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[Caudal anesthesia combined with general anesthesia in comparison with general anesthesia in ambulatory circumcision]
1Institut für Anaesthesiologie, Städtischen Kliniken Osnabrück.
Insights
Caudal anesthesia with bupivacaine significantly reduced general anesthesia requirements and improved postoperative recovery in boys undergoing circumcision. This effective pain management led to calmer behavior and faster feeding post-surgery.
Area of Science:
- Pediatric Anesthesiology
- Pain Management
- Surgical Procedures
Background:
- Circumcision is a common outpatient surgical procedure in male infants and children.
- Effective perioperative pain management is crucial for minimizing patient distress and optimizing recovery.
- General anesthesia alone may not provide adequate long-term analgesia, potentially leading to increased medication use and discomfort.
Purpose of the Study:
- To evaluate the efficacy of caudal anesthesia with bupivacaine in reducing general anesthesia requirements during circumcision.
- To assess the impact of caudal anesthesia on perioperative pain relief and postoperative recovery.
- To compare the outcomes of caudal block combined with general anesthesia versus general anesthesia alone.
Main Methods:
- A prospective study comparing 100 boys receiving caudal bupivacaine (1 ml/year of age) plus general anesthesia (group I) with 100 boys receiving general anesthesia alone (group II).
- Caudal injections were administered after general anesthesia induction, with a 98% success rate and no complications.
- Anesthetic levels (enflurane), perioperative opioid (pethidine) and analgesic (paracetamol) requirements, and postoperative outcomes were recorded.
Main Results:
- Group I required significantly lower enflurane concentrations (1.3 vol%) compared to group II (2.7 vol%).
- Pethidine use was substantially lower in group I (8 mg in 17% of patients) versus group II (17.3 mg in 91% of patients).
- Postoperative outcomes in group I included calmer behavior, reduced vomiting (4%), rapid return to feeding, and prolonged analgesia (83% required no further analgesics, lasting 6.3 hours in 15%).
Conclusions:
- Caudal anesthesia with bupivacaine is highly effective in reducing general anesthetic needs and providing excellent postoperative pain relief for pediatric genital surgery.
- This technique enhances patient comfort, leading to improved postoperative behavior, feeding, and reduced need for additional analgesics.
- The safety and efficacy of caudal anesthesia support its routine use in children undergoing circumcision and similar procedures.
Abstract:
In 100 boys (5.9 +/- 3.2 years old) undergoing outpatient circumcision, analgesia was provided with 0.375% bupivacaine 1 ml/year of age by caudal injection (group I), administered after induction of general anesthesia. This group was compared with 100 boys (6.3 +/- 3.4 years old), who received only general anesthesia (group II). The puncture technique described was free of complications and the caudal blocks were 98% successful. There was a great difference with regard to the levels of general anesthesia: the average enflurane concentrations required to block autonomic reactions during surgical intervention was 1.3 vol% in group I and 2.7 vol% in group II. The amount of pethidine needed for perioperative pain relief was 8 mg (+/- 5.7) in 17/100 of group I and 17.3 mg (+/- 6.8) in 91/100 of group II. In addition, paracetamol was given in 10/100 of group I and 30/100 of group II. The boys in group I showed calm postoperative behavior. In both groups there were only slight differences in hemodynamic parameters. Of the parents who answered our questionnaire (50 answers to 60 questionnaires), 68% were amazed at the duration of analgesia. During the late postoperative period, in group I there was an almost total absence of vomiting (4%), with an associated rapid return to normal feeding. In 83% the effect of late postoperative analgesia worked so well that no subsequent analgesic was given. In 15% the pain relief lasted 6.3 +/- 2.5 h. The excellent postoperative pain relief produced by caudal anesthesia justifies its frequent use for children subjected to genital surgery.(ABSTRACT TRUNCATED AT 250 WORDS)