodynamics, levels of cortisol, glucose, lactate and interleukin-6 (IL-6), as well as the quality, duration, depth of anesthesia and the necessity for an inhalation anesthetic, the assessment of complications and the adverse effects have revealed statistically significant differences indicative of a more effective blockade of the pain sensitivity in the combined application of general and regional anesthesia.Conclusion. The technique of combined anesthesia with the application of the combination of 0.25 % bupivacaine solution and adjuvant to 0.1 % morphine has shown the best efficiency and safety during the surgical correction of congenital malformations of the lower departments of the urogenital system in the children.

Comparison of a Combination of Caudal Levobupivacaine with Fentanyl and Levobupivacaine Alone for Alleviating Postoperative Pain During Infraumbilical Procedures in Children Under 3 Years

Background: To compare the post-operative analgesic efficacy of caudal blockade using levobupivacaine alone and a combination of fentanyl with levobupivacaine in children under 3 years undergoing infraumbilical surgeries. Combination of levobupivacaine with fentanyl and levobupivacaine alone in children for caudal block was never studied before. Hence there was a need for the study. Methods: After approval from Institutional Ethical Committee, Kasturba Medical College, Mangaluru, 60 patients of age group 0-3 years, either sex of ASA physical status 1 and 2 undergoing infraumbilical surgeries were chosen after written parental consent and were randomised into 2 groups of 30 each L and LF using computer generated block randomisation to receive caudal blocks. Post operatively assessed for pain using CHIPPS scale at 2, 4, 6, 12 and 24 hours and compared in both groups. Results: Out of 60 patients, 30 in each group [L and LF], CHIPPS scores at 2, 4, 6, 12 and 24 hours post-operatively exhibited a p-value of 0.545, 0.492, 0.626, 0.166, and 0.329 respectively [not significant]. Mean duration of analgesia was 14.60 in Group L & 17.67 in Group LF with a t test p value of 0.119 [not significant]. Conclusion: Combination of fentanyl with levobupivacaine when compared to levobupivacaine alone for caudal block was equianalgesic in children less than 3 years undergoing infra umbilical procedures.

Caudal blockade as the main component of general anesthesia during surgical interventions for necrotic enterocolitis in newborns

Necrotic enterocolitis (NEC) is one of the most complex and least studied problems in neonatal surgery, which significantly affects mortality rates. Aim of the study: Determination of the safest and most effective method of anesthesia during surgical interventions for necrotic enterocolitis in newborns. Material and methods of the study: We conducted a study of two variants of anesthesia, namely non-inhalation anesthesia using dormicum and caudal block, as the first option, and propofol in combination with caudal block as the second version of the technique. The results of the study: The adequacy of caudal anesthesia with lidocaine at a dose of 6 mg/kg was evaluated based on the onset of symptoms of a nociceptive hemodynamic reaction (tachycardia, arterial hypertension, increased stroke volume, and cardiac output). An analysis of the technique of balanced caudal anesthesia, as part of general anesthesia, which we use in surgical interventions for NEC in newborns revealed its high efficiency. The frequency of side effects of caudal blockade and complications in connection with its implementation was insignificant. The listed complications were not threatening the patient’s life and the prognosis of the course of the postoperative period. According to the literature, complications associated with the technique of creating the caudal block are quite rare.

A COMPARATIVE STUDY OF CAUDAL BUTORPHANOL AND FENTANYL FOR ALLEVIATING POST-OPERATIVE PAIN IN INFRAUMBILICAL PROCEDURES IN CHILDREN BELOW 3 YEARS OF AGE

Objective: Caudal block is a common regional anesthetic technique used in children. However, it is limited by relatively shorter duration of analgesia. The objective of this study was to compare the analgesic efficacy of caudal blockade using butorphanol (1) and fentanyl in children below 3 years, undergoing infraumbilical surgeries.Methods: Patients were randomly allocated to two groups of 30 each. Without premedication, patients were induced with thiopentone, relaxed with atracurium for facilitation of LMA insertion, and maintained on O2, N2O, and halothane. Caudal block was then performed using an aseptic technique. One group received caudal butorphanol (25 μg/kg) with 0.25% bupivacaine (0.1 ml/kg) and the other received fentanyl (1 μg/kg). Incision was allowed after 15 min of block. After the completion of surgery, LMA was removed and patients were shifted to the PACU. Non-invasive blood pressure and heart rate were recorded; pain was assessed using modified objective pain score (MOPS) (2) at 2, 4, 6, 12, and 24 h, postoperatively. Oral paracetamol was given at a score >4.Results: The mean duration of analgesia in Group F was 12.47 (standard deviation [SD] 8.216) and 19.67 (SD 7.009) in Group B (p: 0.001, HS). Mean MOPS was 4.6 in the fentanyl group as compared to 2.6 in the butorphanol group at the end of 24 h (p=0.001, HS). Thus, butorphanol provided longer duration of analgesia compared to fentanyl.Conclusion: Caudal additives are safe in children and butorphanol provides significantly longer duration of analgesia as compared to fentanyl, thus avoiding caudal catheterization and intravenous analgesics.