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Perioperative effects of caudal block on pediatric patients in laparoscopic upper urinary tract surgery: a randomized
Bingdong Tao1, Kun Liu1, Dandan Wang1
1Department of Anesthesiology, Shengjing Hospital, China Medical University, 36 Sanhao Street Heping District, Shenyang, 110004, Liaoning Province, China.
Insights
Caudal block with 1.3 mL/kg ropivacaine significantly reduced fentanyl use and improved pain management in pediatric patients undergoing laparoscopic upper urinary tract surgery. This approach offers better postoperative analgesia and hemodynamics compared to no block or lower ropivacaine doses.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Pain Management
Background:
- Caudal block is common for lower body pediatric surgeries.
- Its efficacy in laparoscopic upper urinary tract surgery is understudied.
Purpose of the Study:
- To evaluate the perioperative effects of caudal block in pediatric laparoscopic upper urinary tract surgery.
- To compare different doses of ropivacaine for caudal block.
Main Methods:
- A randomized trial involving 96 pediatric patients (6 months-7 years).
- Groups included no caudal block, 1.0 mL/kg 0.15% ropivacaine, and 1.3 mL/kg 0.15% ropivacaine.
- Primary outcome: perioperative fentanyl use; Secondary outcomes: pain, hemodynamics, rescue fentanyl, side effects.
Main Results:
- 1.3 mL/kg ropivacaine significantly decreased perioperative fentanyl use (P < 0.01 vs. no block; P < 0.05 vs. 1.0 mL/kg).
- The 1.3 mL/kg group showed more stable hemodynamics, lower pain scores, and shorter PACU stay.
- Reduced need for rescue fentanyl was observed in the 1.3 mL/kg group.
Conclusions:
- Caudal block with 1.3 mL/kg 0.15% ropivacaine is effective for pediatric laparoscopic upper urinary tract surgery.
- It reduces perioperative fentanyl needs and enhances postoperative analgesia.
- This dose provides superior outcomes compared to no block or a lower dose.
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.
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