Caudal 0.2% ropivacaine is less effective during surgery than 0.2% levobupivacaine and 0.2% bupivacaine: a double-blind, randomized, controlled trial (original) (raw)
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Anesthesiology and Pain Medicine, 2016
Background: Caudal analgesia is a common method for postoperative pain management in pediatric patients. Additive agents such as opioids and α2 agonists have been used to enhance the analgesic effects of local anesthetics for caudal block. Objectives: The aim of this study was to compare the additive effects of dexmedetomidine and fentanyl on bupivacaine-induced caudal analgesia in pediatric patients who had undergone elective inguinal hernia repair. Methods: This randomized, double-blind clinical trial included children aged 1-5 years who were divided into three groups: the bupivacaine group (Group B) received 0.25% bupivacaine (1 ml/kg), the bupivacaine-dexmedetomidine group (Group BD) received 0.25% bupivacaine (1 mL/kg) plus 2 µg/kg dexmedetomidine, and the bupivacaine-fentanyl group (Group BF) received 0.25% bupivacaine (1 mL/kg) plus 2 µg/kg fentanyl. The hemodynamic variables (heart rate, systolic blood pressure, respiratory rate, and peripheral arterial oxygen saturation) were measured perioperatively. Pain, sedation and motor block scores and adverse events (nausea and vomiting, pruritis, hypotension, bradycardia, urinary retention and respiratory depression) were documented at 30 and 60 minutes, and the 1st, 2nd, 4th, 6th, 12th and 24th hours after the operation. The other recordings include the duration of surgery and analgesic requirement. Results: A total of 61 patients were analyzed. The lowest pain scores were found in the BD group at all time points (P < 0.001). The sedation scores were higher in the BD group than in the other two groups at all time points (P < 0.001). No motor block was observed after the operation. Only three patients required analgesic administration 2 to 6 hours after the operation in group B. No side effects were observed in any of the groups, and there was no significant difference in the duration of surgery among the three groups. Conclusions: The results show that the analgesic and sedative effects were better when dexmedetomidine was added to bupivacaine than when fentanyl was added or bupivacaine alone was administered in the pediatric population studied here that underwent elective inguinal hernia repair.
SciDoc Publishers, 2020
Background and Objectives: The assessment and quantification of postoperative pain is more difficult in children than adults. Regional anesthesia and analgesia has shown to provide excellent analgesia and also provide benefits, which extend beyond the perioperative period. Caudal epidural block is a gold standard technique in paediatric lower abdominal surgeries. The aim of this study is to evaluate perioperative effect of caudal epidural block in children undergoing laparoscopic hernia repair surgeries regarding hemodynamic changes in intra-operative period, postoperative pain score, rescue analgesia requirement and any side effects. Methods: Sixty children aged 2–12 years with ASA grade I or II scheduled for laparoscopic unilateral hernia repair were randomly allocated into two groups: group A (General anaesthesia with caudal block) and group B (General anaesthesia without caudal block). Postoperative pain scores, rescue analgesic requirement, intraoperative hemodynamic changes, any complication related to caudal block were recorded. Results: All children were comparable regarding demographic profile. There was no statistically significant difference in hemodynamic changes between both the groups. The mean postoperative pain score was significantly lower in group A (2.98 ± 1.08) as compared to group B (3.63 ± 1.49) (p = 0.002). Eleven (36%) subjects in group A and 25 (83%) subjects in group B needed rescue analgesic in postoperative period. The incidence of adverse effects was higher (30%) in group A than group B (13%). Conclusion: We concluded that caudal bock with 0.2% ropivacaine in paediatric patients provides better analgesia, without significant intraoperative hemodynamic changes.
Medical Principles and Practice
age, and addition of intraoperative fentanyl were compared among the groups. The time to first use of the analgesic and the number of patients who required analgesic 24 h after surgery in the time intervals within 6 h, between 6 and 12 h, and between 12 and 24 h postoperatively were evaluated among the groups. Statistical analyses were performed with a Dunnett t test, ANOVA, or Kruskal-Wallis test and χ 2 test. Logistic regression analysis was used in order to examine predictive factors on duration of postoperative analgesia. Results: Age, weight, duration of anesthesia, onset time of intraoperative analgesic, dosage, and addition of intraoperative fentanyl were similar among the groups. The time to first analgesic use did not differ among the groups, and logistic regression modelling showed that using the 3 different volumes of levobupivacaine had no predictive influence on duration of postoperative analgesia. The numbers of pa-
Journal of Evidence Based Medicine and Healthcare, 2019
BACKGROUND Inguinal hernia repair in children is the commonest day-care surgical procedure done in the paediatric age group. Regional anaesthesia and nerve blocks are now widely used in children, mostly in conjunction with general anaesthesia. Caudal analgesia is the most common regional block performed in children due to ease of performance and reliability. Paravertebral blockade has recently been shown to produce long lasting postoperative analgesia when used in combination with general anaesthesia in paediatric herniorrhaphy. The objectives of this study were-1) to compare the efficacy of caudal and paravertebral blocks in children. 2) to compare intraoperative hemodynamic parameters and analgesic requirements. 3) to compare postoperative pain relief in both the groups. MATERIALS AND METHODS 80 paediatric patients with unilateral inguinal hernia between 2-7 years were allocated into 2 groups of 40 each. Group A received paravertebral block using nerve stimulator at T12-L1 interface, while group B received caudal block using the loss of resistance technique. Statistical analysis-for qualitative data chi square fischer test was used. For quantitative data unpaired t test was used. All analysis was done by SPS statistical method version 16.0. RESULTS Haemodynamic parameters, pain score, incidence of nausea and vomiting were comparable in both the groups. However, duration of postoperative analgesia and urinary retention were found to be significantly different. In Group A mean time for rescue analgesia administration was 11.39 hrs. while for Group B it was 5.32 hrs. (p=0.001). The mean time of voiding urine in group A was 5.32 hours while in group B it was 9.24 hours (p=0.003). CONCLUSION Both the techniques are safe and provide good quality postoperative pain relief. However, the postoperative analgesia was better and the time to void urine was earlier with paravertebral block than with caudal block.
BMC Anesthesiology, 2022
Background: Current knowledge on the ideal local anesthetic concentration for the ultrasound-guided transversus abdominis plane block (TAPB) in pediatrics is scarce. The purpose of this study is to compare the efficacy of US-guided TAPB at two different concentrations of bupivacaine in pediatrics undergoing unilateral inguinal hernia repair. Methods: After random allocation, 74 children aged 1-8 were randomized to receive US-guided TAPB by using 1 mg.kg − 1 bupivacaine as either 0,25% (0,4 ml.kg − 1) (Group 1) or 0,125% (0,8 ml.kg − 1) (Group 2) concentration. All blocks were performed under general anesthesia, immediately after the induction, unilaterally with a lateral approach. All subjects received intravenous 15 mg/kg paracetamol 0.15 mg/kg dexamethasone and 0.1 mg/kg ondansetron intraoperatively. The primary outcome was the efficacy which is assessed by postoperative FLACC behavioral pain assessment score at 15′, 30′, 45′, 1 h, 2 h, 6 h, and 24 h. The secondary outcomes were to assess the total dose of rescue analgesic consumption, length of hospital stay, the incidence of side effects, complications and satisfaction levels of the patients' parents and the surgeons. Results: Sixty-four children were recruited for the study. Postoperative pain scores were equal between the two groups. There was no need for a rescue analgesic in any group after the postoperative 6 th hour. No local or systemic complication or side effect related to anesthesia or surgery was reported. Conclusion: TAPB using 1 mg.kg − 1 bupivacaine administered as either high volume/low concentration or low volume/high concentration was providing both adequate analgesia and no side effects. Trial registration: This trial was retrospectively registered at Clini caltr als. gov, NCT04 202367.
Research Square (Research Square), 2022
Background: Current knowledge on the ideal local anesthetic concentration for the ultrasound-guided transversus abdominis plane block (TAPB) in pediatrics is scarce. The purpose of this study is to compare the e cacy of US-guided TAPB at two different concentrations of bupivacaine in pediatrics undergoing unilateral inguinal hernia repair. Methods: After random allocation, 74 children aged 1-8 were randomized to receive US-guided TAPB by using 1 mg.kg-1 bupivacaine as either 0,25% (0,4 ml.kg-1) (Group 1) or 0,125% (0,8 ml.kg-1) (Group 2) concentration. All blocks were performed under general anesthesia, immediately after the induction, unilaterally with an intercostoiliac approach. All subjects received intravenous 15 mg/kg paracetamol 0.15 mg/kg dexamethasone and 0.1 mg/kg ondansetron intraoperatively. The primary outcome was the e cacy and is assessed by postoperative FLACC behavioral pain assessment score at 15', 30', 45', 1h, 2h, 6h, and 24h. The secondary outcomes were to assess the total dose of rescue analgesic consumption, length of hospital stay, the incidence of side effects, complications and satisfaction levels of the patients' parents and the surgeons. Results: Sixty-four children were recruited for the study. Postoperative pain scores were equal between the two groups. There was no need for a rescue analgesic in any group after the postoperative 6 th hour. No local or systemic complication or side effect related to anesthesia or surgery was reported. Conclusion: TAPB using 1 mg.kg-1 bupivacaine administered as either high volume/low concentration or low volume/high concentration was providing both adequate analgesia and no side effects. TAPB is an effective analgesic technique for children undergoing inguinal hernia repair.
Annals of Medical Research, 2019
In our study, we aimed to evaluate retrospectively the efficacy of postoperative analgesia in patients with caudal block versus paracetamol in 67 cases, between the ages of 2-8 years who had undergone elective inguinal hernia and circumcision surgery after induction of general anesthesia. Material and Methods: In this study, we evaluated retrospectively the files of 67 cases between 2-8 years old patients who had caudal block or I.V. paracetamol who undergone inguinal hernia and circumcision operation between September 2017 and September 2018. The files of the cases, anesthesia follow-up forms and nurse observation forms were examined; demographic data, vital signs, duration of surgery, postoperative analgesic requirement and recorded complications were evaluated. Results: The mean age was 3.2±2.35 years in the caudal group and 4.3±2.15 years in the paracetamol group, the mean body weight was 15.1±4.51 kg in the caudal group and 19.4±6.4 in the paracetamol group. The surgical period of patients in the caudal group was 51±12.2 minutes and it was 37.8±15.8 in the paracetamol group. The mean duration of postoperative analgesia was 8.1±1.42 hours in the caudal group and 1.05±1.0 hours in the paracetamol group. There were no complications in any of the patients in the postoperative period. No significant results were found in the vital signs of both groups. While VAS values were statistically significant at 6th and 12th hours, VAS value at 24th hour was not statistically significant. Conclusion: Caudal epidural anesthesia may be a simple and safe method of anesthesia effective in postoperative pain control. May it ensure serious patient comfort with reduced analgesic requirements after surgery. It may be recommended to use pediatric surgery under umbilicus for high success rates and low complication rates.
Open Access Macedonian Journal of Medical Sciences, 2016
AIM: The aim of this study is to evaluate anesthesia and recovery profile in pediatric patients after inguinal hernia repair with caudal block or local wound infiltration.MATERIAL AND METHODS: In this prospective interventional clinical study, the anesthesia and recovery profile was assessed in sixty pediatric patients undergoing inguinal hernia repair. Enrolled children were randomly assigned to either Group Caudal or Group Local infiltration. For caudal blocks, Caudal Group received 1 ml/kg of 0.25% bupivacaine; Local Infiltration Group received 0.2 ml/kg 0.25% bupivacaine. Investigator who was blinded to group allocation provided postoperative care and assessments. Postoperative pain was assessed. Motor functions and sedation were assessed as well.RESULTS: The two groups did not differ in terms of patient characteristic data and surgical profiles and there weren’t any hemodynamic changes between groups. Regarding the difference between groups for analgesic requirement there were ...
Regional anaesthesia for hernia repair in children: local vs caudal anaesthesia
Canadian Journal of Anaesthesia, 1995
The purpose of this study was to compare the effect of local anaesthesia (1_,,4) with that of caudal anaesthesia (CA) on postoperative care of children undergoing inguinal hernia repair. This was a randomized, single-blind investigation of 202 children aged 1-13 yr. Anaesthesia was induced with NeO / 02 and halothane or propofol and maintained with N20/Oz/halothane. Local anaesthesia included ilioinguinal and iliohypogastric nerve block plus subcutaneous injection by the surgeon of up to 0.3 ml" kg -1 bupivacaine 0.25% with 5 #g" kg -t adrenaline. The dose for caudal anaesthesia was 1 ml" kg -1 up to 20 ml bupivacaine 0.2% with 5 t~g" kg -t adrenaline. Postoperative pain was assessed with mCHEOPS in the anaesthesia recovery room, with postoperative usage of opioid and acetaminophen in the hospital, and with parental assessment of pain with a VAS. Vomiting, time to.first ambulation and first urination were recorded. The postoperative pain scores and opioid usage were similar; however, the LA-group required more acetaminophen in the Day Care Surgical Unit. The incidence of vomiting and the times to.first ambulation and first urination were similar. The LA-patients had a shorter recovery room stay (40 + 9 vs 45 • 15 rain, P < 0.02). The postoperative stay was prolonged in the CA group (176 • 32 vs 165 • 26 min, P = 0.02). We conclude that LA and CA have similar effects on postoperative care with only slight differences.
Anaesthesia, Pain & Intensive Care, 2019
Background and Objective: Millions of children receive sedative, anesthetic and analgesic drugs for surgery worldwide. Caudal epidural block with bupivacaine is widely used for perioperative analgesia in children undergoing surgeries under general anesthesia. Current study aims to determine postoperative pain relief and side effects due to caudally administered 0.25% bupivacaine (0.5-1 ml/kg) alone and a combination of 0.25% bupivacaine (0.5-1 ml/kg) with tramadol (1 mg/kg).Methodology: A randomized clinical trial was conducted at department of Anesthesiology, Shaikh Zayed Hospital, Lahore. Study duration was 1 year and 6 months (February 2015-August 2016). A sample size of 108 patients was calculated using WHO calculator. Non probability consecutive sampling was used. Patients were randomly divided into two groups; Group B was given inj. bupivacaine 0.25% while Group BT received a combination of 0.25% bupivacaine (0.5-1 ml/kg) with tramadol (1 mg/kg). Patients were observed for sed...