PEDİATRİK HİPOSPADİAS CERRAHİSİNDE ULTRASON İLE DÜZLEM DIŞI VE DÜZLEM İÇİ TEKNİKLER KULLANILARAK KAUDAL EPIDURAL BLOK KARŞILAŞTIRMASI: PROSPEKTİF RANDOMİZE KLİNİK BİR ÇALIŞMA
Abstract
Amaç: Pediatrik hipospadias cerrahisinde ultrason kılavuzluğunda düzlem dışı teknik ve düzlem içi teknikler kullanılarak yapılan kaudal epidural blok (CB) uygulamalarının başarı oranlarını ve postoperatif ağrı düzeylerini karşılaştırmak.
Yöntemler: Pediatrik hipospadias cerrahisi geçiren 162 hasta in-plane veya out of-plane ultrason kılavuzluğunda CB'ye randomize edildi. Birincil sonuç CB'nin başarı oranıydı. İkincil sonuçlar postoperatif ağrı düzeylerini (FLACC skoru), ilk analjezi gereksinim süresini, toplam parasetamol tüketim miktarını ve komplikasyonları içeriyordu. İşlem verileri kör gözlemciler tarafından toplandı. Bulgular: Birincil sonuçlarda, iğne denemelerinin medyan sayısı (%87,8'e karşı %56,3, p<.001), ilk girişteki başarı oranı (%93,9'a karşı %62,5, p<.001), görüntüleme oranı (%90,2'ye karşı %31,3, p<.001), lokal anestezik (LA) yayılma oranı (%87,8'e karşı %46,3, p<.001) ve blok uygulama süresi (41,44 ± 25,87 sn'ye karşı 78,11 ± 43,13 sn, p<.001) açısından sırasıyla düzlem içi ve düzlem dışı gruplar arasında farklar vardı. Ayrıca, 12. ve 24. saatlerdeki düzlem dışı ve düzlem içi FLACC skorları (sırasıyla p=.024 ve p=.012), ilk analjezi gereksinim zamanı (p=.009) ve 24 saatlik ağrı derecelendirmelerinde toplam parasetamol tüketimi miktarı (p=.018) arasında da farklar vardı. Komplikasyonlarda fark yoktu.
Sonuç: Ultrason rehberliğinde in-plane teknik, başarı oranı ve postoperatif analjezi açısından out of-plane tekniğe göre üstün olan alternatif bir tekniktir.
References
- 1. Klocke RT, Jenkinson T, Glew D. Sonographically guided caudal epidural steroid injections. Journal of ultrasound in medicine. 2003;22(11):1229-1232.
- 2. Roberts S, Ultrasonographic guidance in pediatric regional anesthesia. Part 2: techniques. Pediatric Anesthesia, 2006;16(11):1112-1124.
- 3. Kao SC, Lin SC. Caudal epidural block: an updated review of anatomy and techniques. BioMed research international, 2017;2017:1-5.
- 4. Eksert, S. and S. Ender, Kaudal Blok Uygulanan Pediatrik Hastalarda Ultrason ile Konvansiyonel Kör Tekniğin Karşılaştırılması. Celal Bayar Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi, 2019;6(2):111-114. (Turkish)
- 5. Roberts, SA, Guruswamy V, Galvez I. Caudal injectate can be reliably imaged using portable ultrasound–a preliminary study. Pediatric Anesthesia, 2005;15(11):948-952.
- 6. Wang LZ, Hu XX, Zhang YF, Chang XY. A randomized comparison of the caudal block by sacral hiatus injection under ultrasound guidance with traditional sacral canal injection in children. Pediatric Anesthesia, 2013;23(5):395-400.
- 7. Ahiskalioglu A, Yayik AM, Ahiskalioglu EO, et al. Ultrasound-guided versus conventional injection for caudal block in children: a prospective randomized clinical study. Journal of Clinical Anesthesia, 2018;44:91-96.
- 8. Ecoffey C. Pediatric regional anesthesia–update. Current Opinion in Anesthesiology, 2007;20(3):232-235.
- 9. Fredrickson M, Danesh‐Clough T. Ultrasound‐guided femoral catheter placement: a randomized comparison of the in‐plane and out‐of‐plane techniques. Anaesthesia, 2013;68(4):382-390.
- 10. Schwenk ES, Gandhi K, Baratta, JL, et al. Ultrasound-Guided Out-of-Plane vs. In-Plane Interscalene Catheters: A Randomized, Prospective Study. Anesth Pain Med, 2015;5(6):e31111.
- 11. Takeshita J, Tachibana K, Nakajima Y, et al. Long-axis in-plane approach versus short-axis out-of-plane approach for ultrasound-guided central venous catheterization in pediatric patients: A randomized controlled trial. Pediatric Critical Care Medicine, 2020;21(11):996-1001.
- 12. Abukawa Y, Hiroki K, Morioka N, et al. Ultrasound versus anatomical landmarks for caudal epidural anesthesia in pediatric patients. BMC Anesthesiology, 2015;15(1):1-4.
- 13. Karaca O, Pinar HU, Gokmen Z, Dogan R, Ultrasound-guided versus conventional caudal block in children: A prospective randomized study. European journal of pediatric surgery, 2019;29(06):533-538.
COMPARISON OF CAUDAL EPIDURAL BLOCK USING OUT-OF-PLANE AND IN-PLANE TECHNIQUES WITH ULTRASOUND IN PEDIATRIC HYPOSPADIAS SURGERY: A PROSPECTIVE RANDOMIZED CLINICAL STUDY
Abstract
Aim: To compare the success rates and postoperative pain levels of caudal epidural block (CB) applications using ultrasound-guided out-of-plane technique and in-plane techniques in pediatric hypospadias surgery.
Methods: One hundred sixty-two patients who underwent pediatric hypospadias surgery were randomized to either the in-plane or out-of-plane ultrasound-guided CB. The primary outcome was the success rate of CB. Secondary outcomes included postoperative pain levels (FLACC score), the first analgesia requirement time, the total amount of paracetamol consumption, and complications. Procedural data were collected by blinded observers.
Results: There were differences in the primary outcome of the number of needle attempts 87.8% vs. 56.3%, p<.001), the success rate at the first entry (93.9% vs. 62.5%, p<.001), the visualization rate (90.2% vs. 31.3%, p<.001), a local anesthetic (LA) spread rate (87.8% vs. 46.3%, p<.001), and the duration of block application (41.44 ± 25.87 sec vs. 78.11 ± 43.13 sec, p<.001), respectively, between the in-plane and out-of-plane groups. There were also differences between out-of-plane and in-plane FLACC scores at the 12th and 24th hours (p=.024 and p=.012, respectively), the first analgesia requirement time (p=.009), and the total amount of paracetamol consumption (p=.018) in 24-hour pain ratings. There were no differences in complications.
Conclusion: Ultrasound-guided in-plane technique is an alternative technique that is superior to the out-of-plane technique for its success rate and postoperative analgesia.
References
- 1. Klocke RT, Jenkinson T, Glew D. Sonographically guided caudal epidural steroid injections. Journal of ultrasound in medicine. 2003;22(11):1229-1232.
- 2. Roberts S, Ultrasonographic guidance in pediatric regional anesthesia. Part 2: techniques. Pediatric Anesthesia, 2006;16(11):1112-1124.
- 3. Kao SC, Lin SC. Caudal epidural block: an updated review of anatomy and techniques. BioMed research international, 2017;2017:1-5.
- 4. Eksert, S. and S. Ender, Kaudal Blok Uygulanan Pediatrik Hastalarda Ultrason ile Konvansiyonel Kör Tekniğin Karşılaştırılması. Celal Bayar Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi, 2019;6(2):111-114. (Turkish)
- 5. Roberts, SA, Guruswamy V, Galvez I. Caudal injectate can be reliably imaged using portable ultrasound–a preliminary study. Pediatric Anesthesia, 2005;15(11):948-952.
- 6. Wang LZ, Hu XX, Zhang YF, Chang XY. A randomized comparison of the caudal block by sacral hiatus injection under ultrasound guidance with traditional sacral canal injection in children. Pediatric Anesthesia, 2013;23(5):395-400.
- 7. Ahiskalioglu A, Yayik AM, Ahiskalioglu EO, et al. Ultrasound-guided versus conventional injection for caudal block in children: a prospective randomized clinical study. Journal of Clinical Anesthesia, 2018;44:91-96.
- 8. Ecoffey C. Pediatric regional anesthesia–update. Current Opinion in Anesthesiology, 2007;20(3):232-235.
- 9. Fredrickson M, Danesh‐Clough T. Ultrasound‐guided femoral catheter placement: a randomized comparison of the in‐plane and out‐of‐plane techniques. Anaesthesia, 2013;68(4):382-390.
- 10. Schwenk ES, Gandhi K, Baratta, JL, et al. Ultrasound-Guided Out-of-Plane vs. In-Plane Interscalene Catheters: A Randomized, Prospective Study. Anesth Pain Med, 2015;5(6):e31111.
- 11. Takeshita J, Tachibana K, Nakajima Y, et al. Long-axis in-plane approach versus short-axis out-of-plane approach for ultrasound-guided central venous catheterization in pediatric patients: A randomized controlled trial. Pediatric Critical Care Medicine, 2020;21(11):996-1001.
- 12. Abukawa Y, Hiroki K, Morioka N, et al. Ultrasound versus anatomical landmarks for caudal epidural anesthesia in pediatric patients. BMC Anesthesiology, 2015;15(1):1-4.
- 13. Karaca O, Pinar HU, Gokmen Z, Dogan R, Ultrasound-guided versus conventional caudal block in children: A prospective randomized study. European journal of pediatric surgery, 2019;29(06):533-538.
Details
| Primary Language | English |
|---|---|
| Subjects | Anaesthesiology |
| Journal Section | Original Article |
| Authors | |
| Publication Date | April 30, 2025 |
| Submission Date | August 12, 2024 |
| Acceptance Date | March 24, 2025 |
| Published in Issue | Year 2025 Volume: 35 Issue: 2 |
The Journal of General Medicine is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY NC).