Background And Objectives: The 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.
Methods: All 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.
Results: Of 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.
Conclusions: There 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.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1111/pan.14830 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Factors influencing agitation during anesthesia recovery after laparoscopic hernia repair under total inhalation combined with caudal block anesthesia.
World J Gastrointest Surg
November 2024
Department of Anesthesiology, Nanning Tenth People's Hospital, Nanning 530105, Guangxi Zhuang Autonomous Region, China.
Background: Laparoscopic hernia repair is a minimally invasive surgery, but patients may experience emergence agitation (EA) during the post-anesthesia recovery period, which can increase pain and lead to complications such as wound reopening and bleeding. There is limited research on the risk factors for this agitation, and few effective tools exist to predict it. Therefore, by integrating clinical data, we have developed nomograms and random forest predictive models to help clinicians predict and potentially prevent EA.
View Article and Find Full Text PDFA randomized double-blinded study assessing the effect of different doses of transnasal dexmedetomidine on the median effective concentration of ropivacaine for a caudal block.
Front Med (Lausanne)
November 2024
Department of Anesthesiology, Chongqing Traditional Chinese Medicine Hospital, Chongqing, China.
Background: Perineural administration of dexmedetomidine (PN-DEX) can enhance the efficacy of local anesthetics used in regional nerve blocks while decreasing the median effective concentration (EC50) of these anesthetics. Intranasal administration of dexmedetomidine (IN-DEX) is more accessible for sedation during regional anesthesia because of its non-invasive systemic administration and demonstrates synergism with local anesthetic. However, it remains unclear whether IN-DEX affects the EC50 of local anesthetics used in caudal blocks.
View Article and Find Full Text PDFBack to the Future: Historic Insights and Recent Innovations in Pediatric Regional Anesthesia.
J Clin Med
November 2024
Department of Anesthesiology, Stony Brook University Health Science Center, Stony Brook, NY 11794, USA.
Pediatric regional anesthesia is evolving with new peripheral nerve blocks and techniques aimed at improving perioperative pain management. While caudal blocks have long been standard due to their simplicity and low complication rates, newer fascial plane blocks offer comparable efficacy with enhanced nerve coverage tailored to specific surgeries. Moreover, adjuncts like dexmedetomidine and dexamethasone have shown promise in prolonging block duration and enhancing post-operative pain relief and patient satisfaction.
View Article and Find Full Text PDFComparison of the Analgesic Efficacy of Ultrasound-Guided Transperineal Approach Using Pudendal Nerve Block Versus Caudal Block in Children Undergoing Urological Surgeries: A Randomized Controlled Trial.
Cureus
November 2024
Department of Pediatrics and Neonatology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND.
Introduction: Caudal block is an effective regional anesthesia technique for perineal surgeries but is associated with various adverse effects. Recently, pudendal nerve block has emerged as a promising alternative for these procedures. This study assessed the effectiveness of a novel transperineal technique for ultrasound-guided pudendal nerve block and compares it with ultrasound-guided caudal block for perineal surgeries in pediatric patients.
View Article and Find Full Text PDFPrevalence of Caudal Block and Duration of Analgesia of Caudal Dexmedetomidine Adjunct in Pediatric Lower Abdominal Surgery.
J Nepal Health Res Counc
October 2024
Department of Anaesthesiology and Critical Care, Kanti Childrens Hospital, Maharajgunj, Kathmandu, Nepal.
Article Synopsis
- Caudal block is a popular method for managing postoperative pain in children, but its effects can be brief.
- This study evaluated the prevalence and effectiveness of dexmedetomidine as an adjunct to prolong analgesia in children aged 2 to 7 undergoing lower abdominal surgeries.
- Results showed that 50.03% of the 449 children received a caudal block, with those using dexmedetomidine and ropivacaine experiencing approximately 840 minutes of pain relief post-surgery.
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!