Caudal Injection (caudal + injection)

Distribution by Scientific Domains
Medical Sciences100%

Selected Abstracts

Effect of dexmedetomidine on the characteristics of bupivacaine in a caudal block in pediatrics

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 2 2009
I. SAADAWY
Background: Dexmedetomidine (DEX) is a highly selective ,2 -adrenoceptor agonist that has been used increasingly in children. However, the effect of caudal DEX has not been evaluated before in children. This prospective randomized double-blinded study was designed to evaluate the analgesic efficacy of caudal DEX with bupivacaine in providing pain relief over a 24-h period. Methods: Sixty children (ASA status I) aged 1,6 years undergoing unilateral inguinal hernia repair/orchidopexy were allocated randomly to two groups (n=30 each). Group B received a caudal injection of bupivacaine 2.5 mg/ml, 1 ml/kg; Group BD received the same dose of bupivacaine mixed with DEX 1 ,g/kg during sevoflurane anesthesia. Processed electroencephalogram (bispectral index score), heart rate, blood pressure, pulse oximetry and end-tidal sevoflurane were recorded every 5 min. The characteristics of emergence, objective pain score, sedation score and quality of sleep were recorded post-operatively. Duration of analgesia and requirement for additional analgesics were noted. Results: The end-tidal sevoflurane concentration and the incidence of agitation were significantly lower in the BD group (P<0.05). The duration of analgesia was significantly longer (P<0.001) and the total consumption of rescue analgesic was significantly lower in Group BD compared with Group B (P<0.01). There was no statistically significant difference in hemodynamics between both groups. However, group BD had better quality of sleep and a prolonged duration of sedation (P<0.05). Conclusion: Caudal DEX seems to be a promising adjunct to provide excellent analgesia without side effects over a 24-h period. It has the advantage of keeping the patients calm for a prolonged time. Implications statement: Caudally administered DEX (1 ,g/kg), combined with bupivacaine, was associated with an extended duration of post-operative pain relief. [source]

Efficacy of bupivacaine-neostigmine and bupivacaine-tramadol in caudal block in pediatric inguinal herniorrhaphy

PEDIATRIC ANESTHESIA, Issue 9 2010
REZA TAHERI MD
Summary Background:, Limited duration of analgesia is among the limitations of single caudal injection with local anesthetics. Therefore, the purpose of this study was to evaluate the effectiveness and safety of bupivacaine in combination with either neostigmine or tramadol for caudal block in children undergoing inguinal herniorrhaphy. Methods:, In a double-blinded randomized trial, sixty children undergoing inguinal herniorrhaphy were enrolled to receive a caudal block with either 0.25% bupivacaine (1 ml·kg,1) with neostigmine (2 ,g·kg,1) (group BN) or tramadol (1 mg·kg,1) (group BT). Hemodynamic variables, pain and sedation scores, additional analgesic requirements, and side effects were compared between two groups. Results:, Duration of analgesia was longer in group BT (17.30 ± 8.24 h) compared with group BN (13.98 ± 10.03 h) (P = 0.03). Total consumption of rescue analgesic was significantly lower in group BT compared with group BN (P = 0.04). There were no significant differences in heart rate, mean arterial pressure, and oxygen saturation between groups. Adverse effects excluding the vomiting were not observed in any patients. Conclusion:, In conclusion, tramadol (1 mg·kg,1) compared with neostigmine (2 ,g·kg,1) might provide both prolonged duration of analgesia and extended time to first analgesic in caudal block. [source]

A survey of pediatric caudal extradural anesthesia practice

PEDIATRIC ANESTHESIA, Issue 9 2009
ROBERT MENZIES MBBS FRCA
Summary Background:, Caudal extradural blockade is one of the most commonly performed procedures in pediatric anesthesia. However, there is little information available on variations in clinical practice. Objectives:, To perform a survey of members of the Association of Paediatric Anaesthetists of Great Britain and Ireland who undertake caudal anesthesia. Methods:, An ,online' World Wide Web questionnaire collected information on various aspects of clinical practice. The survey ran from April to June 2008. Results:, There were 366 questionnaires completed. The majority of respondents had >5 years of pediatric experience and performed up to ten caudal extradural procedures a month. The commonest device used was a cannula (69.7%) with 68.6% using a 22G device. There was a trend toward the use of a cannula in those anesthetists with <15 years experience, while those with >15 years experience tended to use a needle. Most anesthetists (91.5%) did not believe that there was a significant risk of implantation of dermoid tissue into the caudal extradural space. The majority used a combination of clinical methods to confirm correct placement. Only 27 respondents used ultrasound. The most popular local anesthetics were bupivacaine (43.4%) and levobupivacaine (41.7%). The most common additives were clonidine (42.3%) and ketamine (37.5%). The caudal catheter technique was used by 43.6%. Most anesthetists (74%) wear gloves for a single shot caudal injection. Conclusions:, This survey provides a snapshot of current practice and acts a useful reference for the development of enhanced techniques and new equipment in the future. [source]

Transient loss of motor-evoked responses associated with caudal injection of morphine in a patient with spondylolisthesis undergoing spinal fusion

PEDIATRIC ANESTHESIA, Issue 5 2006
PETER R.J. GIBSON MBBS FANZCA
Summary A 7-year-old girl having posterior spinal fusion for Grade 3 anterior spondylolisthesis at the L5/S1 level was administered 2.5 mg of morphine in 10 ml saline via the caudal epidural route before surgery. Motor-evoked responses were markedly diminished in her lower limbs for 1 h following this but returned spontaneously. She suffered no neurological injury. The cause for this is postulated to be transient cauda equina compression from the volume of injectate. This complication of caudal injection has not been reported before. The possible mechanisms for this are discussed. We believe that significant L5/S1 spondylolisthesis should be considered a contraindication to the use of caudal epidural injections. [source]