Do caudal blocks cause complications following hypospadias surgery in children?

Ayob, Farrah; Arnold, R.

doi:10.1111/anae.13490

Cited by 14 publications

(14 citation statements)

References 17 publications

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“…Previous studies have demonstrated that duration of surgery and type of hypospadias repair impact surgical results. Additional complicating factors were the specific surgical technique, patient age, penile engorgement, postoperative inflammatory response, and tissue edema …”

Section: Introductionmentioning

confidence: 99%

Effect of anesthesia for hypospadias repair on perioperative complications

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Kim

et al. 2019

Pediatric Anesthesia

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Hypospadias is a common anomaly among males 1 with several variations, each with a slightly different surgical approach toward correction of the defects in the urethral fold and ventral foreskin. 1 Previous studies have demonstrated that duration of surgery and type of hypospadias repair impact surgical results. Additional complicating factors were the specific surgical technique, patient age, penile engorgement, postoperative inflammatory response, and tissue edema. [1][2][3][4][5][6][7][8] Recent publications from centers in the United States, India, and Korea report that children undergoing hypospadias repair with caudal regional anesthesia/analgesia could have increased postoperative surgical complications. [2][3][4][5] This was unexpected to many of us, AbstractBackground: Recent publications from the United States, India, and Korea report that children undergoing hypospadias repair with caudal regional anesthesia/analgesia could have increased postoperative surgical complications. Aims:The purpose of this retrospective cohort study was to assess the impact between caudal regional anesthesia, other regional anesthesia, and no regional anesthesia on complications after hypospadias repair at a tertiary care children's hospital in Ottawa, Canada, with an expectation to changing practices if a link was found. Method:We reviewed the health records of 827 children with hypospadias undergoing penile surgery from January 1991-June 2017. The final sample size for the analysis consisted of 764 patients and 825 procedures. Results:The overall complications were almost identical when considering anesthesia effects, and this similarity persisted when we assessed specifically for only surgical complications. We had 716, 94, and 15 subjects who had a caudal block, penile block, and general anesthesia only, respectively, and their complication rates were 28, 31, and 27%, respectively, and their fistula formation rates were 10, 6, and 0%, respectively, and their stricture formation rates were 8, 7, and 20%,, respectively.Hypospadias type and surgical repair technique were marked predictors of complications in the postoperative period.Conclusion: Anesthesia technique appears to have minor impact on complications after hypospadias repair, while surgical technique and type of hypospadias impact complications after hypospadias surgery in children. Based upon these results, we will not change our current practice of using a variety of regional anesthesia techniques for children undergoing hypospadias repair. K E Y W O R D Sanesthesia, caudal, complications, hypospadias repair, regional anesthesia | 761as a caudal has been routine practice of pediatric anesthesiologists for 40+ years and is strongly supported by most surgical colleagues and families.We wanted to review our results and determine if the issues and concerns noted in other centers were also occurring at Children's Hospital of Eastern Ontario, Ottawa, Canada. If so, we would need to change our routine practice to an improved, evidence-based medicine practice, ie, stop ...

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Section: Introductionmentioning

confidence: 99%

Effect of anesthesia for hypospadias repair on perioperative complications

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Kim

et al. 2019

Pediatric Anesthesia

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“…Proximal hypospadias is associated with a much higher incidence of all of the complications that were evaluated in this study. When evaluating distal hypospadias alone, the incidence of fistula and all other complications was comparable between the two groups, as noted in the accompanying editorial [2] and found in other papers [3,5]. The abstracts by SotoAviles et al [6], cited in the accompanying editorial in support of an association between caudal analgesia and fistula following hypospadias repair, have yet to be published in a peer-reviewed journal and must be viewed with caution.…”

Section: A L Ambrosoli L Guzzettimentioning

confidence: 51%

“…Successful nerve blockade is less reliably achieved than intrathecal anaesthesia [2]. The obturator nerve supplies the adductor muscle group and gives off an articular branch to innervate the knee joint.…”

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confidence: 99%

“…The aim of our study was to compare two of the most commonly used regional techniques in day-case knee arthroscopy and not to promote regional anaesthesia versus general anaesthesia. Indeed, Tighe's observation about the supposed disadvantages of regional anaesthesia for day-case knee arthroscopy appears to be borne out by US data showing a fall in neuraxial anaesthesia use for meniscectomy from 11% in 1996 to 6.3% in 2006, although the use of peripheral nerve blocks increased from 0.6% to 9.8% over the same time period [2]. These data could be influenced by the complications associated to the local anaesthetic used in that period, and not seen with the prilocaine used in our study [3].…”

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confidence: 99%

“…In our study, we felt that the risk/benefit ratio of a third (obturator) block in addition to femoral and sciatic block was unfavorable. Caudal anaesthesia safety for hypospadias repair Kim et al reported an association between caudal block and postoperative complications following primary hypospadias repair [1,2]. I have also studied this subject [3], and would like to ask the authors about certain aspects of their methodology.…”

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confidence: 99%

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