Comparison of Ultrasound-Guided Caudal Epidural Blocks and Spinal Anesthesia for Anorectal Surgery: A Randomized Controlled Trial

Chen, Shibiao; Wei, Aiping; Jia, Min; Li, Lei; Zhang, Yang

doi:10.1007/s40122-022-00389-7

Cited by 9 publications

(7 citation statements)

References 18 publications

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“…There were a further 7 reports involving 153 patients where awake combined spinal caudal anesthesia was performed. There were 3 prospective trials, 12,21,22,54,55 1 retrospective trial, 10 2 randomized controlled trials and 1 case report (Table 2). 56…”

Section: Includedmentioning

confidence: 99%

Awake caudal anesthesia in ex‐premature infants undergoing lower abdominal surgery: A narrative review

Frawley,

McCann

2023

Pediatric Anesthesia

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Background and ObjectivesThe aim of this narrative review is to evaluate the literature describing the use of caudal anesthetic‐based techniques in premature and ex‐premature infants undergoing lower abdominal surgery.MethodsAll available literature from inception to August 2023 was retrieved according to Preferred Reporting Items for Systematic Reviews and Meta‐Analysis guidelines from Medline, PubMed, Embase, and the Cochrane Library. Two authors reviewed all references for eligibility, abstracted data, and appraised quality.ResultsOf the 211 articles identified, 45 met our inclusion criteria yielding 1548 cases with awake caudal anesthesia. The review included 558 (36.0%) cases of awake caudal anesthesia, 837 cases (54.1%) of “awake” caudal anesthesia with sedation, and 153 cases (9.9%) of combined spinal caudal epidural anesthesia without sedation.The overall anesthetic failure rate was 7.2% (71.9:1000 caudals). Failure rates were highest for CSEA (13.7%, 7.7–18.4), intermediate for awake caudal (6.6%, 5.26–9.51), and lowest for sedated caudal anesthesia (5.85%, 4.48–7.82). The incidence (range) of perioperative apnea was highest for sedated caudal anesthesia (8.16, 0%–24%), intermediate for awake caudal (7.62%, 0%–60%), and lowest for CSEA (5.53%, 0%–14.3%).High spinal anesthesia occurred in 0.84%, or 8.35:1000 caudals overall. The incidence was highest in awake caudal anesthesia cases (1.97% or 19.7:1000 caudals), intermediate with caudal with sedation (1.07% or 10.7:1000 caudals), and lowest in CSEA (0.7% or 6.6:1000 caudals).Our review was confounded by incomplete data reporting and small sample sizes as most were case reports. There were no high‐quality randomized controlled trials, and the eight single‐center retrospective data reviews lacked sufficient data to perform meta‐analysis.ConclusionsThere is insufficient evidence to validate or refute the benefits of the use of “awake” caudal anesthesia in premature and ex‐premature infants. The high doses of local anesthetics used, the high failure rate, and the increased incidence of high spinal anesthesia would suggest that the techniques offer no real advantages over awake spinal anesthesia or general anesthesia with a regional block.

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Section: Includedmentioning

confidence: 99%

Awake caudal anesthesia in ex‐premature infants undergoing lower abdominal surgery: A narrative review

Frawley,

McCann

2023

Pediatric Anesthesia

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“…We read with great interest the article by Chen et al [ 1 ] which revealed that, compared with spinal anesthesia (SA), the application of ultrasound-guided caudal epidural blocks (CEB) in anorectal surgery had improved the satisfaction of patients, including effective analgesia 24 h after operation, reduced the need for analgesia, reduced the incidence of phantom limb syndrome (PLS), postoperative nausea and vomiting (PONV), reduced the incidence of mean arterial pressure (MAP) > 20% from baseline, and delayed the time of first request for analgesia. These excellent results might provide the choice of anesthesia methods in our clinical work.…”

Section: Key Summary Pointsmentioning

confidence: 99%

Letter to the Editor Regarding “Comparison of Ultrasound-Guided Caudal Epidural Blocks and Spinal Anesthesia for Anorectal Surgery: A Randomized Controlled Trial”

Zhu

2022

Pain Ther

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“…To the Editor, Thank you for informing us about the letter discussing our recently published research article ''Comparison of ultrasound-guided caudal epidural blocks and spinal anesthesia for anorectal surgery: a randomized controlled trial'' [1]. We would like to thank Professor Zhu et al for their kind comments about our research.…”

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confidence: 99%

A Response to: Letter to the Editor Regarding “Comparison of Ultrasound-Guided Caudal Epidural Blocks and Spinal Anesthesia for Anorectal Surgery: A Randomized Controlled Trial”

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Comparison of Ultrasound-Guided Caudal Epidural Blocks and Spinal Anesthesia for Anorectal Surgery: A Randomized Controlled Trial

Cited by 9 publications

References 18 publications

Awake caudal anesthesia in ex‐premature infants undergoing lower abdominal surgery: A narrative review

Awake caudal anesthesia in ex‐premature infants undergoing lower abdominal surgery: A narrative review

Letter to the Editor Regarding “Comparison of Ultrasound-Guided Caudal Epidural Blocks and Spinal Anesthesia for Anorectal Surgery: A Randomized Controlled Trial”

A Response to: Letter to the Editor Regarding “Comparison of Ultrasound-Guided Caudal Epidural Blocks and Spinal Anesthesia for Anorectal Surgery: A Randomized Controlled Trial”

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