Analgesic efficacy of caudal dexamethasone combined with ropivacaine in children undergoing orchiopexy

BACKGROUND

Epidural administration of dexamethasone might reduce postoperative pain in adults. We evaluated whether a caudal block of 0.1 mg kg(-1) dexamethasone combined with ropivacaine improves analgesic efficacy in children undergoing day-case orchiopexy.

METHODS

This randomized, double-blind study included 80 children aged 6 months to 5 yr who underwent day-case, unilateral orchiopexy. Patients received either 1.5 ml kg(-1) of 0.15% ropivacaine (Group C) or 1.5 ml kg(-1) of 0.15% ropivacaine in which dexamethasone of 0.1 mg kg(-1) was mixed (Group D) for caudal analgesia. Postoperative pain scores, rescue analgesic consumption, and side-effects were evaluated 48 h after operation.

RESULTS

Postoperative pain scores at 6 and 24 h post-surgery were significantly lower in Group D than in Group C. Furthermore, the number of subjects who remained pain free up to 48 h after operation was significantly greater in Group D [19 of 38 (50%)] than in Group C [four of 37 (10.8%); P<0.001]. The number of subjects who received oral analgesic was significantly lower in Group D [11 of 38 (28.9%)] than in Group C [20 of 37 (54.1%); P=0.027]. Time to first oral analgesic administration after surgery was also significantly longer in Group D than in Group C (P=0.014). Adverse events after surgery including vomiting, fever, wound infection, and wound dehiscence were comparable between the two groups.

CONCLUSIONS

The addition of dexamethasone 0.1 mg kg(-1) to ropivacaine for caudal block can significantly improve analgesic efficacy in children undergoing orchiopexy. Clinical trial registration NCT01604915.

Preconditioning effects of the anesthetic administered to the donor on grafted kidney function in living donor kidney transplantation recipients

BACKGROUND

In living donor kidney transplantation (LDKT), we evaluated if there was any difference in grafted kidney function according to the type of anesthetic used in the donor because some laboratory studies have demonstrated that volatile anesthetics at clinically relevant concentrations protect the kidneys against renal ischemia-reperfusion injury.

METHODS

In part I of the study, we retrospectively compared grafted kidney function [serum creatinine levels (Cr) and estimated glomerular filtration rates (eGFR) in recipients of LDKT] according to the type of donors' volatile anesthetic (sevoflurane [group Sevo, 166 patients], isoflurane [group Iso, 55] or desflurane [group Des, 61]). In part II, we prospectively compared grafted kidney function and neutrophil gelatinase-associated lipocalin (NGAL) levels in the serum and urine of recipients according to the anesthetic used in the donor (desflurane [group Des, N.=50] vs. propofol [group Pro, N.=50]).

RESULTS

In part I, the eGFR of the Des group was greater than that of the Sevo or Iso groups (P=0.017) until POD 7. However, in part II, there were no significant changes in Cr and eGFR by POD 7, no differences in the levels of NGAL in the serum and urine on POD 1 and 2, or in Cr and eGFR on the day of discharge between the Des and Pro groups.

CONCLUSIONS

The inhalational anesthetic administered to donors does not improve grafted kidney function in recipients undergoing LDKT to a greater extent than propofol.

The relative position of ilioinguinal and iliohypogastric nerves in different age groups of pediatric patients

BACKGROUND

Ilioinguinal nerve (IIN) and iliohypogastric nerve (IHN) blocks provide good perioperative pain relief for children undergoing inguinal procedures such as inguinal hernia repair, orchiopexy, and hydrocelectomy. The aim of this ultrasound imaging study is to compare the relative anatomical positions of IIN and IHN in different age groups of pediatrics.

METHODS

Two-hundred children (aged 1-82 months, ASA I or II) undergoing day-case surgery were consecutively included in this study. Following the induction of general anesthesia, an ultrasonographic exam was performed using a high-frequency linear probe that was placed on an imaginary line connecting the anterior superior iliac spine (ASIS) to the umbilicus.

RESULTS

There were significant differences in ASIS-IIN (distance from ASIS to IIN), ASIS-IHN (distance from the ASIS to the IHN), and IIN-IHN (distance between IIN and IHN) between the age groups: <12 months (n=84), 12-36 months (n=80), and >37 months (n=36). However, IIN-Peritoneum (distances from IIN to peritoneum), skin-IIN, and skin-IHN (depth of IIN and IHN relative to skin) were similar in three groups. ASIS-IIN and ASIS-IHN showed significantly positive correlations with age.

CONCLUSIONS

Age should be considered when placing a needle in landmark techniques for pediatric II/IH nerve blocks. However, needle depth should be confirmed by the fascial click due to the lack of predictable physiologic factors.

Determination of the optimal angle for needle insertion during caudal block in children using ultrasound imaging

Using ultrasound imaging, the optimal angle for needle insertion during caudal epidural injection in children was estimated. After general anaesthesia, ultrasonography was performed at the sacral hiatus in 130 children aged 2-84 months positioned in the lateral position. The median [range] values for the intercornual, caudal space depth and the distance from skin to the posterior sacral bony surface were 17.0 [9.6-24] mm, 3.5 [1-8] mm and 21.0 [10-39] mm, respectively. The optimal angle showed no significant correlation with age, weight, height or body surface area. The median [range] calculated optimal angle for the needle was 21.0 [10-38] degrees. We conclude that the needle should be inserted at about 20 degrees to the skin to avoid puncture of the bone and potential intra-osseous injection.

The effect of epidural sufentanil in ropivacaine on urinary retention in patients undergoing gastrectomy

BACKGROUND

Although epidural opioids have excellent analgesic property, their side-effects limit its use in patient-controlled epidural analgesia (PCEA). This study was designed to compare side-effects of epidural sufentanil in ropivacaine with that of morphine in ropivacaine focusing on lower urinary tract function after major abdominal surgery.

METHODS

In total 60 patients undergoing gastrectomy were randomly allocated to receive either sufentanil in ropivacaine (Group S, n=30) or morphine in ropivacaine (Group M, n=30) for their PCEA. Epidural catheter was inserted between the 7th and 8th thoracic spine. Visual analogue pain score and side-effects such as nausea, vomiting, pruritus, hypotension and urinary retention were evaluated during postoperative days (PODs) 1 and 2 in the postanaesthetic care unit.

RESULTS

The incidence of serious to major micturition problem in Group S was lower than that in Group M (P<0.001). The incidence of pruritus, nausea and vomiting was also lower in Group S than in Group M on POD 1.

CONCLUSIONS

The lower incidence of major/serious micturition problem in patients receiving sufentanil in ropivacaine thoracic epidural analgesia suggests that continuation of urinary drainage may not be necessary from POD 1 onwards.