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Caudal epidural blockade for major orthopedic hip surgery in adolescents.

Schloss B, Martin D, Tripi J, Klingele K, Tobias JD - Saudi J Anaesth (2015 Apr-Jun)

Bottom Line: Although the failed block rate was high (31%), there was decreased opioid use in the perioperative arena as well as during the first 24 postoperative hours in patients who had a successful caudal epidural block.Furthermore, discharge home was possible in 27% of patients who received a caudal epidural block compared to 0% of patients who did not receive a caudal block.Factors resulting in a failed block in this patient population as well as the use of the ultrasound as an added modality to increase block success are reviewed.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology, Nationwide Children's Hospital, Columbus, Ohio, United States.

ABSTRACT

Background: There continues to be a significant focus on the value of regional and neuraxial anesthesia techniques for adjunctive use when combined with general anesthesia. The reported advantages include decreased patient opiate exposure, decreased medication-related adverse effects, decreased postanesthesia recovery room time and hospital stay, and increased patient satisfaction.

Materials and methods: The authors present a case-controlled series evaluating the use of a single caudal epidural injection prior to incision as an adjunct to general anesthesia for the open repair of slipped capital femoral epiphysis. Opiate consumption, pain scores, and hospital stay were compared between the two cohorts of 16 adolescent patients. All patients received a demand-only patient-controlled opiate delivery system.

Results: Although the failed block rate was high (31%), there was decreased opioid use in the perioperative arena as well as during the first 24 postoperative hours in patients who had a successful caudal epidural block. Furthermore, discharge home was possible in 27% of patients who received a caudal epidural block compared to 0% of patients who did not receive a caudal block.

Conclusion: The potential utility of caudal epidural block as an adjunct to general anesthesia during major hip surgery in adolescents is presented. Factors resulting in a failed block in this patient population as well as the use of the ultrasound as an added modality to increase block success are reviewed.

No MeSH data available.


Related in: MedlinePlus

Average pain scores plotted over time
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Figure 2: Average pain scores plotted over time

Mentions: Of the 16 patients in the caudal experimental group, five patients were determined to have a failed caudal block (31%). Therefore, 11 subjects remained in the caudal epidural block group and 16 in the control group for further analysis. Patient demographics are provided in Table 1. There were no significant differences between the groups with respect to age, weight, or gender. Opioid consumption in the operating room, in the PACU, and for the first 24 h of the inpatient hospital stay are outlined in Table 2 and Figure 1. The repeated measure ANOVA demonstrated that the difference in morphine equivalents between groups remained statistically constant over time and is, therefore, reported as one single point estimate. The opioid needs of the control group were 2.94 mg (morphine equivalents) higher than the caudal epidural group [95% confidence interval of 1.53-4.35 with P = 0.0003, Table 3]. The pain scores measured in the PACU and at 6, 12, and 24 h of inpatient stay are outlined in Table 4 and Figure 2. The repeated measure ANOVA demonstrated that the pain scores between groups changed over time. Therefore, point differences are reported at each time point. Although the pain scores were lower in the PACU and at 6 and 12 postoperative hours, this did not achieve statistical significance at any time point. The average hospital stay was 2.1 days ±0.98 for the experimental group and 2.5 days ± 0.63 for the control group (P = NS). The percentage of patients discharged home at 1 day was 27% for the experimental group and 0% for the control (P = 0.06). There were no complications noted in the experimental group as a result of the caudal epidural block.


Caudal epidural blockade for major orthopedic hip surgery in adolescents.

Schloss B, Martin D, Tripi J, Klingele K, Tobias JD - Saudi J Anaesth (2015 Apr-Jun)

Average pain scores plotted over time
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4374215&req=5

Figure 2: Average pain scores plotted over time
Mentions: Of the 16 patients in the caudal experimental group, five patients were determined to have a failed caudal block (31%). Therefore, 11 subjects remained in the caudal epidural block group and 16 in the control group for further analysis. Patient demographics are provided in Table 1. There were no significant differences between the groups with respect to age, weight, or gender. Opioid consumption in the operating room, in the PACU, and for the first 24 h of the inpatient hospital stay are outlined in Table 2 and Figure 1. The repeated measure ANOVA demonstrated that the difference in morphine equivalents between groups remained statistically constant over time and is, therefore, reported as one single point estimate. The opioid needs of the control group were 2.94 mg (morphine equivalents) higher than the caudal epidural group [95% confidence interval of 1.53-4.35 with P = 0.0003, Table 3]. The pain scores measured in the PACU and at 6, 12, and 24 h of inpatient stay are outlined in Table 4 and Figure 2. The repeated measure ANOVA demonstrated that the pain scores between groups changed over time. Therefore, point differences are reported at each time point. Although the pain scores were lower in the PACU and at 6 and 12 postoperative hours, this did not achieve statistical significance at any time point. The average hospital stay was 2.1 days ±0.98 for the experimental group and 2.5 days ± 0.63 for the control group (P = NS). The percentage of patients discharged home at 1 day was 27% for the experimental group and 0% for the control (P = 0.06). There were no complications noted in the experimental group as a result of the caudal epidural block.

Bottom Line: Although the failed block rate was high (31%), there was decreased opioid use in the perioperative arena as well as during the first 24 postoperative hours in patients who had a successful caudal epidural block.Furthermore, discharge home was possible in 27% of patients who received a caudal epidural block compared to 0% of patients who did not receive a caudal block.Factors resulting in a failed block in this patient population as well as the use of the ultrasound as an added modality to increase block success are reviewed.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology, Nationwide Children's Hospital, Columbus, Ohio, United States.

ABSTRACT

Background: There continues to be a significant focus on the value of regional and neuraxial anesthesia techniques for adjunctive use when combined with general anesthesia. The reported advantages include decreased patient opiate exposure, decreased medication-related adverse effects, decreased postanesthesia recovery room time and hospital stay, and increased patient satisfaction.

Materials and methods: The authors present a case-controlled series evaluating the use of a single caudal epidural injection prior to incision as an adjunct to general anesthesia for the open repair of slipped capital femoral epiphysis. Opiate consumption, pain scores, and hospital stay were compared between the two cohorts of 16 adolescent patients. All patients received a demand-only patient-controlled opiate delivery system.

Results: Although the failed block rate was high (31%), there was decreased opioid use in the perioperative arena as well as during the first 24 postoperative hours in patients who had a successful caudal epidural block. Furthermore, discharge home was possible in 27% of patients who received a caudal epidural block compared to 0% of patients who did not receive a caudal block.

Conclusion: The potential utility of caudal epidural block as an adjunct to general anesthesia during major hip surgery in adolescents is presented. Factors resulting in a failed block in this patient population as well as the use of the ultrasound as an added modality to increase block success are reviewed.

No MeSH data available.


Related in: MedlinePlus