General versus general anaesthesia combined with caudal block in laparoscopic-assisted Soave pull-through of Hirschsprung disease: a retrospective study

Abstract

Background Caudal block is one of the most preferred regional anesthesia for sub-umbilical region surgeries in the pediatric population. However, few studies are available on caudal block performed in laparoscopic-assisted Soave pull-through of Hirschsprung disease (HD). We aimed to compare general anesthesia (GA) and general anesthesia combined with caudal block (GA + CA) in laparoscopic-assisted Soave pull-through of HD. Methods A retrospective review was performed in children with HD operated in our hospital between 2017 and 2020. Patients were divided into the GA and GA + CA group. The primary outcome was the duration of operation, and secondary outcomes included intraoperative hemodynamic changes, the Face, Legs, Activity, Cry, Consolability (FLACC) scale, dose of anesthetics, and incidence of side effects. Results A total of 47 children with HD were included in the study, including 20 in the GA group and 27 in the GA + CA Group. The two groups were similar in age, gender, weight and type of HD (P > 0.05). The GA + CA group had significantly shorter duration of operation (especially the transanal operation time) (median 1.20 h vs. 0.83 h, P < 0.01) and recovery time (mean 18.05 min vs. 11.89 min, P < 0.01). The mean doses of sufentanil and rocuronium bromide during the procedure and FLACC scores at 1 h and 6 h after surgery were also lower in the GA + CA group (p < 0.01). The hemodynamic changes in the GA + CA group were more stable at time of t2 (during transanal operation) and t3 (10 min after transanal operation), but there was no significant difference in the incidence of postoperative side effects between the two groups (P = 1.000). Conclusion General anesthesia combined with caudal block can shorten the duration of operation, and provide more stable intraoperative hemodynamics and better postoperative analgesia.

Caudal Block for Analgesia in Pediatrics Undergoing Hypospadias Repair Surgery under General Anesthesia

“…This was in concordance with Lin et al (7) , who had patients underwent caudal block with general anesthesia experienced decreased mean fentanyl and rocuronium bromide dosages during the surgery. They came to the conclusion that caudal block and general anesthesia together produced greater postoperative analgesia.…”

“…The aforementioned findings were consistent with Lin et al (7) research, which compared general anesthesia (GA), and GA and caudal anesthesia (CA) during a laparoscopically assisted Soave pull-through for Hirschsprung's disease. The recuperation time was noticeably quicker for the GA and CA group.…”

“…According to Lin et al (7) , there wasn't an obvious distinction among the two groups in the frequency of postoperative adverse effects, supporting the findings of the current investigation. Sharma et al's (15) research also demonstrated that caudal anesthesia provides superior intraoperative and post-operative analgesia with fewer problems.…”

“…The current research discovered that general anesthesia combined with caudal block resulted in greater hemodynamic stability than general anesthesia alone. The current finding was corroborated by Lin et al (7) , who found that hemodynamic parameters throughout the surgery were more stable in the general caudal group than in Group G.…”

“…This was supported by Lin et al (7) , who found that the FLACC scores in the general anesthetic plus caudal block group were lower at 1 and 6 hours following surgery. Additionally, Al-Metwally, Mohamed et al (13) discovered that although other postoperative outcomes are comparable, general anesthesia performs worse than caudal bupivacaine when using FLACC scores for postoperative analgesia in children under the age of six who are undergoing infra-umbilical procedures.…”