Comparison of caudal block using bupivacaine and ketamine with ilioinguinal nerve block for orchidopexy in children

Abstract

SummaryWe have performed a retrospective analysis of the peri-operative course of 218 consecutive patients who underwent routine coronary artery bypass graft surgery in this institution. All patients received a standardised general anaesthetic using target-controlled infusions of alfentanil and propofol. One hundred patients also received thoracic epidural anaesthesia with bupivacaine and clonidine, started before surgery and continued for 5 days after surgery. The remaining 118 patients received target-controlled infusion of alfentanil for analgesia for the first 24 h after surgery, followed by intravenous patient-controlled morphine analgesia for a further 48 h. Using computerised patient medical records, we analysed the frequency of respiratory, neurological, renal, gastrointestinal, haematological and cardiovascular complications in these two groups. New arrhythmias requiring treatment occurred in 18% of the thoracic epidural anaesthesia group of patients compared with 32% of the general anaesthesia group (p 0.02). There was also a trend towards a reduced incidence of respiratory complications in the thoracic epidural anaesthesia group. The time to tracheal extubation was decreased in the epidural group, with the tracheas of 21% of the patients being extubated immediately after surgery compared with 2% in the general anaesthesia group (p < 0.001). There were no serious neurological problems resulting from the use of thoracic epidural analgesia.Keywords Anaesthetic techniques, regional; epidural, thoracic. Surgery ; coronary artery bypass grafts. Complications ; postoperative. ...................................................................................... Correspondence to: Dr N. B. Scott Accepted: 2 March 1997 In recent years there has been a growing interest in the use of thoracic epidural anaesthesia for coronary artery bypass surgery. Its potential advantages include excellent analgesia [1], improved pulmonary function [2], early tracheal extubation [2, 3] and cardiac protection as a result of sympathetic blockade [4]. Thoracic epidural anaesthesia decreases the stress response to sternotomy and cardiopulmonary bypass. Increased sympathetic activity may lead to an increase in arterial pressure, tachycardia and an imbalance between the myocardial oxygen demand and supply, with increased myocardial oxygen extraction and the possibility of ischaemic episodes. Moore et al. showed that plasma concentrations of adrenaline and noradrenaline did not increase in the first 24 h after cardiac surgery in patients receiving thoracic epidural anaesthesia compared with a conventional anaesthetic technique [5]. Other studies have shown that haemodynamic stability was maintained during and after surgery using thoracic epidural anaesthesia [6][7][8][9].Thoracic epidural anaesthesia has been shown to decrease pain and improve the endocardial to epicardial blood flow ratio, thereby decreasing the number of ischaemic episodes [10][11][12]. Thoracic epidural anaesthesia has also been shown to decrease infarct ...

Elective orchidopexy in the paediatric population: a trial of intra-operative spermatic cord block

“…They did not specifically measure post-operative pain. In a further comparison of IIB to caudal block in orchidopexy, Findlow's randomised trial of 40 boys found caudal block superior to IIB in both duration of analgesia and amount of analgesic required [21]. Comparing caudal block to IIB, Stow measured plasma bupivacaine concentrations and found that uptake was more rapid after IIB and reached a higher mean peak concentration.…”

“…Looking specifically at regional anaesthesia for orchidopexy, some studies suggest a superiority of caudal block over IIB (without the addition of SCB) [20,21]. Somri measured plasma catecholamines in 30 boys randomised to IIB or caudal block for orchidopexy [20].…”

Ultrasound-Guided Transversus Abdominis Plane Block Versus Ilioinguinal/Iliohypogastric Block in Intraoperative Anesthesia and Analgesia in Pediatric Patients: A Randomized Controlled Study

“…For postoperative pain control in children, regional analgesia is preferred more often because it is easier to apply and does not require additional equipment and care tients, but the results are contradictory (9,(13)(14)(15)(16). While the TAP block is associated with longer analgesia time, lower pain scores, and less analgesic need in some studies (13)(14)(15), it is argued in some studies that II/IH block is preffered in the postoperative period (9,16,17).…”

“…While the TAP block is associated with longer analgesia time, lower pain scores, and less analgesic need in some studies (13)(14)(15), it is argued in some studies that II/IH block is preffered in the postoperative period (9,16,17). In the meta-analysis of Wang et al (18) in 2016, it was emphasized that ultrasoundguided II/IH nerve or TAP blocks reduce the need for analgesia during surgery and reduce the pain scores significantly.…”

The epidural and intrathecal administration of ketamine

“…Findlow et al [101] made a comparison of caudal blocks using bupivacaine and ketamine with ilioinguinal nerve block. Forty boys weighing less than 25 kg undergoing unilateral orchidopexy were randomly allocated to receive one of two analgesic regimens.…”