scholarly journals The Termination Level of the Dural Sac Relevant to Caudal Epidural Block in Lumbosacral Transitional Vertebrae: A Comparison between Sacralization and Lumbarization Groups

2018 ◽  
Vol 1 (21;1) ◽  
pp. 73-81 ◽  
Author(s):  
Yu Mi Jeong
Keyword(s):  
Back Pain ◽  
Epidural Block ◽  
University Hospital ◽  
Dural Sac ◽  
Significant Difference ◽  
Caudal Epidural Block ◽  
The Mean ◽  
Lumbosacral Transitional Vertebrae ◽  
Caudal Margin ◽  
Caudal Epidural

Background: Lumbosacral transitional vertebrae (LSTV) are a relatively common variant and have been considered as one of the reasons for back pain. It is not unusual for clinicians to encounter patients with LSTV who require caudal epidural block (CEB) for pain management. Objective: We investigated the termination level of the dural sac (DS) and anatomical features of the lumbosacral region relevant to CEB in patients with LSTV and compared these findings between sacralization and lumbarization groups. Study Design: A retrospective evaluation. Setting: A university hospital with inpatient and outpatient LSTV cases presenting low back pain. Methods: Four hundred ninety-four LSTV patients were included and categorized into sacralization (n = 201) or lumbarization groups (n = 293). Magnetic resonance imaging (MRI) of all of the LSTV patients were reviewed to determine the level of DS termination, the shortest distance between the apex of the sacral hiatus and DS, and the presence and the caudal level of sacral perineural cysts. Each lumbosacral vertebra column was divided into 3 equal portions (upper, middle, and lower thirds). The MRI findings in both of the groups were compared and analyzed. Results: The distribution frequency of the levels of DS termination demonstrated a significant difference between the 2 groups. The mean caudal DS level in the lumbarization group was significantly lower than the sacralization group (lower third of the S2 [131 {44.7%} of 293 patients] vs. lower third of the S1 [78 {38.8%} of 201 patients]). The DS terminated at the S3 in more than 19% of the lumbarization group, whereas in only one case of the sacralization group. Although the incidence of perineural cysts was not significantly different between the 2 groups, the mean level of caudal margin of perineural cysts in the lumbarization group was significantly lower than the sacralization group (middle third of the S3 [10 {35.7%} of 28 cases] vs. middle third of the S2 [11 {44%} of 25 cases]). Limitations: This study reveals several limitations including the practical challenge of accurate enumeration of the transitional segment and the constraints on generalizability posed by the single-country study. Conclusion: When planning CEB for patients with LSTV, pre-procedural MRI to check the anatomical structures, including the level of DS termination and caudal margin of perineural cysts, would be of great use for lowering the risk of unexpected dural puncture during the procedure, especially in the lumbarization cases. Key words: Termination of the dural sac, dural sac termination, lumbosacral transitional vertebrae, transitional vertebra, caudal epidural block

scholarly journals Comparison between caudal epidural block and popliteal nerve block for postoperative analgesia in children undergoing foot surgery: a randomized controlled trial

2020 ◽  
Vol 8 (2) ◽  
pp. 560
Author(s):  
Tailang Bumer ◽  
Lokesh Kashyap ◽  
M. K. Arora ◽  
R. K. Batra ◽  
Ganga Prasad ◽  
...  
Keyword(s):  
Nerve Block ◽  
Postoperative Analgesia ◽  
Controlled Trial ◽  
Demographic Data ◽  
Epidural Block ◽  
Block Group ◽  
Foot Surgery ◽  
Significant Difference ◽  
Caudal Epidural Block ◽  
Caudal Epidural

Background: Pain following surgery in children cause discomfort, restlessness and agitation in the postoperative period which may result in an increased incidence of nausea, vomiting and maladaptive behavioural changes. Regional anaesthesia is commonly used as an adjunct to general anaesthesia for perioperative analgesia in children as part of a multimodal approach of pain relief. This study is to compare between caudal epidural block and popliteal nerve block for postoperative analgesia in children undergoing foot surgery.Methods: A prospective randomized single blind study was carried out on 30 children aged 1-12 years of either sex undergoing foot surgery. Patients were randomly assigned into caudal epidural block group and Popliteal nerve block group, 15 children each. Both groups receive 1 ml/kg of 0.25% bupivacaine. Foot surgery was carried out under general anesthesia along with regional block for all children. After completion of surgery, children were shifted to PACU and HR, BP, SPO2 were monitored. Patient was discharged from PACU after CHEOPS (1-5 years) or VAS (6-12 years) <4. Parental satisfaction, sedation score, PONV, and any other side effects were recorded.Results: Demographic data and baseline vital signs were comparable between two groups. Statistically significant difference (p=0.025) in number of attempts in giving block in group A (1.20±0.41) than group B (1.80±0.86). The mean postoperative pain scores, CHEOPS and VAS were comparable in both groups.Conclusions: Both caudal epidural block and popliteal nerve block provides comparable and adequate analgesia in children undergoing elective foot surgery.

The level of termination of the dural sac by MRI and its clinical relevance in caudal epidural block in adults

2013 ◽  
Vol 35 (7) ◽  
pp. 579-584 ◽  
Author(s):  
N. Senoglu ◽  
M. Senoglu ◽  
F. Ozkan ◽  
C. Kesilmez ◽  
B. Kızıldag ◽  
...  
Keyword(s):  
Clinical Relevance ◽  
Epidural Block ◽  
Dural Sac ◽  
Caudal Epidural Block ◽  
Caudal Epidural

scholarly journals Postoperative pain management for circumcision; Comparison of frequently used methods

2019 ◽  
Vol 36 (2) ◽  
Author(s):  
Caglar Münevveroglu ◽  
Mehmet Gunduz
Keyword(s):  
Pain Management ◽  
Postoperative Pain ◽  
Postoperative Pain Management ◽  
Epidural Block ◽  
Block Group ◽  
Intravenous Paracetamol ◽  
Significant Difference ◽  
Caudal Epidural Block ◽  
Caudal Epidural ◽  
Penile Block

Objective: To determine the ideal method for postoperative pain management after circumcision by comparing the most frequently used different methods like; dorsal penile block, caudal epidural block, subcutaneous ring block, intravenous paracetamol and intravenous tramadol HCl. Methods: Between May 1st 2015 to May 1st 2016, 500 children between 2-10 year old were circumcised at the department of pediatric surgery of Istanbul Medipol University Health Care Practice & Research Center Sefakoy Hospital. Five groups were formed according to postoperative analgesia methods which were planned to be compared; Group-I. penile block, Group-II. Caudal epidural block, Group-III. subcutaneous ring block, Group-IV as intravenous paracetamol and Group-V as intravenous tramadol HCl. In order to evaluate the postoperative pain levels of children, Children’s Hospital Eastern Ontario Pain Scale (CHEOPS) was filled at 30, 60, 120, 180 minutes after circumcision by a researcher who does not know which method was applied. Results: No significant difference is found between the groups (p>0.05). In the statistical analysis, no significant difference was found in the effect of analgesia methods on CHEOPS scores between 30, 60, 120 and 180 minutes (p>0.05). In parallel with this result, no significant difference was found in the effect of heart beat rates and respiration rate averages between 30, 60, 120 and 180 minutes (p>0.05). Conclusion: It has been shown that none of the five method has any superiority in reducing pain after circumcision and that all five methods can be used. However, we think that side effects of regional anesthesia and systemic analgesic applications should not be ignored. doi: https://doi.org/10.12669/pjms.36.2.505 How to cite this:Munevveroglu C, Gunduz M. Postoperative pain management for circumcision; Comparison of frequently used methods. Pak J Med Sci. 2020;36(2):---------. doi: https://doi.org/10.12669/pjms.36.2.505 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals Evaluation of Adding Dexmedetomidine to Ropivacaine in Pediatric Caudal Epidural Block: A Randomized, Double-blinded Clinical Trial

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Farnad Imani ◽  
Reza Farahmand Rad ◽  
Reza Salehi ◽  
Mahzad Alimian ◽  
Zahra Mirbolook Jalali ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Abdominal Surgery ◽  
Pain Score ◽  
Study Groups ◽  
Epidural Block ◽  
Caudal Block ◽  
Significant Difference ◽  
Caudal Epidural Block ◽  
Double Blinded ◽  
Caudal Epidural

Background: Caudal block is one of the methods of pain management performed following lower abdominal surgery, though having its own limitations. Objectives: In the present study, the effects and side effects of adding dexmedetomidine to ropivacaine in the caudal epidural block were investigated in children after lower abdominal surgery. Methods: In this randomized, double-blinded clinical trial, 46 children aged three to six years were divided into two groups to perform a caudal block following lower abdominal surgery under general anesthesia. The injectable solution contained ropivacaine in the R group (1 mL/kg ropivacaine 0.2%), as the control group, and dexmedetomidine (2 µg/kg) and ropivacaine 0.2% (1 mL/kg) in the DR group. The pain score (modified CHEOPS score), duration of analgesia, amount of analgesia consumed (i.v. paracetamol), hemodynamic changes, and possible adverse effects were assessed at one, two, and six hours in both groups. Results: The pain score at one and two hours showed no significant difference between the two study groups (P > 0.05). In the DR group, however, the pain score at the sixth hour was significantly lower, and the duration of analgesia was longer (P = 0.001). The amount of analgesic consumption was also lower in the DR group (P = 0.001). However, there was no significant difference in systolic blood pressure and heart rate (P < 0.05), in the case of diastolic blood pressure, a significant difference (P < 0.05) was seen (DR group lower than the R group). There was no statistically significant difference between the study groups in the duration of surgery, recovery time, and side effects (P < 0.05). Conclusions: In the present study, the addition of dexmedetomidine to ropivacaine in the caudal epidural blockade improved postoperative analgesia without significant adverse effects in pediatric patients.

scholarly journals Comparison of caudal and intravenous dexamethasone as adjuvants for caudal epidural block: A double blinded randomised controlled trial

2016 ◽  
Vol 60 (12) ◽  
pp. 948 ◽  
Author(s):  
Bharath Srinivasan ◽  
Rakesh Karnawat ◽  
Sadik Mohammed ◽  
Bharat Chaudhary ◽  
Anil Ratnawat ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Controlled Trial ◽  
Epidural Block ◽  
Caudal Epidural Block ◽  
Randomised Controlled ◽  
Double Blinded ◽  
Caudal Epidural

Ultrasound-Guided Caudal Epidural Block for Bilateral Testicular Ectopy and Circumcision in Child above 6 Years with Joubert Syndrome

2021 ◽  
Vol 6 (1) ◽  
Author(s):  
Fekih Hassen Amjed ◽  
◽  
Ben Fraj Asma ◽  
Blaiti Hajer ◽  
Ben Slimen Ahmed ◽  
...  
Keyword(s):  
Respiratory Control ◽  
Perioperative Period ◽  
Joubert Syndrome ◽  
Epidural Block ◽  
Opioid Use ◽  
Ultrasound Guided ◽  
Polygraphic Recordings ◽  
Caudal Epidural Block ◽  
Anesthesia Technique ◽  
Caudal Epidural

Background: Abnormal respiratory control has been clearly documented in infants and children with Joubert Syndrome (JS) by polygraphic recordings, characterized by episodes of apnea, tachypnea, and/or hyperpnea and the risk of recurrence of these episodes increase probably in perioperative period. In those cases, the choice of anesthesia technique and postoperative pain protocol, constitute a challenge for anesthesiologists. Case: We describe a case of successful ultrasound-guided Caudal Epidural Block (CEB) for children above 6 years with Joubert Syndrome undergoing bilateral testicular ectopy and circumcision avoiding opioid-use. Conclusions: Despite the difficulty to achieve CEB in child above 6 years, the ultrasound-guided can increase the success providing effective analgesia in-patient with a high-risk of respiratory failure as child with JS.

Vasovagal Syncope during a Caudal Epidural Block in a Patient with Vertebral Fractures: A case report

2001 ◽  
Vol 41 (3) ◽  
pp. 383
Author(s):  
Jun Hak Lee ◽  
Soo Jong Lee ◽  
Sang Cheol Park ◽  
Chae Sik Yun ◽  
Ki Nam Lee ◽  
...  
Keyword(s):  
Case Report ◽  
Vertebral Fractures ◽  
Vasovagal Syncope ◽  
Epidural Block ◽  
Caudal Epidural Block ◽  
Caudal Epidural

scholarly journals Caudal Epidural Block in Children: Comparison of Needle Insertion Parallel with Caudal Canal versus Conventional Two-Step Technique

2010 ◽  
Vol 38 (3) ◽  
pp. 525-529 ◽  
Author(s):  
K.-M. Shin ◽  
J.-H. Park ◽  
H.-K. Kil ◽  
S.-S. Kang ◽  
I.-S. Kim ◽  
...  
Keyword(s):  
Needle Insertion ◽  
Epidural Block ◽  
Caudal Epidural Block ◽  
Caudal Epidural
Sign in / Sign up

Export Citation Format

Share Document