[Caudal block in the surgical repair of vesico-renal reflux]
P Chauvet1, M Lefeuvre, C Chemla
1Département d'anesthésie-réanimation, Centre hospitalier régional, Reims.
Insights
Caudal anesthesia using a Lidocaine and Bupivacaine mixture provided excellent pain relief and muscle relaxation for pediatric vesico-renal reflux surgery. This technique ensured stable hemodynamics, controlled bleeding, and a swift return to normal digestion with no complications.
Area of Science:
- Pediatric Anesthesiology
- Pediatric Urology
- Surgical Pain Management
Context:
- Vesico-renal reflux (VRR) is a common condition in children requiring surgical intervention.
- Local and regional anesthesia techniques are increasingly explored for pediatric surgical procedures to minimize systemic effects.
- Caudal anesthesia offers a potential method for loco-regional anesthesia in pediatric lower abdominal surgeries.
Purpose:
- To evaluate the efficacy and safety of caudal anesthesia using a mixed solution of Lidocaine 1% and Bupivacaine 0.5% with Adrenaline for surgical cure of vesico-renal reflux in children.
- To assess the intraoperative and postoperative analgesic effects, hemodynamic stability, respiratory function, and potential complications associated with this anesthetic technique.
Summary:
- One hundred and twenty children underwent surgical correction for vesico-renal reflux utilizing caudal anesthesia with a Lidocaine-Bupivacaine-Adrenaline mixture and complementary narcosis.
- Intraoperatively, the technique provided excellent and prolonged analgesia and muscle relaxation, with stable hemodynamics, no adverse ventilatory effects, reduced blood loss, and better temperature control.
- Postoperatively, effective analgesia lasted an average of 12 hours, facilitating a rapid return to normal digestive function without any reported complications.
Impact:
- This study demonstrates that caudal anesthesia with a Lidocaine-Bupivacaine-Adrenaline mixture is a safe and effective anesthetic option for pediatric vesico-renal reflux surgery.
- The technique offers significant benefits including excellent pain control, hemodynamic stability, and faster recovery, potentially reducing the need for general anesthesia and its associated risks.
- Findings support the wider adoption of this loco-regional anesthesia approach in pediatric urological surgery.
Abstract:
One hundred and twenty children have benefited from surgical cure for vesico-renal reflux under loco-regional anesthesia per caudal way, with use of a mixed solution of Lidocaine 1%, Bupivacaine 0.5%, with Adrenaline, along with a complementary narcosis. During the per operative time: the subsequent analgesia and muscular relief have always been excellent and lasted long enough. The hemodynamic status always showed a perfect stability. As to the ventilation, no deleterious effect could be demonstrated. Per operative blooding is reduced and central temperature is more easily controlled. During the post-operative time: the caudal anesthesia has allowed to maintain an efficient analgesia during a mean period of 12 hours which has been considered as sufficient. All the children went quickly back to a normal digestive function. There was no complication relevant to this technique.
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