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Published in: BMC Pediatrics 1/2019

Open Access 01-12-2019 | Anesthetics | Research article

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

Authors: Bingdong Tao, Kun Liu, Dandan Wang, Mengmeng Ding, Ni Yang, Ping Zhao

Published in: BMC Pediatrics | Issue 1/2019

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Abstract

Background

While 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.

Methods

Ninety-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.

Results

Caudal 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.

Conclusions

Caudal 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 registration

Clinical trial number: ChiCTR1800015549​, chictr.org.cn.
Literature
1.
go back to reference Esposito C, Escolino M, Turrà F, Roberti A, Cerulo M, Farina A, Caiazzo S, Cortese G, Servillo G, Settimi A. Current concepts in the management of inguinal hernia and hydrocele in pediatric patients in laparoscopic era. Semin Pediatr Surg. 2016;25:232–40.CrossRef Esposito C, Escolino M, Turrà F, Roberti A, Cerulo M, Farina A, Caiazzo S, Cortese G, Servillo G, Settimi A. Current concepts in the management of inguinal hernia and hydrocele in pediatric patients in laparoscopic era. Semin Pediatr Surg. 2016;25:232–40.CrossRef
2.
go back to reference Amano H. Comparison of single-incision laparoscopic percutaneous extraperitoneal closure (SILPEC) and open repair for pediatric inguinal hernia: a single-center retrospective cohort study of 2028 cases. Surg Endosc. 2017;31:4988–95.CrossRef Amano H. Comparison of single-incision laparoscopic percutaneous extraperitoneal closure (SILPEC) and open repair for pediatric inguinal hernia: a single-center retrospective cohort study of 2028 cases. Surg Endosc. 2017;31:4988–95.CrossRef
3.
go back to reference Lacy AM, García-Valdecasas JC, Delgado S, Castells A, Taurá P, Piqué JM, Visa J. Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet. 2002;359:2224–9.CrossRef Lacy AM, García-Valdecasas JC, Delgado S, Castells A, Taurá P, Piqué JM, Visa J. Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet. 2002;359:2224–9.CrossRef
4.
go back to reference Sood J. Advancing frontiers in anaesthesiology with laparoscopy. WJG. 2014;20:14308.CrossRef Sood J. Advancing frontiers in anaesthesiology with laparoscopy. WJG. 2014;20:14308.CrossRef
5.
go back to reference Yoshida H, Kushikata T, Kabara S, Takase H, Ishihara H, Hirota K. Flat electroencephalogram caused by carbon dioxide pneumoperitoneum. Anesth Analg. 2007;105:1749–52 tableofcontents.CrossRef Yoshida H, Kushikata T, Kabara S, Takase H, Ishihara H, Hirota K. Flat electroencephalogram caused by carbon dioxide pneumoperitoneum. Anesth Analg. 2007;105:1749–52 tableofcontents.CrossRef
6.
go back to reference Collard V, Mistraletti G, Taqi A, Asenjo JF, Feldman LS, Fried GM, Carli F. Intraoperative esmolol infusion in the absence of opioids spares postoperative fentanyl in patients undergoing ambulatory laparoscopic cholecystectomy. Anesth Analg. 2007;105:1255–62 tableofcontents.CrossRef Collard V, Mistraletti G, Taqi A, Asenjo JF, Feldman LS, Fried GM, Carli F. Intraoperative esmolol infusion in the absence of opioids spares postoperative fentanyl in patients undergoing ambulatory laparoscopic cholecystectomy. Anesth Analg. 2007;105:1255–62 tableofcontents.CrossRef
7.
go back to reference Beers RA, Calimlim JR, Uddoh E, Esposito BF, Camporesi EM. A comparison of the cost-effectiveness of remifentanil versus fentanyl as an adjuvant to general anesthesia for outpatient gynecologic surgery. Anesth Analg. 2000;91:1420–5.CrossRef Beers RA, Calimlim JR, Uddoh E, Esposito BF, Camporesi EM. A comparison of the cost-effectiveness of remifentanil versus fentanyl as an adjuvant to general anesthesia for outpatient gynecologic surgery. Anesth Analg. 2000;91:1420–5.CrossRef
8.
go back to reference Basha I. A Systematic Analysis On Opioid-Free General Anesthesia Versus Opioid-Based General Anesthesia For Bariatric Surgery; 2017. p. 1–22. Basha I. A Systematic Analysis On Opioid-Free General Anesthesia Versus Opioid-Based General Anesthesia For Bariatric Surgery; 2017. p. 1–22.
9.
go back to reference Kumar K, Kirksey MA, Duong S, Wu CL. A review of opioid-sparing modalities in perioperative pain management. Anesth Analg. 2017;125:1749–60.CrossRef Kumar K, Kirksey MA, Duong S, Wu CL. A review of opioid-sparing modalities in perioperative pain management. Anesth Analg. 2017;125:1749–60.CrossRef
10.
go back to reference Brasher C, Gafsous B, Dugue S, Thiollier A, Kinderf J, Nivoche Y, Grace R, Dahmani S. Postoperative pain Management in Children and Infants: an update. Pediatr Drugs. 2014;16:129–40.CrossRef Brasher C, Gafsous B, Dugue S, Thiollier A, Kinderf J, Nivoche Y, Grace R, Dahmani S. Postoperative pain Management in Children and Infants: an update. Pediatr Drugs. 2014;16:129–40.CrossRef
11.
go back to reference Kao S-C, Lin C-S. Caudal epidural block: an updated review of anatomy and techniques. Biomed Res Int. 2017;2017:1–5.CrossRef Kao S-C, Lin C-S. Caudal epidural block: an updated review of anatomy and techniques. Biomed Res Int. 2017;2017:1–5.CrossRef
12.
go back to reference Marhofer P, Keplinger M, Klug W, Metzelder ML. Awake caudals and epidurals should be used more frequently in neonates and infants. Pediatr Anesth. 2014;25:93–9 Morton N, ed.CrossRef Marhofer P, Keplinger M, Klug W, Metzelder ML. Awake caudals and epidurals should be used more frequently in neonates and infants. Pediatr Anesth. 2014;25:93–9 Morton N, ed.CrossRef
13.
go back to reference Zhu C, Zhang S, Gu Z, Tong Y, Wei R. Caudal and intravenous dexamethasone as an adjuvant to pediatric caudal block: a systematic review and meta-analysis. Paediatr Anaesth. 2018;28:195–203.CrossRef Zhu C, Zhang S, Gu Z, Tong Y, Wei R. Caudal and intravenous dexamethasone as an adjuvant to pediatric caudal block: a systematic review and meta-analysis. Paediatr Anaesth. 2018;28:195–203.CrossRef
14.
go back to reference Faasse MA, Lindgren BW, Frainey BT, Marcus CR, Szczodry DM, Glaser AP, Suresh S, Gong EM. Perioperative effects of caudal and transversus abdominis plane (TAP) blocks for children undergoing urologic robot- assisted laparoscopic surgery. J Pediatr Urol. 2015;11:121.e1–7.CrossRef Faasse MA, Lindgren BW, Frainey BT, Marcus CR, Szczodry DM, Glaser AP, Suresh S, Gong EM. Perioperative effects of caudal and transversus abdominis plane (TAP) blocks for children undergoing urologic robot- assisted laparoscopic surgery. J Pediatr Urol. 2015;11:121.e1–7.CrossRef
15.
go back to reference Sethi N, Pant D, Dutta A, Koul A, Sood J, Chugh PT. Comparison of caudal epidural block and ultrasonography-guided transversus abdominis plane block for pain relief in children undergoing lower abdominal surgery. J Clin Anesth. 2016;33:322–9.CrossRef Sethi N, Pant D, Dutta A, Koul A, Sood J, Chugh PT. Comparison of caudal epidural block and ultrasonography-guided transversus abdominis plane block for pain relief in children undergoing lower abdominal surgery. J Clin Anesth. 2016;33:322–9.CrossRef
16.
go back to reference Sato M, Iida T, Kikuchi C, Sasakawa T, Kunisawa T. Comparison of caudal ropivacaine-morphine and paravertebral catheter for major upper abdominal surgery in infants. Paediatr Anaesth. 2017;27:524–30 Bosenberg A, ed.CrossRef Sato M, Iida T, Kikuchi C, Sasakawa T, Kunisawa T. Comparison of caudal ropivacaine-morphine and paravertebral catheter for major upper abdominal surgery in infants. Paediatr Anaesth. 2017;27:524–30 Bosenberg A, ed.CrossRef
17.
go back to reference Merkel SI, Voepel-Lewis T, Shayevitz JR, Malviya S. The FLACC: a behavioral scale for scoring postoperative pain in young children. Pediatr Nurs. 1997;23:293–7.PubMed Merkel SI, Voepel-Lewis T, Shayevitz JR, Malviya S. The FLACC: a behavioral scale for scoring postoperative pain in young children. Pediatr Nurs. 1997;23:293–7.PubMed
18.
go back to reference Johansson M, Kokinsky E. The COMFORT behavioural scale and the modified FLACC scale in paediatric intensive care. Nurs Crit Care. 2009;14:122–30.CrossRef Johansson M, Kokinsky E. The COMFORT behavioural scale and the modified FLACC scale in paediatric intensive care. Nurs Crit Care. 2009;14:122–30.CrossRef
19.
go back to reference Gupta A, Bah M. NSAIDs in the treatment of postoperative pain. Curr Pain Headache Rep. 2016;20:62.CrossRef Gupta A, Bah M. NSAIDs in the treatment of postoperative pain. Curr Pain Headache Rep. 2016;20:62.CrossRef
20.
go back to reference Hanna MN, Murphy JD, Kumar K, Wu CL. Regional techniques and outcome: what is the evidence? Curr Opin Anaesthesiol. 2009;22:672–7.CrossRef Hanna MN, Murphy JD, Kumar K, Wu CL. Regional techniques and outcome: what is the evidence? Curr Opin Anaesthesiol. 2009;22:672–7.CrossRef
21.
go back to reference Ma N, Duncan JK, Scarfe AJ, Schuhmann S, Cameron AL. Clinical safety and effectiveness of transversus abdominis plane (TAP) block in post-operative analgesia: a systematic review and meta-analysis. J Anesth. 2017;31:432–52.CrossRef Ma N, Duncan JK, Scarfe AJ, Schuhmann S, Cameron AL. Clinical safety and effectiveness of transversus abdominis plane (TAP) block in post-operative analgesia: a systematic review and meta-analysis. J Anesth. 2017;31:432–52.CrossRef
22.
go back to reference Brogi E, Kazan R, Cyr S, Giunta F, Hemmerling TM. Transversus abdominal plane block for postoperative analgesia: a systematic review and meta-analysis of randomized-controlled trials. Can J Anaesth. 2016;63:1184–96.CrossRef Brogi E, Kazan R, Cyr S, Giunta F, Hemmerling TM. Transversus abdominal plane block for postoperative analgesia: a systematic review and meta-analysis of randomized-controlled trials. Can J Anaesth. 2016;63:1184–96.CrossRef
23.
go back to reference Sandeman DJ, Bennett M, Dilley AV, Perczuk A, Lim S, Kelly KJ. Ultrasound-guided transversus abdominis plane blocks for laparoscopic appendicectomy in children: a prospective randomized trial. Br J Anaesth. 2011;106:882–6.CrossRef Sandeman DJ, Bennett M, Dilley AV, Perczuk A, Lim S, Kelly KJ. Ultrasound-guided transversus abdominis plane blocks for laparoscopic appendicectomy in children: a prospective randomized trial. Br J Anaesth. 2011;106:882–6.CrossRef
24.
go back to reference Kendigelen P, Tutuncu AC, Erbabacan E, Ekici B, Köksal G, Altındas F, Kaya G. Ultrasound-assisted transversus abdominis plane block vs wound infiltration in pediatric patient with inguinal hernia: randomized controlled trial. J Clin Anesth. 2016;30:9–14.CrossRef Kendigelen P, Tutuncu AC, Erbabacan E, Ekici B, Köksal G, Altındas F, Kaya G. Ultrasound-assisted transversus abdominis plane block vs wound infiltration in pediatric patient with inguinal hernia: randomized controlled trial. J Clin Anesth. 2016;30:9–14.CrossRef
25.
go back to reference Koo B-N, Hong J-Y, Kil HK. Spread of ropivacaine by a weight-based formula in a pediatric caudal block: a fluoroscopic examination. Acta Anaesthesiol Scand. 2010;54:562–5.CrossRef Koo B-N, Hong J-Y, Kil HK. Spread of ropivacaine by a weight-based formula in a pediatric caudal block: a fluoroscopic examination. Acta Anaesthesiol Scand. 2010;54:562–5.CrossRef
26.
go back to reference Schulte-Steinberg O, Rahlfs VW. Spread of extradural analgesia following caudal injection in children. A statistical study. Br J Anaesth. 1977;49:1027–34.CrossRef Schulte-Steinberg O, Rahlfs VW. Spread of extradural analgesia following caudal injection in children. A statistical study. Br J Anaesth. 1977;49:1027–34.CrossRef
27.
go back to reference Thomas ML, Roebuck D, Yule C, Howard RF. The effect of volume of local anesthetic on the anatomic spread of caudal block in children aged 1-7 years. Paediatr Anaesth. 2010;20:1017–21.CrossRef Thomas ML, Roebuck D, Yule C, Howard RF. The effect of volume of local anesthetic on the anatomic spread of caudal block in children aged 1-7 years. Paediatr Anaesth. 2010;20:1017–21.CrossRef
28.
go back to reference Brenner L, Marhofer P, Kettner SC, Willschke H, Machata A-M, Al-Zoraigi U, Lundblad M, Lönnqvist PA. Ultrasound assessment of cranial spread during caudal blockade in children: the effect of different volumes of local anaesthetics. Br J Anaesth. 2011;107:229–35.CrossRef Brenner L, Marhofer P, Kettner SC, Willschke H, Machata A-M, Al-Zoraigi U, Lundblad M, Lönnqvist PA. Ultrasound assessment of cranial spread during caudal blockade in children: the effect of different volumes of local anaesthetics. Br J Anaesth. 2011;107:229–35.CrossRef
29.
go back to reference Triffterer L, Machata A-M, Latzke D, Willschke H, Rebhandl W, Kimberger O, Marhofer P. Ultrasound assessment of cranial spread during caudal blockade in children: effect of the speed of injection of local anaesthetics. Br J Anaesth. 2012;108:670–4.CrossRef Triffterer L, Machata A-M, Latzke D, Willschke H, Rebhandl W, Kimberger O, Marhofer P. Ultrasound assessment of cranial spread during caudal blockade in children: effect of the speed of injection of local anaesthetics. Br J Anaesth. 2012;108:670–4.CrossRef
30.
go back to reference Lundblad M, Lönnqvist P-A, Eksborg S, Marhofer P. Segmental distribution of high-volume caudal anesthesia in neonates, infants, and toddlers as assessed by ultrasonography. Paediatr Anaesth. 2011;21:121–7.CrossRef Lundblad M, Lönnqvist P-A, Eksborg S, Marhofer P. Segmental distribution of high-volume caudal anesthesia in neonates, infants, and toddlers as assessed by ultrasonography. Paediatr Anaesth. 2011;21:121–7.CrossRef
Metadata
Title
Perioperative effects of caudal block on pediatric patients in laparoscopic upper urinary tract surgery: a randomized controlled trial
Authors
Bingdong Tao
Kun Liu
Dandan Wang
Mengmeng Ding
Ni Yang
Ping Zhao
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Pediatrics / Issue 1/2019
Electronic ISSN: 1471-2431
DOI
https://doi.org/10.1186/s12887-019-1812-0

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