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PEDİYATRİK CERRAHİDE KAUDAL ANALJEZİ ETKİNLİĞİNİN RETROSPEKTİF OLARAK DEĞERLENDİRİLMESİ

Year 2006, Volume: 7 Issue: 2, 27 - 30, 01.08.2006

Abstract

Amaç:Retrospektif olarak, hastanemizde 2006 yılının Ocak-Haziran ayları arasında, pediatrik cerrahideinguinal, ürogenital ve rektal bölgede elektif cerrahi operasyon geçirmiş 125 olguda genel anestezi indüksiyonusonrasında yapılan kaudal bloğun, intraoperatif, postoperatif dönemde analjezik etkinliğini vekomplikasyonlarını değerlendirmeyi amaçladık.Gereç ve yöntem:Retrospektif olarak pediatrik cerrahide elektif cerrahi operesyon geçirmiş kaudal blokuygulanmış hasta dosyalarında yer alan anestezi izlem, anestezi derlenme odası hasta takip ve hemşire gözlemformları incelenerek, demografik veriler, operasyon türü, indüksiyon ve idamede uygulanan anestezik ajanlar,anestezi şekli, kaudal blokta uygulanan lokal anesteziğin türü, miktarı, konsantrasyonu; intraoperatif,postoperatif dönemde uygulanan analjezik ihtiyaçları ile verilme zamanları ve komplikasyonlar kaydedilmiştir.Bulgular:Yaş ortalamaları 41.57±38.55, yaş aralığı 1-132 ay olup, cinsiyet 118 erkek (%94.4) ve 7 kız (%5.6),vücut ağırlıkları ortalama 14.60±7.81 kg olarak bulundu. Kaudal blokla %0.25 bupivakainden 1ml/kg uygulananhastaların anestezi süreleri ortalama 61.50±42.07 dak. olarak bulunmuştur. İntraoperatif dönemde herhangi biranaljezik yapılmamış olup postoperatif analjezi süreleri ortalama 412.88±163.13 dak. olarak saptanmıştır.Postoperatif dönemde herhangi bir komplikasyon bildirilmemiştir.Sonuç:Kaudal blok pediatrik cerrahide inguinal, ürogenital, rektal bölgede yapılan operasyonlarda intraoperatifve postoperatif dönemde analjezi sağlamada etkili bir yöntem olduğunu gözlemledik

References

  • 1. Silvani P, Camporesi A, Agostino MR, Salvo I. Caudal anaesthesia in pediatrics: an update. Minerva Anesthesiol 2006; 72; 453-9.
  • 2. Kayhan Z., Klinik Anestezi , Logos Yayıncılık, Mayıs 2004. 3. baskısayfa 694-5.
  • 3. Dalens B, Hasnaoui A. Caudal anesthesia in pediatric surgery: success rate and adverse effects in 750 consecutive patients.AnesthAnalg 1989: 68: 83-9.
  • 4. Locatelli B, Ingelmo P, Sonzogni V, Zanella A, Gatti V, Spotti2 A, Di Marco S, Fumagalli R. Randomized, double-blind, phase III, controlled trial comparing levobupivacaine 0.25%, ropivacaine 0.25% and bupivacaine 0.25% by the caudal route in children. Br J Anaesth 2005; 94: 36671.
  • 5. Giaufre E, Dalens B, Gombert A. Epidemiology and morbidity of regional anesthesia in children: a one-year prospective survey of the French-Language Society of Pediatric Anesthesiologists.Anesth Analg 1996; 83: 9412.
  • 6. Morgan GE, Mikhail MS, Murray MJ, Larson CP. Clinical Anesthesiology, ingilizce 3. baskıdan Türkçe'ye çevrilmiş, 3. baskı (çeviren: Tulunay M, Cuhruk H.) Güneş Kitabevi,Ankara, 2004; 273-4.
  • 7. Tobias JD. Postoperative analgesia and intraoperative inhalational anesthetic requirements during umbilical herniorrhaphy in children: postincisional local infiltration versus preincisional caudal epidural block. J ClinAnesth. 1996; 8: 634-8.
  • 8. Mazoit JX, Decaux A, Bouaziz H, Edouard A. Comparative ventricular electrophysiologic effect of racemic bupivacaine, levobupivacaine, and ropivacaine on the isolated rabbit heart. Anesthesiology 2000; 93: 78492.
  • 9. Morrison SG, Dominguez JJ, Frascarolo P, Reiz S. A comparison of the electrocardiographic cardiotoxic effects of racemic bupivacaine, levobupivacaine, and ropivacaine in anesthetized swine. Anesth Analg 2000; 90: 130814.
  • 10. Breschan C, Jost R, Krumphuolz R, Schaumberger F, Sttetner H, Marhofer P, Likar R. A prospective study comparing the analgesic efficacy of levobupivacaine, ropivacaine and bupivacaine in pediatric patient undergoing caudal blockade. PediatrAnaesth 2005; 15: 301-6.
  • 11. Frawley GP, Downie S, Huang GH. Levobupivacaine caudal anesthesia in children a randomized double blind comparison with bupivacaine. Pediatr Anaesth 2006; 16: 754-60.
  • 12. Johnston P, Findlow D, Aldridge LM et al. The effect of ketamine on 0.25% and 0.125% bupivacaine for caudal epidural blockade in children. Pediatr Anaesth 1999; 9: 31-4.
  • 13. Gunter JB, Dunn CM, Bennie JB, Pentecost DL, Bower RJ, Ternberg JL. Optimum concentration of bupivacaine for combined caudal-general anesthesia in children.Anesthesiology 1991; 75: 57-61
  • 14. Hansen TG, Morton NS, Cullen PM, Watson DG. Plasma concentrations and pharmacokinetics of bupivacaine with and without adrenaline following caudal anaesthesia in infants. Acta Anaesthesiol Scand 2001; 45: 42-7.
  • 15. De Beer DAH, Thomas ML. Caudal additives in children--solutions or problems. Br JAnaesth 2003; 90: 487-98.
  • 16. Gunter J. Caudal anesthesia in children: A survey. Anesthesiology 1991; 75: 936
  • 17. Veyckemans F, Van Obbergh LJ, Gouverneur JM. Lessons from 1100 pediatric caudal blocks in a teaching hospital. RegAnesth 1992; 17: 119-25.
  • 18. Sanders JC. Paediatric regional anaesthesia, a survey of practice in the United kingdom. Br J Anaesth 2002; 89; 707-10.
  • 19. Schrock CR, Barry J. The dose of caudal epidural analgesia andduration of postoperative analgesia PediatrAnaesth 2003; 3: 403-8.
  • 20. Verghese ST, Hannallah ST, Rice LJ, BelmanAB, Patel KM. Caudal anaesthesia in children: effecte of volume vs concentration of bupivacaine on blockingspermetic cord traction response during orchidopexy. Anesth Analg 2002; 95: 1219-23.
  • 21. Busoni P, Andreuccetti T. The spread of caudal analgesia in children: a mathematical model. Anesth Intensive Care 1986; 14: 140-4.
  • 22. Warner MA, Kunkel SE, Offord KO, Atchison SR, Dawson B. The effects of age, epinephrine and operative site on duration of caudal analgesia in pediatric patients.AnesthAnalg 1987: 66: 995-8.
  • 23. Fischer QA, McComiskey CM, Hill JL et al. Postoperative voiding interval and duration of analgesia following peripheral or caudal block in children.AnesthAnalg 1993: 76: 173-7.
  • 24. Leong CK, Ng AS, Chew SL. Caudal morphine in paediatric patients: A comperative of two different doses in children after major urogenital surgery. Ann Acad Med Singapore 1998:27: 371-5.
  • 25. Kundra P, Deepalakshmi K, Ravishankar M. Preemptive caudal bupivacaine and morphine for postoperative analgesia in children.AnesthAnalg 1998: 87: 52-6.
  • 26. Ivani G, Mereto N, Lampugnani E, De Negri P, Torre M, Mattioli G, Jasonni V, Lonngvist PA. Ropivacaine in peadiatric surgery: Preliminary result. Pediatr Anaesth. 1998; 8: 127-9.
  • 27. Tuncer S.,YosunkayaA., Reisli R.,TavlanA., Cicekci F, Otelcioglu S. Effect of caudal block on stress responses in children. Pediatr International 2004: 46: 53-7.
  • 28. Locatelli B,. Ingelmo P,. Sonzogni V,. Zanella A, Gatti V,. Spotti A, Di Marco S,.Fumagalli R. Randomized, double-blind, phase III, controlled trial comparing levobupivacaine 0.25%, ropivacaine 0.25% and bupivacaine 0.25% by the caudal route in children. Br J Anaesth 2005; 94: 36671.
  • 29. Wolf AR, Valley RD, Fear DW et al. Bupivacaine for caudal analgesia in infants and children: the optimal effective concentration.Anesthesiology 1988; 69: 102-6
  • 30. Barıs S, Karakaya D, Kelsaka E, Guldogus F,Arıturk E, Tür A. Comparison of fentanylbupivacaine or midazolambupivacaine mixtures with plain bupivacaine for caudal anaesthesia in children. Pediatr anaesth 2003: 13; 126-31.
  • 31. Joshi W, Connelly NR, Dwyer M et al. A comparison of two.concentrations of bupivacaine and adrenaline with and without fentanyl in paediatric inguinal herniorrhaphy. PediatrAnaesth 1999; 9: 317320.
  • 32. Campbell FA, Yentis SM, Fear DW et al. Analgesic efficacy and safety of a caudal bupivacaine-fentanyl mixture in children. Can JAnaesth 1992; 39: 661-4.
  • 33. Ivani G, De Negri P, Conio A et al. Comparison of racemic bupivacaine, ropivacaine and levobupivacaine for pediatric caudal anesthesia: effects on postoperative analgesia and motor block. RegAnesth Pain Med 2002; 27: 157-61.
  • 34. Astuto M, Disma N, Arena C. Levobupivacaine 0.25% compared with ropivacaine 0.25% by the caudal route in children. Eur JAnaesthesiolog 2003; 20: 826-30.
  • 35. Da Conceicao MJ, Coelho l, Khalil M. Ropivacaine 0.25% compared with bupivacaine 0.25% by caudal route. PaediatrAnaesth 1999; 9: 229-33.
  • 36. Eyres RL, Bishop W, Oppenheim RC, Brown TCK. Plasma bupivacaine concentrations in children during caudal epidural analgesia. Anaesth Intensive Care 1983; 11: 20-2
  • 37. Albright GA. Cardiac arrest following regional anesthesia with etidocaine or bupivacaine. Anesthesiology 1979; 51: 285-7

Evaluation of Efficacy of Caudal Analgesia on Pediatric Surgery

Year 2006, Volume: 7 Issue: 2, 27 - 30, 01.08.2006

Abstract

Objective: We aimed to retrospectively evaluate analgesic effect and complications in intraoperative and post operative periods of caudal block performed after induction of general anesthesia in 125 pediatric patients who underwent elective surgical operations on the inguinal, urogenital and rectal regions in 2006. Material and Methods: Data were collected from anesthesia monitoring forms, recovery room monitoring forms and nursing monitoring forms about demographics, types of operations, anesthetic agents used for induction and maintenance of anesthesia, types of anesthesia, types, doses and concentrations of local anesthetics used for caudal block, analgesics given in intraoperative and postoperative periods, time of analgesic administration and complications. Results: The patients were aged 1-132 months, with a mean of 41.57±38.55 months. Out of 125 patients, 118 (94.4%) were male and 7 (5.6%) female with a mean weight of 14.60±7.81 kg. Duration of anesthesia was 61.50±42.07 min in patients administered 0.25% bubivacain for caudal block. No analgesics were administered during operation and mean duration of analgesia in the postoperative period was 412.88±163.13 min. No complications were noted in the postoperative period. Conclusion: It can be concluded that caudal block decreases the need for general anesthesia in the intraoperative period and provides effective analgesia in the postoperative period in operations on the inguinal, urogenital and rectal regions.

References

  • 1. Silvani P, Camporesi A, Agostino MR, Salvo I. Caudal anaesthesia in pediatrics: an update. Minerva Anesthesiol 2006; 72; 453-9.
  • 2. Kayhan Z., Klinik Anestezi , Logos Yayıncılık, Mayıs 2004. 3. baskısayfa 694-5.
  • 3. Dalens B, Hasnaoui A. Caudal anesthesia in pediatric surgery: success rate and adverse effects in 750 consecutive patients.AnesthAnalg 1989: 68: 83-9.
  • 4. Locatelli B, Ingelmo P, Sonzogni V, Zanella A, Gatti V, Spotti2 A, Di Marco S, Fumagalli R. Randomized, double-blind, phase III, controlled trial comparing levobupivacaine 0.25%, ropivacaine 0.25% and bupivacaine 0.25% by the caudal route in children. Br J Anaesth 2005; 94: 36671.
  • 5. Giaufre E, Dalens B, Gombert A. Epidemiology and morbidity of regional anesthesia in children: a one-year prospective survey of the French-Language Society of Pediatric Anesthesiologists.Anesth Analg 1996; 83: 9412.
  • 6. Morgan GE, Mikhail MS, Murray MJ, Larson CP. Clinical Anesthesiology, ingilizce 3. baskıdan Türkçe'ye çevrilmiş, 3. baskı (çeviren: Tulunay M, Cuhruk H.) Güneş Kitabevi,Ankara, 2004; 273-4.
  • 7. Tobias JD. Postoperative analgesia and intraoperative inhalational anesthetic requirements during umbilical herniorrhaphy in children: postincisional local infiltration versus preincisional caudal epidural block. J ClinAnesth. 1996; 8: 634-8.
  • 8. Mazoit JX, Decaux A, Bouaziz H, Edouard A. Comparative ventricular electrophysiologic effect of racemic bupivacaine, levobupivacaine, and ropivacaine on the isolated rabbit heart. Anesthesiology 2000; 93: 78492.
  • 9. Morrison SG, Dominguez JJ, Frascarolo P, Reiz S. A comparison of the electrocardiographic cardiotoxic effects of racemic bupivacaine, levobupivacaine, and ropivacaine in anesthetized swine. Anesth Analg 2000; 90: 130814.
  • 10. Breschan C, Jost R, Krumphuolz R, Schaumberger F, Sttetner H, Marhofer P, Likar R. A prospective study comparing the analgesic efficacy of levobupivacaine, ropivacaine and bupivacaine in pediatric patient undergoing caudal blockade. PediatrAnaesth 2005; 15: 301-6.
  • 11. Frawley GP, Downie S, Huang GH. Levobupivacaine caudal anesthesia in children a randomized double blind comparison with bupivacaine. Pediatr Anaesth 2006; 16: 754-60.
  • 12. Johnston P, Findlow D, Aldridge LM et al. The effect of ketamine on 0.25% and 0.125% bupivacaine for caudal epidural blockade in children. Pediatr Anaesth 1999; 9: 31-4.
  • 13. Gunter JB, Dunn CM, Bennie JB, Pentecost DL, Bower RJ, Ternberg JL. Optimum concentration of bupivacaine for combined caudal-general anesthesia in children.Anesthesiology 1991; 75: 57-61
  • 14. Hansen TG, Morton NS, Cullen PM, Watson DG. Plasma concentrations and pharmacokinetics of bupivacaine with and without adrenaline following caudal anaesthesia in infants. Acta Anaesthesiol Scand 2001; 45: 42-7.
  • 15. De Beer DAH, Thomas ML. Caudal additives in children--solutions or problems. Br JAnaesth 2003; 90: 487-98.
  • 16. Gunter J. Caudal anesthesia in children: A survey. Anesthesiology 1991; 75: 936
  • 17. Veyckemans F, Van Obbergh LJ, Gouverneur JM. Lessons from 1100 pediatric caudal blocks in a teaching hospital. RegAnesth 1992; 17: 119-25.
  • 18. Sanders JC. Paediatric regional anaesthesia, a survey of practice in the United kingdom. Br J Anaesth 2002; 89; 707-10.
  • 19. Schrock CR, Barry J. The dose of caudal epidural analgesia andduration of postoperative analgesia PediatrAnaesth 2003; 3: 403-8.
  • 20. Verghese ST, Hannallah ST, Rice LJ, BelmanAB, Patel KM. Caudal anaesthesia in children: effecte of volume vs concentration of bupivacaine on blockingspermetic cord traction response during orchidopexy. Anesth Analg 2002; 95: 1219-23.
  • 21. Busoni P, Andreuccetti T. The spread of caudal analgesia in children: a mathematical model. Anesth Intensive Care 1986; 14: 140-4.
  • 22. Warner MA, Kunkel SE, Offord KO, Atchison SR, Dawson B. The effects of age, epinephrine and operative site on duration of caudal analgesia in pediatric patients.AnesthAnalg 1987: 66: 995-8.
  • 23. Fischer QA, McComiskey CM, Hill JL et al. Postoperative voiding interval and duration of analgesia following peripheral or caudal block in children.AnesthAnalg 1993: 76: 173-7.
  • 24. Leong CK, Ng AS, Chew SL. Caudal morphine in paediatric patients: A comperative of two different doses in children after major urogenital surgery. Ann Acad Med Singapore 1998:27: 371-5.
  • 25. Kundra P, Deepalakshmi K, Ravishankar M. Preemptive caudal bupivacaine and morphine for postoperative analgesia in children.AnesthAnalg 1998: 87: 52-6.
  • 26. Ivani G, Mereto N, Lampugnani E, De Negri P, Torre M, Mattioli G, Jasonni V, Lonngvist PA. Ropivacaine in peadiatric surgery: Preliminary result. Pediatr Anaesth. 1998; 8: 127-9.
  • 27. Tuncer S.,YosunkayaA., Reisli R.,TavlanA., Cicekci F, Otelcioglu S. Effect of caudal block on stress responses in children. Pediatr International 2004: 46: 53-7.
  • 28. Locatelli B,. Ingelmo P,. Sonzogni V,. Zanella A, Gatti V,. Spotti A, Di Marco S,.Fumagalli R. Randomized, double-blind, phase III, controlled trial comparing levobupivacaine 0.25%, ropivacaine 0.25% and bupivacaine 0.25% by the caudal route in children. Br J Anaesth 2005; 94: 36671.
  • 29. Wolf AR, Valley RD, Fear DW et al. Bupivacaine for caudal analgesia in infants and children: the optimal effective concentration.Anesthesiology 1988; 69: 102-6
  • 30. Barıs S, Karakaya D, Kelsaka E, Guldogus F,Arıturk E, Tür A. Comparison of fentanylbupivacaine or midazolambupivacaine mixtures with plain bupivacaine for caudal anaesthesia in children. Pediatr anaesth 2003: 13; 126-31.
  • 31. Joshi W, Connelly NR, Dwyer M et al. A comparison of two.concentrations of bupivacaine and adrenaline with and without fentanyl in paediatric inguinal herniorrhaphy. PediatrAnaesth 1999; 9: 317320.
  • 32. Campbell FA, Yentis SM, Fear DW et al. Analgesic efficacy and safety of a caudal bupivacaine-fentanyl mixture in children. Can JAnaesth 1992; 39: 661-4.
  • 33. Ivani G, De Negri P, Conio A et al. Comparison of racemic bupivacaine, ropivacaine and levobupivacaine for pediatric caudal anesthesia: effects on postoperative analgesia and motor block. RegAnesth Pain Med 2002; 27: 157-61.
  • 34. Astuto M, Disma N, Arena C. Levobupivacaine 0.25% compared with ropivacaine 0.25% by the caudal route in children. Eur JAnaesthesiolog 2003; 20: 826-30.
  • 35. Da Conceicao MJ, Coelho l, Khalil M. Ropivacaine 0.25% compared with bupivacaine 0.25% by caudal route. PaediatrAnaesth 1999; 9: 229-33.
  • 36. Eyres RL, Bishop W, Oppenheim RC, Brown TCK. Plasma bupivacaine concentrations in children during caudal epidural analgesia. Anaesth Intensive Care 1983; 11: 20-2
  • 37. Albright GA. Cardiac arrest following regional anesthesia with etidocaine or bupivacaine. Anesthesiology 1979; 51: 285-7
There are 37 citations in total.

Details

Other ID JA92BE36VG
Journal Section Research Article
Authors

Erdal Gezer This is me

Bakiye Uğur This is me

Selda Şen This is me

Mustafa Oğurlu This is me

Osman Nuri Aydın This is me

Feray Gürsoy This is me

Publication Date August 1, 2006
Published in Issue Year 2006 Volume: 7 Issue: 2

Cite

EndNote Gezer E, Uğur B, Şen S, Oğurlu M, Aydın ON, Gürsoy F (August 1, 2006) Evaluation of Efficacy of Caudal Analgesia on Pediatric Surgery. Meandros Medical And Dental Journal 7 2 27–30.