For a study, researchers sought to find a link between caudal epidural block (CEB) and urethrocutaneous fistula (UCF) development in the postoperative phase. About 50 ASA 1 and 2 children with distal hypospadias, aged 0–8, were assigned to 1 of 2 groups: CEB (GA with CEB, 0.2% ropivacaine 1 ml/kg; n=25) or Non-CEB (GA without CEB; n=25). To determine penile engorgement, investigators performed penile measures before and 20 minutes after CEB delivery. After induction of anesthesia, intraoperative hemodynamics were measured at 10-minute intervals. In all groups, intraoperative and postoperative IV fentanyl use was monitored in the first 24 hours. For a score of more than 4 on the FLACC scale, rescue analgesia was given. Following surgery, children were seen in the pediatric surgery OPD monthly for the first 3 months, then 6 months later, and yearly to assess for the development of UCF. On follow-up, UCF was discovered in just 2 children, 1 from each group, with an overall incidence of 4%. There was no difference in the incidence of UCF between CEB patients and non-CEB patients. In the CEB group, there was a 26.8% increase in penile volume from baseline (P=0.000). At various time intervals, the CEB group’s intraoperative heart rate and mean arterial pressure were considerably lower than the non-CEB group’s. The CEB group did not require any extra intraoperative IV fentanyl augmentation. In the first 24 hours after surgery, the CEB group consumed considerably less fentanyl (P=0.000). Despite the rise in penile volume after CEB, there was no difference in the occurrence of postoperative UCF between the 2 groups. CEB was a safe and effective analgesic that could be used until the results of well-designed prospective randomized trials with extended follow-up were published.
Source:www.sciencedirect.com/science/article/abs/pii/S1477513121005295
