Perioperative effects of caudal and transversus abdominis plane (TAP) blocks for children undergoing urologic robot-assisted laparoscopic surgery

Faasse, Mark A.; Lindgren, Bruce W.; Frainey, Brendan; Marcus, C.R.; Szczodry, D.M.; Glaser, Alexander; Suresh, Santhanam; Gong, Edward M.

doi:10.1016/j.jpurol.2014.10.010

Cited by 20 publications

(12 citation statements)

References 28 publications

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“…A recent assessment of regional anesthesia options following robotic assisted procedures including transversus abdominal plane (TAP) and caudal blocks versus no regional block addressed these questions. A significant reduction in intraoperative opioid use and need for antiemetics was seen in children undergoing upper or lower tract urologic robotic surgery with a caudal block as compared to TAP or no regional anesthesia [ 65 ]. However, there was no significant difference in postoperative opioid use, maximum pain scores within 24 h postoperatively or length of hospital stay [ 65 ].…”

Section: Robotic Approaches To Reconstructive Proceduresmentioning

confidence: 99%

“…A significant reduction in intraoperative opioid use and need for antiemetics was seen in children undergoing upper or lower tract urologic robotic surgery with a caudal block as compared to TAP or no regional anesthesia [ 65 ]. However, there was no significant difference in postoperative opioid use, maximum pain scores within 24 h postoperatively or length of hospital stay [ 65 ]. As surgical management options continue to evolve, ongoing optimization of surgical planning and perioperative management continues to be needed to refine techniques and outcomes for children with neurogenic bladder.…”

Section: Robotic Approaches To Reconstructive Proceduresmentioning

confidence: 99%

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The Management of the Pediatric Neurogenic Bladder

Cheng

2016

Curr Bladder Dysfunct Rep

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Neurogenic bladder is a heterogeneous entity that may result from a variety of conditions affecting the central or peripheral nervous systems. Regardless of etiology, the overall goals of management are primarily twofold. As a neurogenic bladder may affect the ability to store urine safely and to empty the bladder efficiently, early management is focused on optimization of bladder storage function to prevent irreversible injury to either the upper or lower urinary tracts. In older children, this goal is added to the challenge of maximizing quality of life through achievement of urinary continence and independence in bladder management that continues into the transition to adulthood.In this review, we seek to bring the reader up-to-date regarding management of the pediatric neurogenic bladder with a focus on literature published in the past year. We discuss key contributions related to fetal intervention for myelomeningocele, monitoring and medical management of the neurogenic bladder and prediction of postoperative outcomes. Put together, these studies highlight the continued need for further research to improve evidence-based medical and surgical decision-making strategies for children affected by neurogenic bladder.

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Section: Robotic Approaches To Reconstructive Proceduresmentioning

confidence: 99%

Section: Robotic Approaches To Reconstructive Proceduresmentioning

confidence: 99%

The Management of the Pediatric Neurogenic Bladder

Cheng

2016

Curr Bladder Dysfunct Rep

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“…Caudal block, a well-established technique in pediatric surgeries such as lower limb surgery and lower abdominal surgery, can produce good analgesic effects and maintain stable hemodynamics [11–13]. Several studies show that caudal block also produces good postoperative analgesic effects after pediatric laparoscopic surgery [14, 15]. However, to our knowledge, only a small number of studies have investigated the effect of caudal block in the laparoscopic surgery for upper abdomen [14, 16], and few of them have investigated the impact of caudal block on opioid sparing during pediatric surgeries.…”

Section: Introductionmentioning

confidence: 99%

“…Several studies show that caudal block also produces good postoperative analgesic effects after pediatric laparoscopic surgery [14, 15]. However, to our knowledge, only a small number of studies have investigated the effect of caudal block in the laparoscopic surgery for upper abdomen [14, 16], and few of them have investigated the impact of caudal block on opioid sparing during pediatric surgeries. Therefore, we conducted a prospective study to investigate the effect of caudal block on upper abdominal surgery under laparoscopy.…”

Section: Introductionmentioning

confidence: 99%

Perioperative effects of caudal block on pediatric patients in laparoscopic upper urinary tract surgery: a randomized controlled trial

Tao

Wang

et al. 2019

BMC Pediatr

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BackgroundWhile caudal block has been widely used during pediatric lower limbs and lower abdominal surgeries, few studies to date have evaluated the perioperative effects of caudal block on pediatric patients in laparoscopic upper urinary tract surgery.MethodsNinety-six pediatric patients, aged 6 months to 7 years, ASA grade I-II, scheduled to undergo laparoscopic upper urinary tract surgery, were randomized to a non-block group (no caudal block performed), an ROP1.0 group (patients received 1.0 mL/kg of 0.15% ropivacaine) and an ROP1.3 group (patients received 1.3 mL/kg of 0.15% ropivacaine). The primary outcome variable was perioperative fentanyl use. The secondary outcome variables were pain score, hemodynamic fluctuation, the number of patients needing rescue fentanyl and side effects.ResultsCaudal block with 1.3 mL/kg of 0.15% ropivacaine significantly decreased perioperative fentanyl usage (ROP 1.3 vs. non-caudal block, P < 0.01; ROP 1.3 vs. ROP 1.0, P < 0.05). Moreover, patients in the ROP1.3 group, compared to those without, displayed more stable hemodynamics, lower pain score in the PACU and 8 h after operation, less demand for rescue fentanyl, shorter time of PACU stay.ConclusionsCaudal block with 1.3 mL/kg of 0.15% ropivacaine reduced perioperative fentanyl use during laparoscopic upper urinary tract surgery on pediatric patients and produced good postoperative analgesia when compared with no caudal block and caudal block with 1.0 mL/kg of 0.15% ropivacaine.Trial registrationClinical trial number: ChiCTR1800015549, chictr.org.cn.

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“…Evidence showed that caudal block had advantage of higher safety profile over other regional or local anaesthesia modalities [3] . A Chicago retrospective study revealed that caudal block could effectively reduce intraoperative opioids use compared with TAP in paediatric robotic assisted urological surgeries [4] . On contrary, use of caudal block was less desirable in adult patients mainly because of anaesthesiologist's unfamiliarity, inferior location of puncture, lower efficacy and risk of infection [5] .…”

Section: Introductionmentioning

confidence: 99%

The effect of adjunct caudal block on postoperative analgesia in robot-assisted laparoscopic radical prostatectomy: A prospective randomized controlled, single blinded pilot study in a tertiary centre

Chen

Sim

Kan

2018

Asian Journal of Urology

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ObjectiveCaudal block provides satisfactory postoperative pain relief in lower abdominal operations. This pilot study explores its safety and effect on postoperative pain control in patients who underwent robot-assisted laparoscopic radical prostatectomy (RARP).MethodsFrom 2013 to 2014, 40 consecutive patients were randomized into two groups — one received caudal block using ropivacaine immediately after operation, the other received standard analgesia. Primary outcome measure was pain score based on 11-point Likert scale (0–10) recorded at recovery room, and at 6, 12, 24, 48, and 72 h after operation. All analgesic requirements, opioid-related adverse events and time to passage of flatus were examined.ResultsMean age of the two groups was similar (60.4 vs. 62.3 years, p = 0.33), as was American Society of Anaesthesiologists (ASA) class, body mass index (BMI) and operation times. No significant difference in median pain scores was reported in recovery room (2 vs. 3, p = 0.34), and at 6 h (2 vs. 2, p = 0.94), 12 h (0 vs. 0, p = 0.62), 24 h (1 vs. 0, p = 0.58), 48 h (1 vs. 0, p = 0.36) and 72 h (0 vs. 0, p = 0.78) postoperatively between control and caudal block groups, respectively. There was a higher mean opioid usage in the caudal block group which was not statistically significant. Although this was statistically insignificant while no significant difference in mean paracetamol usage was observed postoperatively. Median time to passage of flatus was similar (2.0 vs. 2.0 days, p = 0.97). There was one case of superficial wound infection and no opioid-related adverse events observed. Hospital stay was similar in both groups (2.5 vs. 2.5 days, p = 0.96).ConclusionAlthough a safe modality, caudal block in post RARP patients does not seem to improve pain control nor reduce analgesia requirements.

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Perioperative effects of caudal and transversus abdominis plane (TAP) blocks for children undergoing urologic robot-assisted laparoscopic surgery

Cited by 20 publications

References 28 publications

The Management of the Pediatric Neurogenic Bladder

The Management of the Pediatric Neurogenic Bladder

Perioperative effects of caudal block on pediatric patients in laparoscopic upper urinary tract surgery: a randomized controlled trial

The effect of adjunct caudal block on postoperative analgesia in robot-assisted laparoscopic radical prostatectomy: A prospective randomized controlled, single blinded pilot study in a tertiary centre

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