Caudal epidural block versus other methods of postoperative pain relief for circumcision in boys

Cyna, Allan M; Jha, S; Parsons, JE

doi:10.1002/14651858.cd003005

Cited by 18 publications

(19 citation statements)

References 16 publications

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“…Our findings address a similar question using similar approaches as a previous meta-analysis of 10 trials for circumcision36 and showed a similar result that there was no detectable difference in the need for rescue and PONV between caudal group and penile block group. However, the review showed that there are more motor block (one trial, 100 boys) and motor or leg weakness (two trials, 107 boys) in caudal block.…”

Section: Discussionsupporting

confidence: 86%

Analgesic efficacy and impact of caudal block on surgical complications of hypospadias repair: a systematic review and meta-analysis

Zhu

Rong

Tong

et al. 2019

Regional Anesthesia &Amp; Pain Medicine

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Background and objectivesis commonly used for children undergoing hypospadias repair. However, the safety of caudal block for hypospadias repair in children is controversial in terms of surgical complications such as urethrocutaneous fistula and glans dehiscence. We sought to perform a meta-analysis to estimate the analgesic efficacy and relative complications of caudal block for hypospadias repair in children.MethodsWe identified comparative studies of caudal block versus peripheral nerve block or no caudal block; studies were published or presented through 1 January 2018, and reports of analgesic efficacy or surgical complications of hypospadias repair in children were identified. Peripheral nerve block includes dorsal nerve penile block and pudendal nerve block. Data were abstracted from studies comparing caudal block with peripheral nerve block or no caudal block; original source data were used when available. We prespecified separate assessments of randomized controlled trials (RCTs) and observational studies given the inherent differences between types of study designs. Data from 298 patients in four RCTs and from 1726 patients in seven observational studies were included. RCT and observational data were analyzed separately.ResultsIn RCTs, caudal blocks (compared with peripheral nerve blocks) showed no detectable differences in terms of need for additional analgesia within 24 hours after the surgery (OR 10.49; 95% CI 0.32 to 343.24; p=0.19), but limited data showed lower pain scores 24 hours after the surgery (standardized mean difference (SMD) 1.57; 95% CI 0.29 to 2.84; p=0.02), a significantly shorter duration of analgesia (SMD −3.33; 95% CI −4.18 to −2.48; p<0.0001) and analgesics consumption. No significant differences were observed in terms of postoperative nausea and vomiting (OR 3.08; 95% CI 0.12 to 77.80; p=0.50) or motor weakness (OR 0.01; 95% CI −0.03 to 0.05; p=0.56). Only one randomized study showed that caudal blocks (compared with peripheral nerve blocks) were associated with detectable differences in urethrocutaneous fistula rate (OR 25.27; 95% CI 1.37 to 465.01; p=0.03) and parental satisfaction rate (OR 0.07; 95% CI 0.02 to 0.21; p<0.00001). In observational studies, caudal block was not associated with surgical complications in all types of primary hypospadias repair (OR 1.83; 95% CI 0.80 to 4.16; p=0.15). To adjust for confounding factors and to eliminate potential selection bias involving caudal block indication, we performed subgroup analysis including only patients with distal hypospadias. This analysis revealed similar complication rates in children who received a caudal block and in children not receiving caudal block (OR 1.02; 95% CI, 0.39 to 2.65; p=0.96). This result further confirmed that caudal block was not a risk factor for surgical complications in hypospadias repair. The direction of outcomes in all the other subgroup analyses did not change, suggesting stability of our results.ConclusionsIn RCTs, only limited data showed peripheral nerve blocks providing better analgesic qua...

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Section: Discussionsupporting

confidence: 86%

Analgesic efficacy and impact of caudal block on surgical complications of hypospadias repair: a systematic review and meta-analysis

Zhu

Rong

Tong

et al. 2019

Regional Anesthesia &Amp; Pain Medicine

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“…The inadequate response rates in cases of a penile block may also be attributed to the very small, dorsal penile nerve, which cannot be visualized easily on ultrasonograms. [12] In a study performed with 260 patients, Roberts et al [13] demonstrated that despite the minimal side effects of an intraoperatively administered, single dose of IV paracetamol, the addition of a single IV dose of paracetamol to standard narcotic and non-narcotic analgesics did not provide a sta-tistically significant improvement in pain control. Jung et al [14] demonstrated that IV fentanyl in doses of 1.5 μg kg -1 decreased postoperative agitation without prolonging the recovery period, and no significant correlation was found between preoperative anxiety and postoperative agitation.…”

Section: Discussionmentioning

confidence: 99%

The Evaluation of the Factors Affecting Emergence Agitation in Pediatric Anesthesia Practise

Uğur¹

2018

South Clin Ist Euras

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Objective:The agitation that is sometimes seen in children during the recovery period after the administration of anesthesia can be a difficult problem to solve, and can turn a successful procedure into a distressing situation. This prospective, observational study was intended to determine factors that may lead to postoperative agitation in children in order to contribute to future pediatric anesthesia studies. Methods:A total of 206 patients between 3 and 10 years of age who underwent operations performed by the departments of orthopedics and traumatology; urology; eye diseases; ear, nose, and throat diseases; pediatric surgery; and plastic and reconstructive surgery and whose physical status was classified as American Society of Anaesthesiologists I or II were included in the study. The patients' age, gender, details of preoperative fasting, previous surgeries (if any), premedication used (if any) and the method of application, the induction technique and drug used for anesthesia, airway management method, drugs used to maintain anesthesia and duration, postoperative analgesic management, and the duration of stay in the recovery room were recorded. In addition, the Face, Legs, Activity, Cry, Consolability score; the Pediatric Anesthesia Emergence Delirium score; and the modified Aldrete score recorded at the postoperative 10 th minute were analyzed.Results: Statistical evaluation revealed that age, operation type, anesthesia technique and drug selected, airway management method, drug used for induction and maintenance of anesthesia, and the duration of anesthesia significantly affected postoperative agitation (p<0.05). Regression analysis determined that patient age and the drug selected for the induction and the maintenance of anesthesia were independent risk factors for agitation developing during the recovery period. Conclusion:The age of the child, the duration of anesthesia, and the preferred anesthesia induction technique were the primary factors affecting agitation seen in children during recovery from anesthesia. Since the age of the patient and the duration of the surgery and anesthesia are factors that it is difficult or impossible to change, the anesthesia induction technique to be used is an important tool for the anesthesiologist to control the development of agitation during the recovery period.

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“…Paediatric circumcision is a common procedure [19] and caudal adjuvant drugs are frequently used to prolong analgesia. This study adds to the evidence base to support this practice.…”

Section: Discussionmentioning

confidence: 99%

A comparison of caudal bupivacaine and ketamine with penile block for paediatric circumcision

Margetts

Carr

McFadyen

et al. 2008

European Journal of Anaesthesiology

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A prmpective blind trial wus conducted comparing the analgesia and udrerse eflecrs produced h.y c~uudul extradural blockude (cuudul block) with blockade of' the dorsal nerves of the penis (penile hlmck) in 38 ho.ys undergoing elective circumcision. Analgesia was assessed by senior nurses using a linear unulopr .scale and by the response to direct questioning over the jirst 7 hours ufter .rurgerj. The degree und durution of' postoperative analgesia was similar in the fwo groups. However. the r~uudul hlock group iiud u higher incidence q f motor hlockude (p = < 0.01). One technical.failirre occurred in the penile block group. If is cmcluded that N penile block is a satisfactory alternative to ruudul hlwkatlr n.ith rrgurd t(1 postoperative unulgesia and q&s several spec@c advantages. There is a continuing search for a completely satisfactory method of pain relief after circum-cision. The basic requirements of any technique are that it is safe, reliably effective, and produces analgesia of adequate duration. In addition, further requirements can be suggested. including ease of administration. avoidance of the pain of injection, and a low risk of adverse effects, particularly those with serious and permanent sequelae. In the case of day-case surgery, rapid recovery is of importance. Caudal blockade with local anaesthetic solutions administered after induction of general anaesthesia prior to surgcry, has become a widespread approach to the problem. having been shown to be more efi-ective than intramuscular morphine.' However, although this has been shown to be a very safe technique, there is, nonetheless. a significant incidence of serious neurological sequelae.2 Batemanj advocates penile blockade as a simple and equally effective alternative. Bacon4 evaluated this technique in 20 patients, 17 of whom were children undergoing circum-cision. All cases experienced no pain for at least 6 hours postoperatively and no complications were noted during surgery, recovery. or at routine outpatient follow up. A blind prospective study was therefore planned to compare the techniques of penile and caudal blockade.

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Caudal epidural block versus other methods of postoperative pain relief for circumcision in boys

Cited by 18 publications

References 16 publications

Analgesic efficacy and impact of caudal block on surgical complications of hypospadias repair: a systematic review and meta-analysis

Analgesic efficacy and impact of caudal block on surgical complications of hypospadias repair: a systematic review and meta-analysis

The Evaluation of the Factors Affecting Emergence Agitation in Pediatric Anesthesia Practise

A comparison of caudal bupivacaine and ketamine with penile block for paediatric circumcision

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