Öz
Amaç: Kaudal epidural anestezi, pediatrik hasta grubunda umblikus altı cerrahi girişimlerinde uygula-
nan, öğrenilmesi ve uygulaması kolay, güvenilir bir rejyonal anestezi yöntemidir. Postoperatif dönemde analjezi sağlamada mükemmel sonuç verir, ancak geniş serili yayınlar azdır. Çalışmamızda pediatrik üro- loji vakalarında kaudal epidural blok uygulamasının etkinliğinin değerlendirilmesi amaçlandı.
Gereç ve Yöntemler: Ankara Çocuk Sağlığı ve Hastalıkları Hematoloji-Onkoloji Eğitim Araştırma Hastanesi’nde Ocak 2008-Şubat 2013 tarihleri arasında kaudal epidural blok uygulanmış pediatrik üro- loji vaka kayıtları retrospektif olarak değerlendirildi. Bu hastaların demografik verileri, operasyon türleri, blok uygulaması sırasında gelişen komplikasyonlar ve başarısız kabul edilen olgular kaydedildi. Postope- ratif analjezi etkinliği ve ek analjezik ihtiyacı değerlendirildi.
Bulgular: Toplam 5536 vaka çalışmaya alındı. Hastaların ortanca yaşı 4 yaş (Çeyrekler Arası Aralık:
1-7yaş) bulundu. Hastaların 4538’i (%82) erkek, 998’i (%18) kız idi. Dört (%0.07) olguda dura delinmesi,
276 (%4.98) olguda damar ponksiyonu kaydedilmiştir. İki yüz yirmi bir (%3.9) olguda ise kaudal blok işlemine son verilmiştir. Ayrıca 122 (%2,2) hastanın kaudal blokları başarısız kabul edilmiştir. Çalışmaya alınan 4096 (%73.9) hasta günübirlik vakadır. Taburculuk öncesi 48 (%1.15) hastaya ek analjezik ajan verilmiştir. Günübirlik hasta grubu dışındaki hastalarda postoperatif 6. saatte analjezik ilaç başlanmıştır. Sonuç: Kaudal epidural anestezi peroperatif ve postoperatif ağrı kontrolünde etkili, uygulaması kolay, basit ve güvenli bir anestezi yöntemidir. Operasyon esnasında güçlü analjezi sağlar. Sonrasında ise anal- jezik gereksiniminde azalma ile ciddi hasta konforu sağlar. Umblikus altı pediatrik cerrahi olgularında yüksek başarı ve düşük komplikasyon oranları nedeniyle kullanımı önerilir.
Anahtar Kelimeler: Pediatrik, Epidural anestezi, Ürolojik cerrahi
ABSTRACT
Objective: In pediatric surgery, caudal epidural analgesia is reliable, easy to learn regional anesthesia
technique in surgical procedures under the umbilicus. Despite its frequent use, excellent analgesic properties, current literature search yielded only a few large series reported. We aimed to present our institutional experience reflecting the collective data in pediatric urological surgical cases
Mateials and Methods: The anesthesia records of 5536 consecutive pediatric urological surgical cases who underwent caudal epidural anesthesia procedure between January 2008-February 2013 were retrospectively analyzed. Parameters including the type of surgery, demographic findings, need for additional analgesic agents, the complications related to the procedure, the percentage of failed cases were analyzed.
Results: Total patients with a median age of 4 years (interquartile range: 1-7) were enrolled. There were
4538 male (82%), 998 female (18%) patients. In four cases the procedure was terminated due to dural puncture. Inadvertent penetration of vascular space was noted in 276 (4,98%) cases. In 221 cases, it was terminated due to the failure of correct placement of the needle despite repeated attempts. The procedure was categorized as failure in 122 (2,2%) cases. 4096 patients were discharged on the same day. In 48 patients (1,5%) additional analgesic dose was needed. In the patients who required prolonged hospitalization additional analgesic was started at postoperative 6th hour.
Conclusion: Caudal epidural anesthesia is easy, safe and effective technique in preoperative and postoperative pain control.. The main advantages are high success, low complication rates, lesser analgesic dose requirement. In the light of our study results, we recommend routine use of the caudal epidural procedure in pediatric urological surgery cases.
Key Words: Pediatric, Epidural anesthesia, Urological surgery
Anahtar Kelimeler
Kaynakça
- Silvani P, Camporesi A, Agostino MR, Salvo I. Caudal anesthesia in pediatrics: an update. Minerva Anestesiologica. 2006;72(6):453-459.
- Taylor R, Eyres R, Chalkiadis GA, Austin S. Efficacy and safety of caudal injection of levobupivacaine, 0.25%, in children under 2 years of age undergoing inguinal hernia repair, circumcision or orchidopexy. Paediatr Anaesth. 2003;13(2):114-121.
- Bogaert GA, Trouet D, Bernaerts J, Luysmans P, Evers G, Wille M. Additional to caudal bupivacaine preemptive oral ibuprofen does not improve postoperative pain, nause or vomiting and resumption of normal activities in children after ambulatory pediatric urologic surgery. J Pediatr Urol. 2005;1(2):61-68.
- Bissonnette B, Dalens B. Regional Anesthetic Tecniques. Wonsiewicz M, Noujaim S, Kurtz S.Pediatric Anesthesia: Principles-practice. New York: Mc Graw Hill, 2002. p. 541
- Markakis DA. Regional anesthesia in pediatrics. Anesthesiology Clinic North America. 2000;18(2):355-381.
- Sanders JC. Paediatric regional anaesthesia, a survey of practice in the United Kingdom. Br J Anaesth. 2002;89(5):707-710.
- Jöhr M, Berger TM. Caudal Blocks. Pediatric Anesthesia. 2012;22(1); 44-50.
- Beyaz SG, Tokgöz O, Tüfek A. Caudal Epidural Block in Children and Infants: Retrospective analysis of 2088 cases. Ann Saudi Med. 2011; 31(5): 494-497.
- Z. Begeç,M Durmuş, Hİ Toprak, A Köroğlu,H Ülger, MÖ Ersoy: Çocuklarda kaudal blok: 2262 olgunun geriye 2262 olgunun geriye dönük incelenmesi. Türk Anest Rean Der Dergisi. 2005;33(5):388-394.
- Eti Z, Batırel H, Göğüş FY. 981 pediatrik hastada kaudal analjezinin geriye dönük değerlendirilmesi. Türk Anestezi Reanimasyon Derneği Dergisi. 2000;28:313-316.
- Dalens B, Hasnaoui A. Caudal anesthesia in pediatric surgery: Success rate and adverse effects in 750 consecutive patients. Anesth Analg.1989;68(2):83-89.
- Veyckemans F, Van Obbergh LJ, Gouverneur JM. Lessons from 1100 pediatric caudal blocks in a teaching hospital.Reg Anesth. 992;17(3):119-125.
- Wang LZ, Hu XX, Zhang YF, Chang XY. A randomized comparison of caudal block by sacral hiatus injection under ultrasound guidance with traditional sacral canal injection in children. Paediatr Anaesth. 2013;23(5):395-400.
- Jöhr M, Sossai R. Colonic puncture during ilioinguinal nerve block in a child. Anesth Analg.1999;88(5):1051-1052.
- Vaisman J. Pelvic Hematoma after an ilioinguinal nerve block for orchialgia. Anesth Analg. 2001;92(4):1048-1049.
- Lim SL, Ng Sb A, Tan GM. Ilioinguinal and iliohypogastric nerve block revisited: Single shot versus double shot technique for hernia repair in children. Paediatr Anaesth. 2002;12(3):255-260.
- Abdellatif AA. Ultrasound-guided ilioinguinal/ iliohypogastric nerve blocks versus caudal block for postoperative analgesia in children undergoing unilateral groin surgery. Saudi J Anaesth. 2012;6(4):367-372.
- Willschke H, Marhofer P, Bösenberg A, Johnston S, Wanzel O, Cox SG et al.Ultrasonography for ilioinguinal/ iliohypogastric nerve blocks in children. British J of Anaesth. 2005;95(2):226-230.
- Ross AK, Eck JB, Tobias JD. Pediatric regional anesthesia: Beyond the caudal. Anesth Analg. 2000;91(1):16-26.
Öz
Objective: In pediatric surgery, caudal epidural analgesia is reliable, easy to learn regional anesthesia technique in surgical procedures under the umbilicus. Despite its frequent use, excellent analgesic properties, current literature search yielded only a few large series reported. We aimed to present our institutional experience reflecting the collective data in pediatric urological surgical casesMateials and Methods: The anesthesia records of 5536 consecutive pediatric urological surgical cases who underwent caudal epidural anesthesia procedure between January 2008-February 2013 were retrospectively analyzed. Parameters including the type of surgery, demographic findings, need for additional analgesic agents, the complications related to the procedure, the percentage of failed cases were analyzed.Results: Total patients with a median age of 4 years were enrolled. There were 4538 male (82%), 998 female (18%) patients. In four cases the procedure was terminated due to dural puncture. Inadvertent penetration of vascular space was noted in 276 (4,98%) cases. In 221 cases, it was terminated due to the failure of correct placement of the needle despite repeated attempts. The procedure was categorized as failure in 122 (2,2%) cases. 4096 patients were discharged on the same day. In 48 patients (1,5%) additional analgesic dose was needed. In the patients who required prolonged hospitalization additional analgesic was started at postoperative 6th hour.Conclusion: Caudal epidural anesthesia is easy, safe and effective technique in preoperative and postoperative pain control.. The main advantages are high success, low complication rates, lesser analgesic dose requirement. In the light of our study results, we recommend routine use of the caudal epidural procedure in pediatric urological surgery cases
Anahtar Kelimeler
Kaynakça
- Silvani P, Camporesi A, Agostino MR, Salvo I. Caudal anesthesia in pediatrics: an update. Minerva Anestesiologica. 2006;72(6):453-459.
- Taylor R, Eyres R, Chalkiadis GA, Austin S. Efficacy and safety of caudal injection of levobupivacaine, 0.25%, in children under 2 years of age undergoing inguinal hernia repair, circumcision or orchidopexy. Paediatr Anaesth. 2003;13(2):114-121.
- Bogaert GA, Trouet D, Bernaerts J, Luysmans P, Evers G, Wille M. Additional to caudal bupivacaine preemptive oral ibuprofen does not improve postoperative pain, nause or vomiting and resumption of normal activities in children after ambulatory pediatric urologic surgery. J Pediatr Urol. 2005;1(2):61-68.
- Bissonnette B, Dalens B. Regional Anesthetic Tecniques. Wonsiewicz M, Noujaim S, Kurtz S.Pediatric Anesthesia: Principles-practice. New York: Mc Graw Hill, 2002. p. 541
- Markakis DA. Regional anesthesia in pediatrics. Anesthesiology Clinic North America. 2000;18(2):355-381.
- Sanders JC. Paediatric regional anaesthesia, a survey of practice in the United Kingdom. Br J Anaesth. 2002;89(5):707-710.
- Jöhr M, Berger TM. Caudal Blocks. Pediatric Anesthesia. 2012;22(1); 44-50.
- Beyaz SG, Tokgöz O, Tüfek A. Caudal Epidural Block in Children and Infants: Retrospective analysis of 2088 cases. Ann Saudi Med. 2011; 31(5): 494-497.
- Z. Begeç,M Durmuş, Hİ Toprak, A Köroğlu,H Ülger, MÖ Ersoy: Çocuklarda kaudal blok: 2262 olgunun geriye 2262 olgunun geriye dönük incelenmesi. Türk Anest Rean Der Dergisi. 2005;33(5):388-394.
- Eti Z, Batırel H, Göğüş FY. 981 pediatrik hastada kaudal analjezinin geriye dönük değerlendirilmesi. Türk Anestezi Reanimasyon Derneği Dergisi. 2000;28:313-316.
- Dalens B, Hasnaoui A. Caudal anesthesia in pediatric surgery: Success rate and adverse effects in 750 consecutive patients. Anesth Analg.1989;68(2):83-89.
- Veyckemans F, Van Obbergh LJ, Gouverneur JM. Lessons from 1100 pediatric caudal blocks in a teaching hospital.Reg Anesth. 992;17(3):119-125.
- Wang LZ, Hu XX, Zhang YF, Chang XY. A randomized comparison of caudal block by sacral hiatus injection under ultrasound guidance with traditional sacral canal injection in children. Paediatr Anaesth. 2013;23(5):395-400.
- Jöhr M, Sossai R. Colonic puncture during ilioinguinal nerve block in a child. Anesth Analg.1999;88(5):1051-1052.
- Vaisman J. Pelvic Hematoma after an ilioinguinal nerve block for orchialgia. Anesth Analg. 2001;92(4):1048-1049.
- Lim SL, Ng Sb A, Tan GM. Ilioinguinal and iliohypogastric nerve block revisited: Single shot versus double shot technique for hernia repair in children. Paediatr Anaesth. 2002;12(3):255-260.
- Abdellatif AA. Ultrasound-guided ilioinguinal/ iliohypogastric nerve blocks versus caudal block for postoperative analgesia in children undergoing unilateral groin surgery. Saudi J Anaesth. 2012;6(4):367-372.
- Willschke H, Marhofer P, Bösenberg A, Johnston S, Wanzel O, Cox SG et al.Ultrasonography for ilioinguinal/ iliohypogastric nerve blocks in children. British J of Anaesth. 2005;95(2):226-230.
- Ross AK, Eck JB, Tobias JD. Pediatric regional anesthesia: Beyond the caudal. Anesth Analg. 2000;91(1):16-26.
Ayrıntılar
| Bölüm | Orjinal Çalışma |
|---|---|
| Yazarlar | |
| Yayımlanma Tarihi | 1 Haziran 2015 |
| Yayımlandığı Sayı | Yıl 2015 Cilt: 5 Sayı: 2 |
