Caudal epidural block instead of general anesthesia in an adult with Duchenne muscular dystrophy

Shafy, Shabana Z.; Hakim, Mohammed; Villalobos, Mauricio Arce; Pearson, Gregory; Veneziano, Giorgio; Tobias, Joseph D.

doi:10.2147/lra.s180867

Cited by 4 publications

(5 citation statements)

References 22 publications

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“…(e DCEB incidence in the Us group was 9.38%, which was significantly reduced compared with the Lm group (55.56%, p < 0.001). In the Us group, the number of needle passes and attempts was significantly reduced (2 (1-4) vs. 9 (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15), p < 0.001; 1 (1-2) vs. 3 (1.25-5), p < 0.001), and the success rate on first needle pass was significantly increased (46.88% vs. 8.33%, p < 0.001), and the time to perform CEB was significantly reduced (1 (1-2.75) vs. 6 (2-7.75), p < 0.001). Moreover, the Us group needed more time to establish the puncture site, but there was a significant between-group difference in the total procedure (both p < 0.001).…”

Section: Ultrasound For Predictive Dceb Patientsmentioning

confidence: 98%

“…(is indicates that CEB may have advantages in patients with advanced cardiac disease or other diseases [6,7]. Performing a CEB is simple and easy to learn; however, a rate as high as 25% of incorrect needle placements, even with experienced anesthesiologists, has been reported in several patients [8].…”

Section: Introductionmentioning

confidence: 99%

“…Compared with other neuraxial techniques, such as spinal or epidural blocks, caudal blocks are rarely associated with hypotension and bradycardia, given their lower sympathetic blockade [ 1 ]. This indicates that CEB may have advantages in patients with advanced cardiac disease or other diseases [ 6 , 7 ]. Performing a CEB is simple and easy to learn; however, a rate as high as 25% of incorrect needle placements, even with experienced anesthesiologists, has been reported in several patients [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

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Establishment of Difficult Caudal Epidural Blockade Prediction Model

Xie

Zhao

Chu

et al. 2022

Evidence-Based Complementary and Alternative Medicine

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Background. We aimed to develop a predictive difficult caudal epidural blockade (pDCEB) model when ultrasound was not available and verified the role of ultrasound in difficult caudal epidural blockade (CEB). Methods. From October 2018 to March 2019, this study consisted of three phases. First, we prospectively enrolled 202 patients scheduled to undergo caudal epidural anesthesia and assessed risk factors by binary logistic regression to develop the predictive scoring system. Second, we enrolled 87 patients to validate it. The receiver operating characteristic (ROC) curve was used to evaluate the performance of the prediction model. Youden-index was used to determine the cut-off value. Third, we enrolled 68 patients with a high risk of difficult CEB (pDCEB score ≥3) and randomized them into ultrasound and landmark groups to verify the role of ultrasound. Result. The rate of difficult CEB was 14.98% overall 289 patients. We found a correlation between unclear palpation of the sacral hiatus (OR 9.688) and cornua (OR 4.725), the number of the sacral hiatus by palpation ≥1 (OR 4.451), and history of difficult CEB (OR 39.282) with a higher possibility of difficult CEB. The area under the receiver operating characteristic curve of the pDCEB model involving the aforementioned factors was 0.889 (95% CI, 0.827–0.952) in the development cohort and 0.862 (95% CI, 0.747–0.977) in the validation cohort. For patients with a pDCEB score ≥3, a preprocedure ultrasound scan could reduce the incidence of difficult CEB (55.56% in the Landmark group vs. 9.38% in the ultrasound group, p < 0.001 ). Conclusion. This novel pDCEB score, which takes into account palpation of the sacral hiatus/cornua, number of the sacral hiatus by palpation ≥1, and history of difficult CEB, showed a good predictive ability of difficult CEB. The findings suggested that performing an ultrasound scan is essential for patients with a pDCEB score ≥3. Trial registration: No: ChiCTR1800018871, Site URL: https://www.chictr.org.cn/edit.aspx?pid=31875&htm=4; Principal investigator: Jialian Zhao, Date of registration: 2018.10.14.

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Section: Ultrasound For Predictive Dceb Patientsmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Establishment of Difficult Caudal Epidural Blockade Prediction Model

Xie

Zhao

Chu

et al. 2022

Evidence-Based Complementary and Alternative Medicine

View full text Add to dashboard Cite

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“…[ 9 ] Several recent case reports of successful caudal anesthesia in adults exist. [ 10 11 ] Landmark-based caudal epidural in adults is associated with lower success rates (68%–75%) than children. [ 12 ] The subjective feel of a loss of resistance, the “whoosh test” (auscultation of the thoracolumbar region while injecting 2 mL of air) and palpation for subcutaneous injection, all have low sensitivity and specificity.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound-guided caudal epidural anesthesia in adults for anorectal procedures

2020

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Introduction: Caudal epidural is a commonly performed regional anesthetic technique in children. In adults, the high-failure rates associated with landmark-based techniques deter its widespread use. Fluoroscopy-guided caudal epidural steroid injections are widely used as a treatment modality in chronic back pain. Ultrasound (US) guidance has been shown to be equally effective as fluoroscopic-guided caudal injections. We aimed to assess the feasibility of US guided caudal epidurals as a sole anesthesia technique in adult patients undergoing minor anorectal procedures. Subjects and Methods: Fifty consecutive adult patients undergoing elective minor anorectal procedures were recruited for this study. Eligible patients received US-guided caudal epidural and success rates, surgical patient and surgeon's comfort were assessed using validated tools. Any adverse events were also observed. Results: The block was successful in all patients. One patient had pain in the perianal region requiring skin infiltration. All patients were either highly satisfied or satisfied of the procedure. Surgeons rated the surgical conditions as highly satisfied (90%), satisfied (8%), or unsatisfied (2%). Two patients rated the caudal injections were of moderate pain, rest all rated it as mildly painful. One patient experienced a single episode of urinary incontinence. Conclusion: US-guided caudal epidural can be considered as an option for anorectal procedures of short duration with acceptable success rates, surgical conditions, and patient comfort.

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“…Compared with other neuraxial techniques, such as spinal or epidural blocks, caudal blocks are rarely associated with hypotension and bradycardia given its lower sympathetic blockade [1]. This indicates that CEB may have advantages in patients with advanced cardiac disease or other diseases [6,7].…”

Section: Introductionmentioning

confidence: 99%

Development and Validation of a Predictive Score and Application of Ultrasound for Difficult Caudal Epidural Blockade in Adult Patients：A Prospective Study

Zhao

Xie

Chu

et al. 2021

Preprint

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Background: We aimed to develop a predictive difficult caudal epidural blockade (pDCEB) model when ultrasound was not available and verify the role of ultrasound in difficult caudal epidural blockade(CEB).Methods: This study consisted of three phases. First, we prospectively enrolled 202 patients and assessed risk factors to develop the predictive scoring system. Second, we enrolled 87 patients to validate it. Third, we enrolled 68 patients with a high risk of difficult CEB (pDCEB score ≥ 3) and randomized them into ultrasound and landmark groups to verify the role of ultrasound. Result: The rate of difficult CEB was 14.98% overall 289 patients. We found a correlation of unclear palpation of the sacral hiatus (OR 9.688) and cornua (OR 4.725), number of the sacral hiatus by palpation ≥ 1 (OR 4.451), and history of difficult CEB (OR 39.282) with higher possibility of difficult CEB. The area under the receiver operating characteristic curve of the pDCEB model involving the aforementioned factors was 0.889 (95% CI, 0.827-0.952) in the development cohort and 0.862 (95% CI, 0.747-0.977) in the validation cohort. For patients with a pDCEB score ≥ 3, pre-procedure ultrasound scan could reduce the incidence of difficult CEB. Conclusion: This novel pDCEB score, which takes into account palpation of the sacral hiatus/cornua, number of the sacral hiatus by palpation ≥ 1, and history of difficult CEB, showed a good predictive ability of difficult CEB. The findings suggested that performing an ultrasound scan is essential for patients with a pDCEB score ≥ 3. 4 Trial registration: No: ChiCTR1800018871, Site url: https://www.chictr.org.cn/edit.aspx?pid=31875&htm=4

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Caudal epidural block instead of general anesthesia in an adult with Duchenne muscular dystrophy

Cited by 4 publications

References 22 publications

Establishment of Difficult Caudal Epidural Blockade Prediction Model

Establishment of Difficult Caudal Epidural Blockade Prediction Model

Ultrasound-guided caudal epidural anesthesia in adults for anorectal procedures

Development and Validation of a Predictive Score and Application of Ultrasound for Difficult Caudal Epidural Blockade in Adult Patients：A Prospective Study

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