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Steinhardt GF. Commentary to reducing fistula rate in hypospadias repair: A comparative study between standard tabularized incised plate repair and incorporation of a layer of spongiosum tissue. J Pediatr Urol 2024; 20:680. [PMID: 38806336 DOI: 10.1016/j.jpurol.2024.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 04/29/2024] [Indexed: 05/30/2024]
Affiliation(s)
- George F Steinhardt
- Helen DeVos Children's Hospital, Urologic Consultants, Grand Rapids, MI 49506, USA.
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Xia Y, Yang Z, Li J, Liu P, Song H, Sun N, Li L, Zhang W. Urethrocutaneous fistula and glans dehiscence formation of hypospadias surgery in patients receiving caudal block vs. non-caudal block: A meta-analysis. J Pediatr Urol 2024; 20:227-236. [PMID: 38000951 DOI: 10.1016/j.jpurol.2023.10.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 10/26/2023] [Accepted: 10/30/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND This meta-analysis aimed to evaluate the difference in postoperative complications as urethrocutaneous fistula or glans dehiscence, in children undergoing primary hypospadias repair with caudal block (CB) versus non-caudal block (NCB). METHODS Data were obtained from MEDLINE, Embase, Web of Science, and the Cochrane Library. Comparative studies of CB versus NCB were identified, with reports of complications published or presented until October 2022. Subgroup analyses were performed based on study type, meatal location (distal only), type of NCB, surgeon and technique, and concentration and dose of anesthetics. RESULTS Compared to the reference group of NCB, CB was not significantly associated with the development of complications following primary hypospadias repair (OR 1.40, 95 % CI 0.88-2.23). After adjusting for confounding factors, such as type of study(OR 1.51, 95%CI: 0.29-7.91), type of NCB[PB (OR 1.82, 95 % CI: 0.87-3.84), GA (OR 1.26, 95 % CI: 0.39-4.04)], meatal location (distal only) (OR 1.22, 95 % CI: 0.61-2.43), surgeon and technique (OR 1.37, 95 % CI: 0.59-3.14) and concentration and dose of anesthetics(OR 2.74, 95 % CI: 0.82-9.20), subgroup analyses revealed no significant association between CB and NCB (P > 0.05). DISCUSSION Previous studies have found a correlation between CB and increased incidence of postoperative complications (urethrocutaneous fistula or glans dehiscence) of hypospadias, but different literature have suggested that surgical technique, surgical duration and the severity of hypospadias, rather than CB, are closely related to the occurrence of complications. In order to reduce confounding factors, subgroup analyses were conducted. The results showed that no correlation could be found in postoperative complications and CB. CONCLUSIONS This meta-analysis compared the incidence of urethrocutaneous fistula or glans dehiscence in the CB and NCB groups for primary hypospadias repair in children, indicating that no clear correlation could be found in postoperative complications and CB. Subgroup analyses on study type, type of NCB, meatal location (distal only), surgeon and technique, and regional anesthetic concentration and dose supported this conclusion.
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Affiliation(s)
- Yujie Xia
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health (NCCH), Beijing, 100045, China.
| | - Zhenzhen Yang
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health (NCCH), Beijing, 100045, China.
| | - Jiayi Li
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health (NCCH), Beijing, 100045, China.
| | - Pei Liu
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health (NCCH), Beijing, 100045, China
| | - Honcheng Song
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health (NCCH), Beijing, 100045, China
| | - Ning Sun
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health (NCCH), Beijing, 100045, China
| | - Lijing Li
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health (NCCH), Beijing, 100045, China.
| | - Weiping Zhang
- Department of Urology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health (NCCH), Beijing, 100045, China.
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Adler AC, Austin PF. Caudal block for hypospadias repair: Unfolding the controversy through statistical analysis and how we can put it all to rest! Paediatr Anaesth 2024; 34:108-111. [PMID: 37902155 DOI: 10.1111/pan.14786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 09/28/2023] [Indexed: 10/31/2023]
Affiliation(s)
- Adam C Adler
- Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital; Baylor College of Medicine, Houston, Texas, USA
| | - Paul F Austin
- Division of Pediatric Urology, Department of Surgery, Texas Children's Hospital; Baylor College of Medicine, Houston, Texas, USA
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Fischer KM, Van Batavia J, Hyacinthe N, Weiss DA, Tan C, Zderic SA, Mittal S, Shukla AR, Kolon TF, Srinivasan AK, Canning DA, Zaontz MR, Long CJ. Caudal anesthesia is not associated with post-operative complications following distal hypospadias repair. J Pediatr Urol 2023; 19:374-379. [PMID: 37002025 DOI: 10.1016/j.jpurol.2023.03.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 09/27/2022] [Accepted: 03/13/2023] [Indexed: 06/19/2023]
Abstract
INTRODUCTION The use of caudal anesthesia at the time of hypospadias repair remains controversial as some prior studies have reported increased postoperative complication rates associated with caudal nerve block. However, these results have been called into question due to confounding factors and heterogeneous study groups. OBJECTIVE Given the importance of identifying true risk factors associated with increased hypospadias complication rate, we examined our experience with caudal anesthesia limiting our analysis to distal repairs. We hypothesized that caudal anesthesia would not be associated with increased postoperative complications. STUDY DESIGN We retrospectively reviewed our institutional hypospadias database from June 2007 to January 2021. All boys who underwent single-stage distal hypospadias repair with either caudal or penile block with minimum 1 month follow up were included. Records were reviewed to determine the type of local anesthesia, type of hypospadias repair, all complications, and time to complication. Association between any complication and local anesthesia type was evaluated by univariate and multivariate logistic regression analysis controlling for age at surgery and type of repair. A sub-analysis was performed for complications occurring ≤30 days. RESULTS Overall, 1008 boys, 832 (82.5%) who received caudal and 176 (17.5%) penile block, were included. Median age at surgery was 8.1 months and median follow up was 13 months. Overall complication rate was 16.4% with 13.8% of patients requiring repeat operation. Median time to complication was 10.59 months and was significantly shorter in the caudal group (8.45 vs. 25.2 months). Caudal anesthesia was associated with higher likelihood of complication on univariate analysis; however, this was not true on multivariate analysis when controlling for age and type of repair. Caudal anesthesia was not associated with increased likelihood of complication within 30 days. DISCUSSION Since the association between caudal anesthesia and hypospadias complications was first suggested, several studies have tried to answer this question with variable results. Our findings add to the evidence that there is no association between caudal anesthesia and increased hypospadias complications in either the short or long term. The major strengths of our study are a large, homogenous study population, robust follow up and inclusion of data from 14 surgeons over 14 years. Limitations include the study's retrospective nature as well as lack of standardized follow up protocol throughout the study period. CONCLUSIONS After controlling for possible confounders, caudal nerve block was not associated with increased risk of postoperative complications following distal hypospadias repair.
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Affiliation(s)
- Katherine M Fischer
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jason Van Batavia
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Nathan Hyacinthe
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Dana A Weiss
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Connie Tan
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Steve A Zderic
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Sameer Mittal
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Aseem R Shukla
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Thomas F Kolon
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Arun K Srinivasan
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Douglas A Canning
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Mark R Zaontz
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Christopher J Long
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
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Di H, Wen Y. Letter to the editor reg: Caudal block and the incidence of hypospadias complications-advances over the past decade and future prospects. J Pediatr Urol 2023:S1477-5131(23)00154-7. [PMID: 37169700 DOI: 10.1016/j.jpurol.2023.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 04/11/2023] [Indexed: 05/13/2023]
Affiliation(s)
- Huajie Di
- Pediatrics, Xuzhou Medical University, Xuzhou, 221004, China; Department of Pediatric Urology, The Affiliated Xuzhou Children's Hospital of Xuzhou Medical University, Xuzhou, 221002, China.
| | - Yi Wen
- Pediatrics, Xuzhou Medical University, Xuzhou, 221004, China; Department of Pediatric Urology, The Affiliated Xuzhou Children's Hospital of Xuzhou Medical University, Xuzhou, 221002, China.
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Hu JC, Belon C, Ravula NR, Durbin-Johnson B, Kurzrock EA. Impact of caudal block on revision rates after hypospadias repair: Multi-institution review. J Pediatr Urol 2023:S1477-5131(23)00053-0. [PMID: 36842912 DOI: 10.1016/j.jpurol.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 02/01/2023] [Accepted: 02/07/2023] [Indexed: 02/13/2023]
Abstract
INTRODUCTION There is controversy surrounding the association between caudal block and complication rates after hypospadias repair. Conflicting results have been reported mostly from single-center, low volume studies and those that did not include relevant variables. OBJECTIVES We hypothesized that caudal block is not associated with increased rates of reoperation after primary repair and is associated with more complex hypospadias surgery. STUDY DESIGN The Clinical Practice Solutions Center database was queried to identify patients who received a primary hypospadias repair between 2009 and 2010. Primary hypospadias repair was further categorized as meatal advancement and glanduloplasty, distal, one-stage proximal, or one-stage perineal repair. Anesthesia coding was evaluated to identify those who received a caudal block. Any revision surgery was captured between 2009 and 2019 and the types of revision surgeries were identified. Variables such as caudal block, age, insurance type, surgeon volume, and surgeon years in practice were analyzed with mixed effects multiple logistic regression models. RESULTS The dataset query identified 3343 pediatric males who had primary hypospadias repair. The procedures were performed by 50 surgeons at 27 hospitals. Primary surgeries included meatal advancement and glanduloplasty (23%), distal (69%), proximal (6.9%), and perineal repairs (1%). Caudal block was administered to 42% of patients. Utilization of caudal block was not associated with type of primary surgery (p = 0.21). Adjusting for all other variables, increased patient age was associated with decreased usage of caudal block (p < 0.001). Analysis did not demonstrate a statistically significant association between utilization of caudal block with rates of revision surgery. CONCLUSIONS This large, multi-institution study demonstrates that the use of caudal block was not associated with more complex hypospadias surgery nor statistically significantly associated with increased rates of revision surgery after primary hypospadias repair.
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Affiliation(s)
- Jonathan C Hu
- University of California Davis Health, Department of Urologic Surgery, 4860 Y St Suite 3500, Sacramento, CA 95817, USA.
| | - Craig Belon
- University of California Davis Health, Department of Anesthesia and Pain Medicine. 4150 V Street, PSSB Suite 1200 Sacramento, CA 95817, USA.
| | - Niroop R Ravula
- University of California Davis Health, Department of Anesthesia and Pain Medicine. 4150 V Street, PSSB Suite 1200 Sacramento, CA 95817, USA.
| | - Blythe Durbin-Johnson
- University of California Davis Health School of Medicine, Division of Biostatistics. One Shields Avenue, Med Sci 1C, Room 145, Davis, CA 95616, USA.
| | - Eric A Kurzrock
- University of California Davis Health, Department of Urologic Surgery, 4860 Y St Suite 3500, Sacramento, CA 95817, USA.
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Yiğit D, Özen V, Kandirici A, Dokucu Aİ. Ultrasound-guided dorsal penile nerve block is a safe block in hypospadias surgery: A retrospective clinical study. Medicine (Baltimore) 2022; 101:e29700. [PMID: 35777019 PMCID: PMC9239652 DOI: 10.1097/md.0000000000029700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Caudal and dorsal penile nerve blocks are commonly used regional anesthesia methods in hypospadias surgery. Some studies have reported that regional anesthesia methods are risk factor for the development of postoperative complications following hypospadias surgery. The aim of the current study is to evaluate the relationship between postoperative complications and regional anesthesia methods used in distal hypospadias surgery. Forty-nine distal hypospadias patients were included. Patients had either received caudal or ultrasound (US)-guided dorsal penile nerve block. The age, type of hypospadias, regional anesthesia method, operation time, and postoperative complications were recorded. Fisher exact test and Mann-Whitney U tests were used to compare the data. Caudal epidural block was used in 25 (51%) patients and US-guided dorsal penile nerve block in 24 (49%) patients. There was no statistically significant difference between the groups regarding the types of hypospadias, operation time, and age. Fistula developed in 4 (16%) patients in the caudal block group and in none of the patients in the dorsal penile nerve block group. Fistula rates were statistically significantly different between the groups (P = .030). Conflicting data are found in the literature on the long-term postoperative complications of the regional anesthesia techniques used in hypospadias surgery. In our study, all patients with urethrocutaneous fistula were in the caudal block group. We believe that our study will contribute to the literature as it is the only study comparing caudal block with US-guided dorsal penile nerve block using in-plane technique in terms of postoperative complications in hypospadias surgery.
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Affiliation(s)
- Doğakan Yiğit
- Department of Pediatric Surgery and Pediatric Urology, Medical Doctor, Health Sciences University, Prof. Dr. Cemil Taşçioğlu City Hospital, Istanbul, Turkey
- *Correspondence: Doğakan Yiğit, Department of Pediatric Surgery and Pediatric Urology, Prof. Dr. Cemil Taşçioğlu City Hospital, Darülaceze Caddesi, Kaptanpaşa Mahallesi, Şişli, İstanbul 34100, Turkey (e-mail: )
| | - Volkan Özen
- Department of Anesthesiology, Health Sciences University, Prof. Dr. Cemil Taşçioğlu City Hospital, Istanbul, Turkey
| | - Aliye Kandirici
- Department of Pediatric Surgery and Pediatric Urology, Medical Doctor, Health Sciences University, Prof. Dr. Cemil Taşçioğlu City Hospital, Istanbul, Turkey
| | - Ali İhsan Dokucu
- Department of Pediatric Surgery and Pediatric Urology, Medical Doctor, Health Sciences University, Prof. Dr. Cemil Taşçioğlu City Hospital, Istanbul, Turkey
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Karagözlü Akgül A, Canmemiş A, Eyvazov A, Hürel H, Kiyan G, Umuroğlu T, Tuğtepe H. Effects of Caudal and Penile Blocks on the Complication Rates of Hypospadias Repair. Balkan Med J 2022; 39:239-245. [PMID: 35669925 PMCID: PMC9326942 DOI: 10.4274/balkanmedj.galenos.2022.2022-1-62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background: The major influencing factors for complications during hypospadias repair are the original location of the meatus, previous urethral surgery, surgical technique, and surgeon’s experience. While the effect of the technique of regional analgesia on complication rates has been considered in some studies, this issue remains controversial.hile the effect of the technique of regional analgesia on complication rates has been considered in some studies, this issue remains controversial. Aims: To determine the effect of caudal block and penile block on complication rates of hypospadias repair in patients with subcoronal hypospadias. Study Design: Retrospective cross-sectional study. Methods: Data of children who underwent hypospadias repair between 2011 and 2019 in our clinic (n = 770) were reviewed retrospectively. Only patients with subcoronal hypospadias and who underwent tubularized incised plate urethroplasty, performed by the same two experienced surgeons (n = 279), were included in the study. The exclusion criteria were incomplete data and follow-up time shorter than 12 months. Data of 279 patients were analyzed. Patients were divided into two groups according to the analgesia type: caudal block (n = 95) and penile block (n = 184), and complication rates were compared between these groups. Results: The median age was 36 months in the caudal block group and 30 months in the penile block group (P = 0.390). The median follow-up times were 54 and 42.7 months in the caudal and penile block groups, respectively. Total complication rates did not differ significantly between the groups and were determined as 10.5% and 12.5% in the caudal and penile groups, respectively. Urethrocutaneous fistula rates were observed as 2.1% and 4.3% (p=0.50). None of the patients had penile chordee and no penile plication was performed in the whole group. Conclusion: This study shows that there is no increase in post-repair complications in patients with subcoronal hypospadias who underwent caudal block.
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Affiliation(s)
- Ahsen Karagözlü Akgül
- Department of Pediatric Surgery, Division of Pediatric Urology, Faculty of Medicine Marmara University, İstanbul, Turkey
| | - Arzu Canmemiş
- Clinic of Pediatric Urology Ministry of Health, Göztepe Prof Dr Süleyman Yalçın Hospital, İstanbul, Turkey
| | - Ali Eyvazov
- Department of Pediatric Surgery, Faculty of Medicine Marmara University, İstanbul, Turkey
| | - Hilal Hürel
- Department of Pediatric Surgery, Faculty of Medicine Marmara University, İstanbul, Turkey
| | - Gürsu Kiyan
- Department of Pediatric Surgery, Faculty of Medicine Marmara University, İstanbul, Turkey
| | - Tümay Umuroğlu
- Department of Anaesthesiology and Reanimation, Faculty of Medicine Marmara University, İstanbul, Turkey
| | - Halil Tuğtepe
- Department of Pediatric Surgery, Division of Pediatric Urology, Faculty of Medicine Marmara University, İstanbul, Turkey
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Adler AC, Bhatia VP, Chandrakantan A, Nathanson BH, Ouellette L, Austin PF. Association of analgesic block with the incidence of complications following hypospadias surgery; a meta-analysis. Urology 2022; 166:11-17. [DOI: 10.1016/j.urology.2022.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/24/2022] [Accepted: 03/01/2022] [Indexed: 12/19/2022]
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Ozen V, Ozen N. Ultrasound-Guided Pudendal Nerve Block versus Ultrasound-Guided Dorsal Penile Nerve Block for Pediatric Distal Hypospadias Surgery. Urol Int 2022; 107:370-376. [PMID: 35144265 DOI: 10.1159/000521718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 12/15/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The primary aim of the study was to use the duration until the first postoperative analgesic requirement after two different block techniques to compare the analgesic effect. The secondary aims were to compare the two methods for postoperative Children's Hospital Eastern Ontario Pain Scale (CHEOPS) scores, complications, and parental satisfaction level. MATERIALS AND METHODS This prospective, observational study was conducted with male patients aged 1-7 years in the ASA I-II group, who were scheduled for hypospadias surgery between November 2019 and April 2020. Ultrasound (US)-guided pudendal nerve block (PNB) or US-guided dorsal penile nerve block (DPNB) was administered under general anesthesia before the operation. Postoperative analgesic need, postoperative pain, complications, and parental satisfaction were noted. The STROBE checklist was followed for reporting. RESULTS The study was conducted with 30 patients in total, divided into 15 patients receiving PNB and 15 patients receiving DPNB. The effective minimum block duration was longer in the pudendal group at 22.22 ± 0.61 h than in the DPNB group at 22.19 ± 0.57 h. Additional analgesic was required in 4 subjects in the pudendal group and 5 in the DPNB group. There was no statistically significant difference in terms of the variables between the two groups (p > 0.05). DISCUSSION US-guided DPNB and PNB were shown to provide successful postoperative analgesia and to have similar effectiveness in pediatric patients undergoing hypospadias surgery in this first prospective study of its kind in the literature. CONCLUSIONS US-guided DPNB and PNB have been demonstrated to provide effective, safe, and long-term postoperative analgesia in pediatric patients who have undergone hypospadias surgery. Parental satisfaction in both groups is positively influenced by the minimum postoperative analgesia requirement, the long-term analgesic effect, and the lack of any complications.
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Affiliation(s)
- Volkan Ozen
- Department of Anesthesiology and Reanimation, Prof. Dr. Cemil TASCIOGLU City Hospital, Istanbul, Turkey
| | - Nurten Ozen
- Department of English Nursing, Florence Nightingale Hospital School of Nursing, Demiroglu Bilim University, Istanbul, Turkey
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Koul A, Shukla D, Aggrawal SK, Sethi N. Incidence of urethrocutaneous fistula following distal hypospadias repair with and without caudal epidural block: A randomized pilot study. J Pediatr Urol 2022; 18:58.e1-58.e7. [PMID: 34863622 DOI: 10.1016/j.jpurol.2021.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 09/19/2021] [Accepted: 11/09/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Recent investigations have raised a doubt regarding the safety of Caudal epidural block (CEB) administered to children with distal hypospadias undergoing tubularised incised plate (TIP) urethroplasty. The primary objective of the study was to investigate whether there is any association between CEB and the occurrence of urethrocutaneous fistula (UCF) in the postoperative period. METHODS Fifty ASA 1 and 2 children with distal hypospadias aged 0-8 years were randomly allocated to CEB group (GA with CEB, 0.2% ropivacaine 1 ml/kg; n = 25) and Non-CEB group (GA without CEB; n = 25). Penile measurements were taken before and 20 min after administration of CEB to assess penile engorgement. Intraoperative hemodynamics were recorded at 10 min intervals after induction of anaesthesia. Consumption of IV fentanyl intraoperatively and postoperatively in first 24 h was recorded in both the groups. Rescue analgesia was administered for a score >4 on FLACC scale. After surgery children were followed up monthly for first three months and then at 6-months and yearly in paediatric surgery OPD to assess for development of UCF. RESULTS UCF was found to occur in only two children, one from each group on follow up, with an overall incidence of 4%. There was no difference in the incidence of UCF in the patients with and without CEB. A 26.8% increase in penile volume from baseline was recorded in CEB group (P = 0.000). The intraoperative heart rate and mean arterial pressure was significantly lower in the CEB group as compared to non CEB group at various time intervals. No additional intraoperative IV fentanyl supplementation was required in CEB group. Fentanyl consumption was significantly less in CEB group postoperatively in first 24 h (P = 0.000). DISCUSSION Administration of CEB was not found to have any impact on UCF formation. No relationship between the increase in penile volume after CEB block and occurrence of UCF was noticed. CONCLUSION Despite increase in penile volume after CEB, there was no difference between the two groups as regards to the occurrence of post operative UCF. CEB is an effective analgesic modality and can be continued to be used till the results of well powered prospective randomised trials with long follow up are reported.
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Affiliation(s)
- Archna Koul
- Department of Anaesthesiology, Pain and Perioperative Medicine, Sir Ganga Ram Hospital, New Delhi, India.
| | - Deepali Shukla
- Department of Anaesthesiology, Pain and Perioperative Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | - Satish K Aggrawal
- Department of Paediatric Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Nitin Sethi
- Department of Anaesthesiology, Pain and Perioperative Medicine, Sir Ganga Ram Hospital, New Delhi, India
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Alizadeh F, Amraei M, Haghdani S, Honarmand A. The effect of caudal epidural block on the surgical complications of hypospadias repair in children aged 6 to 35 months: A randomized controlled trial. J Pediatr Urol 2022; 18:59.e1-59.e6. [PMID: 34887183 DOI: 10.1016/j.jpurol.2021.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 10/29/2021] [Accepted: 11/11/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Caudal epidural block (CEB) in hypospadias surgery has the benefit of reducing post-operative pain and possibly intra-operative bleeding. Some studies, however, have suggested that this technique may increase the rate of post-operative complications. Considering the uncertainty about the effect of CEB on surgical complications of hypospadias repair, the current study was performed. OBJECTIVE The aim of this randomized clinical trial was to compare the complication rates between patients who receive CEB after hypospadias surgery and those who did not. STUDY DESIGN This double-blind randomized controlled trial was conducted on boys aged 6-35 months, who underwent hypospadias repair surgery in a university hospital from March 2018 to March 2019. Sixty patients were randomly divided into two groups (group A: 31 and group B: 29). In group B, CEB was performed, using 0.5 mg/kg of 0.125% bupivacaine (Marcaine). Postoperative complications including fistula, meatal stenosis, dehiscence, and occurrence of bleeding were assessed during six months after surgery. RESULTS The patients were assessed for possible complications at 24 h, one week, one, three and six months after surgery. No remarkable differences were observed between the patients in the two groups in terms of the frequency of dehiscence, fistula, and meatal stenosis (P > 0.05). Moreover, the difference in complication rates between the patients with proximal and distal hypospadias did not reach statistical significance (P = 0.549). DISCUSSION Assessment of complications showed no significant difference between the two study groups in terms of dehiscence, fistula, and meatal stenosis (Clavien type III). In addition, complication rate was not significantly different according to severity of hypospadias between the two groups. Our study had limitations such as short follow up and small sample size, which resulted in insignificant difference in complication rate between proximal and distal hypospadias. These limitations request large studies with long term follow up. CONCLUSION The current study showed that the use of caudal block anesthesia in comparison with general anesthesia did not increase surgical complications, which approved CEB protocol as a safe method in hypospadias repair.
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Affiliation(s)
- Farshid Alizadeh
- Department of Urology, Isfahan University of Medical Sciences (IUMS), Isfahan, Iran.
| | - Mahmoud Amraei
- Department of Urology, Isfahan University of Medical Sciences (IUMS), Isfahan, Iran.
| | - Saeid Haghdani
- Department of Urology, Hasheminejad Kidney Research Center (HKRC), Iran University of Medical Science, Tehran, Iran.
| | - Azim Honarmand
- Anesthesiology and Critical Care Research Center, Department of Anesthesiology and Critical Care, Isfahan University of Medical Sciences (IUMS), Isfahan, Iran.
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Zhang J, Zhu S, Zhang L, Fu W, Hu J, Zhang Z, Jia W. The association between caudal block and urethroplasty complications of distal tubularized incised plate repair: experience from a South China National Children's Medical Center. Transl Androl Urol 2021; 10:2084-2090. [PMID: 34159089 PMCID: PMC8185679 DOI: 10.21037/tau-21-355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background The effect of caudal block (CB) on the incidence of urethroplasty complications in hypospadias repair remains controversial. The evidence is conflicting, and some confounding bias issues need to be addressed. We sought to study a more homogenous group of distal hypospadias patients undergoing primary tubularized incised plate (TIP) repair by a senior pediatric urology surgeon in the past 2 years to examine the relationship between urethroplasty complications and the use of CB. Methods We reviewed our database to identify consecutive patients who had undergone hypospadias repairs by a senior director surgeon at our Center between January 2018 and November 2020. To be eligible to participate in the study, patients had to meet the following inclusion criteria: (I) have distal hypospadias; (II) have undergone a primary TIP repair; and (III) have attended follow-up appointments for a minimum period of 6 months. The primary outcome was the development of urethroplasty complications during the follow-up period. The principal variable of interest was whether or not CB was used perioperatively. The patients were categorized into a CB group (general anesthesia combined with CB) or a control group (general anesthesia only). Other potential risk factors were analyzed, including patient age at operation, patient weight, glans width, and the length of the urethral plate defect. Results Thirty (12.2%) of the distal patients developed postoperative surgical complications. The postoperative surgical complication rates were similar between the different anesthesia groups. Weight, the length of the urethral plate length, and glans width did not contribute to the risk. Age was the only independent risk factor for postoperative surgical complications, and the complication rates increased in older patients. Conclusions Our data from consecutive TIP repairs in distal hypospadias patients indicated no association between the use of CB anesthesia and the postoperative urethroplasty complication rate. Patients who were older in age when they underwent surgery had a higher risk of complications.
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Affiliation(s)
- Jingqi Zhang
- Department of Pediatric Urology, Provincial Key Laboratory of Research in Structure Birth Defect Disease, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Shibo Zhu
- Department of Pediatric Urology, Provincial Key Laboratory of Research in Structure Birth Defect Disease, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Liyu Zhang
- Department of Pediatric Urology, Provincial Key Laboratory of Research in Structure Birth Defect Disease, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Wen Fu
- Department of Pediatric Urology, Provincial Key Laboratory of Research in Structure Birth Defect Disease, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Jinhua Hu
- Department of Pediatric Urology, Provincial Key Laboratory of Research in Structure Birth Defect Disease, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Zhao Zhang
- Department of Pediatric Urology, Provincial Key Laboratory of Research in Structure Birth Defect Disease, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Wei Jia
- Department of Pediatric Urology, Provincial Key Laboratory of Research in Structure Birth Defect Disease, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
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14
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Ekstein M, Weinbroum AA, Ben-Chaim J, Amar E, Schvartz R, Klein Y, Bar-Yosef Y. Comparison of Caudal Block vs. Penile Block vs. Intravenous Fentanyl Only in Children Undergoing Penile Surgery: A Prospective, Randomized, Double Blind Study. Front Pediatr 2021; 9:654015. [PMID: 33842412 PMCID: PMC8033002 DOI: 10.3389/fped.2021.654015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 03/03/2021] [Indexed: 11/16/2022] Open
Abstract
Objectives: Penile surgery is commonly performed in pediatric surgical centers. There is no consensus regarding which analgesic method is most effective in controlling pain in these children. Methods: Consecutive children between 4 months and 16 years of age who underwent elective penile surgery were recruited. After inhaled induction of anesthesia, children were randomized to one of three methods of intraoperative analgesia: caudal block, IV fentanyl titrated to surgical response and spontaneous respiration, or dorsal penile nerve block (DPNB). All patients were given inhaled agents; fentanyl was added if either block was insufficient. Demographic data, analgesic use and pain scores were recorded by a blinded investigator in the PACU and ward. Pain scores, analgesic requirement, and recovery parameters of returning to normal activity level, eating, and voiding post-operatively for up to 4 days, were compared. Results: 116 children were recruited. Pain scores in the post anesthesia care unit were significantly lower in the DPNB and caudal block groups compared to the fentanyl group for the first 30 postoperative min. Pain scores and analgesic use were subsequently similar among the three groups for the rest of the study period. There was no statistical difference in time to eat, return to normal activity or in parental satisfaction scores among the groups. There was a trend toward earliest time to void in the DPNB group. Conclusions: Regional blocks most effectively controlled pain for 30 min after surgery. The choice of intra-operative analgesia protocol had no effect on later pain and recovery parameters.
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Affiliation(s)
- Margaret Ekstein
- Department of Anesthesiology & Critical Care & Pain, Tel Aviv University, Tel Aviv, Israel
| | - Avi A Weinbroum
- Department of Anesthesiology & Critical Care & Pain, Tel Aviv University, Tel Aviv, Israel
| | - Jacob Ben-Chaim
- Department of Pediatric Urology, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Amar
- Department of Orthopedics, Tel-Aviv Medical Center Affiliated With Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - Reut Schvartz
- Department of Anesthesiology & Critical Care & Pain, Tel Aviv University, Tel Aviv, Israel
| | - Yifat Klein
- Department of Anesthesiology & Critical Care & Pain, Tel Aviv University, Tel Aviv, Israel
| | - Yuval Bar-Yosef
- Department of Pediatric Urology, Tel Aviv University, Tel Aviv, Israel
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Wu Y, Wang J, Zhao T, Wei Y, Han L, Liu X, Lin T, Wei G, Wu S. Complications Following Primary Repair of Non-proximal Hypospadias in Children: A Systematic Review and Meta-Analysis. Front Pediatr 2020; 8:579364. [PMID: 33363061 PMCID: PMC7756017 DOI: 10.3389/fped.2020.579364] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 10/13/2020] [Indexed: 12/29/2022] Open
Abstract
Purpose: The aim of this study was to systematically review the literature on the complications and postoperative outcomes of children with non-proximal hypospadias. Methods: Electronic databases including PubMed, Embase, and Cochrane Library CENTRAL were searched systematically from January 1990 to June 2020 for the literature that reported the postoperative outcomes of patients with non-proximal hypospadias. Non-proximal hypospadias encompassed distal and mid-penile hypospadias. Results: We included 44 studies involving 10,666 subjects. Urethrocutaneous fistula (UCF) was the most common complication with an incidence of 4.0% (95% CI, 3.1-5.0%). Incidence of overall complications was 8.0% (95% CI, 6.3-9.8%). Meta-regression analysis revealed that length of urethral stent indwelling (coefficient 0.006; 95% CI, 0.000-0.011; p = 0.036) and penile dressing (coefficient 0.010; 95% CI, 0.000-0.021; p = 0.048) were two risk factors for UCF. Multivariate meta-regression analysis did not identify any independent risk factors for UCF. No differences were found between stent and stentless groups in non-proximal hypospadias regarding incidences of UCF (OR, 0.589; 95% CI, 0.267-1.297), meatal stenosis (OR, 0.880; 95% CI, 0.318-2.437), and overall complications (OR, 0.695; 95% CI, 0.403-1.199). No differences were found between foreskin preservation and circumcision in terms of complications either. Conclusions: UCF is the most common complication following hypospadias repair with an incidence of 4.0%. Independent risk factors for UCF were not identified in the current research. Distal hypospadias repair without stent indwelling is not likely to compromise the postoperative outcome. Further studies should be designed to explore the differences between different surgical approaches and the potential risk factors for complications following hypospadias repair.
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Affiliation(s)
- Yuhao Wu
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing, China
| | - Junke Wang
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing, China
| | - Tianxin Zhao
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing, China
| | - Yuexin Wei
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing, China
| | - Lindong Han
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing, China
| | - Xing Liu
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing, China
| | - Tao Lin
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing, China
| | - Guanghui Wei
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing, China
| | - Shengde Wu
- Department of Urology, Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Chongqing, China
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Braga LH, McGrath M, Farrokhyar F. Dorsal penile block versus caudal epidural anesthesia effect on complications post-hypospadias repair: Dilemmas, damned dilemmas and statistics. J Pediatr Urol 2020; 16:708-711. [PMID: 32900635 DOI: 10.1016/j.jpurol.2020.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 08/07/2020] [Accepted: 08/12/2020] [Indexed: 10/23/2022]
Abstract
The evidence examining the effects of regional blocks on complications posthypospadias repair has been controversial. Nine observational studies have been published thus far, with inconsistent and somewhat contradictory results. In this educational article, we attempt to explain the concepts of study accuracy and precision in the context of the hypospadias literature to shed some light on the reasons behind those controversies. Methodological issues such as selection bias, confounding effect, sample size, confidence interval and study generalizability from studies involving dorsal penile block versus caudal epidural anesthesia in hypospadias repair are discussed.
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Affiliation(s)
- Luis H Braga
- McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada; McMaster University/Department of Surgery/Urology, Hamilton, Ontario, Canada; McMaster Pediatric Surgery Research Collaborative, Hamilton, Ontario, Canada; Clinical Urology Research Enterprise (CURE) Program, McMaster Children's Hospital, Canada; Department of Health, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.
| | - Melissa McGrath
- McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada; McMaster University/Department of Surgery/Urology, Hamilton, Ontario, Canada; McMaster Pediatric Surgery Research Collaborative, Hamilton, Ontario, Canada; Clinical Urology Research Enterprise (CURE) Program, McMaster Children's Hospital, Canada
| | - Forough Farrokhyar
- McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada; McMaster Pediatric Surgery Research Collaborative, Hamilton, Ontario, Canada; Clinical Urology Research Enterprise (CURE) Program, McMaster Children's Hospital, Canada; Department of Health, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
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Zhu C, Wei R, Tong Y, Liu J, Song Z, Zhang S. Analgesic efficacy and impact of caudal block on surgical complications of hypospadias repair: a systematic review and meta-analysis. Reg Anesth Pain Med 2019; 44:259-267. [PMID: 30700621 DOI: 10.1136/rapm-2018-000022] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 06/27/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND OBJECTIVES is commonly used for children undergoing hypospadias repair. However, the safety of caudal block for hypospadias repair in children is controversial in terms of surgical complications such as urethrocutaneous fistula and glans dehiscence. We sought to perform a meta-analysis to estimate the analgesic efficacy and relative complications of caudal block for hypospadias repair in children. METHODS We identified comparative studies of caudal block versus peripheral nerve block or no caudal block; studies were published or presented through 1 January 2018, and reports of analgesic efficacy or surgical complications of hypospadias repair in children were identified. Peripheral nerve block includes dorsal nerve penile block and pudendal nerve block. Data were abstracted from studies comparing caudal block with peripheral nerve block or no caudal block; original source data were used when available. We prespecified separate assessments of randomized controlled trials (RCTs) and observational studies given the inherent differences between types of study designs. Data from 298 patients in four RCTs and from 1726 patients in seven observational studies were included. RCT and observational data were analyzed separately. RESULTS In RCTs, caudal blocks (compared with peripheral nerve blocks) showed no detectable differences in terms of need for additional analgesia within 24 hours after the surgery (OR 10.49; 95% CI 0.32 to 343.24; p=0.19), but limited data showed lower pain scores 24 hours after the surgery (standardized mean difference (SMD) 1.57; 95% CI 0.29 to 2.84; p=0.02), a significantly shorter duration of analgesia (SMD -3.33; 95% CI -4.18 to -2.48; p<0.0001) and analgesics consumption. No significant differences were observed in terms of postoperative nausea and vomiting (OR 3.08; 95% CI 0.12 to 77.80; p=0.50) or motor weakness (OR 0.01; 95% CI -0.03 to 0.05; p=0.56). Only one randomized study showed that caudal blocks (compared with peripheral nerve blocks) were associated with detectable differences in urethrocutaneous fistula rate (OR 25.27; 95% CI 1.37 to 465.01; p=0.03) and parental satisfaction rate (OR 0.07; 95% CI 0.02 to 0.21; p<0.00001). In observational studies, caudal block was not associated with surgical complications in all types of primary hypospadias repair (OR 1.83; 95% CI 0.80 to 4.16; p=0.15). To adjust for confounding factors and to eliminate potential selection bias involving caudal block indication, we performed subgroup analysis including only patients with distal hypospadias. This analysis revealed similar complication rates in children who received a caudal block and in children not receiving caudal block (OR 1.02; 95% CI, 0.39 to 2.65; p=0.96). This result further confirmed that caudal block was not a risk factor for surgical complications in hypospadias repair. The direction of outcomes in all the other subgroup analyses did not change, suggesting stability of our results. CONCLUSIONS In RCTs, only limited data showed peripheral nerve blocks providing better analgesic quality compared with caudal blocks. In real-world non-randomized observational studies with greater number of patients (but with admitted the potential for a presence of selection bias and residual confounders), caudal blocks were not associated with postoperative complications including urethrocutaneous fistula and glans dehiscence.
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Affiliation(s)
- Change Zhu
- Department of Anesthesiology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Rong Wei
- Department of Anesthesiology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yiru Tong
- Department of Anesthesiology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Junjun Liu
- Department of Anesthesiology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Zhaomeng Song
- Department of Anesthesiology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Saiji Zhang
- Department of Anesthesiology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
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Dadure C, Veyckemans F, Bringuier S, Habre W. Epidemiology of regional anesthesia in children: Lessons learned from the European Multi-Institutional Study APRICOT. Paediatr Anaesth 2019; 29:1128-1135. [PMID: 31486563 DOI: 10.1111/pan.13741] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 08/29/2019] [Accepted: 09/02/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Recently, the European prospective observational multicenter cohort study, APRICOT, reported anesthesia techniques and complications in more than 31 000 pediatric procedures. The main objective of this study was to analyze the current practice in regional anesthesia in the 33 countries that participated to APRICOT. METHODS Data on regional anesthesia techniques were extracted from the database of APRICOT (261 centers across 33 European countries). All children, aged from birth to 16 years old, were eligible for inclusion during a 2-week period. Type of regional anesthesia, whether used awake or with sedation or general anesthesia, techniques of guidance, and the drugs administered were analyzed. RESULTS Regional anesthesia was used in 4377 pediatric surgical procedures. The large majority was performed under general anesthesia with central blocks and truncal blocks, representing, respectively, 42.6% and 41.8% of performed techniques. Caudal blocks represented 76.9% of all central blocks. The penile and ilioinguinal/iliohypogastric blocks were the most commonly performed truncal blocks. Anesthetists used mainly anatomical landmarks; ultrasound guidance was applied in only 23.8% of cases. A wide variability of practices was observed in terms of regional anesthesia techniques and local anesthetics among the participating European countries. No serious complications were reported. CONCLUSION These data show a large predominance of central and truncal blocks in APRICOT study. Ultrasound guidance was mainly used for peripheral nerve blocks while central blocks were performed using landmark techniques.
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Affiliation(s)
- Christophe Dadure
- Department of Paediatric and Gynaecology Anaesthesia, Lapeyronie University Hospital, University of Montpellier, Montpellier, France.,Functional Genomics Institute, U1191 INSERM Unit, Montpellier, France
| | - Francis Veyckemans
- Department of Paediatric Anaesthesia, Jeanne de Flandre Hospital, University Hospitals of Lille, Lille, France
| | - Sophie Bringuier
- Department of Anaesthesia and Critical Care, Lapeyronie Hospital, University Hospitals of Montpellier, Montpellier, France
| | - Walid Habre
- Department of Anaesthesia, Pharmacology and Intensive Care, University Hospitals of Geneva, Geneva, Switzerland
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Tanseco PP, Randhawa H, Chua ME, Blankstein U, Kim JK, McGrath M, Lorenzo AJ, Braga LH. Postoperative complications of hypospadias repair in patients receiving caudal block vs. non-caudal anesthesia: A meta-analysis. Can Urol Assoc J 2019; 13:E249-E257. [PMID: 30526802 PMCID: PMC6737734 DOI: 10.5489/cuaj.5688] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
INTRODUCTION We performed a meta-analysis of the current literature to assess the association of caudal block and postoperative complication rates following hypospadias repair. METHODS A Systematic literature search was conducted on October 2017. Five reviewers independently screened, identified, and evaluated comparative studies assessing postoperative outcomes following hypospadias repair with and without caudal block. The incidence of post-surgical complications from each study was extracted for caudal block and control groups to generate the odds ratio (OR) and corresponding 95% confidence intervals (CI). Effect estimates were pooled using inverse-variance method with random-effects model. Subgroup analyses were performed according to study type and hypospadias severity. RESULTS Nine studies (2096patients) of low- to moderate-quality were included for meta-analysis. Overall pooled effect estimates demonstrated increased occurrence of postoperative complication rates among patients with caudal block (OR 2.32; 95% CI 1.29-4.16). Subgroup analysis according to hypospadias severity revealed that a significant increased OR in complication rate was noted among proximal hypospadias (OR 3.55; 95% CI 1.80-7.01), but not distal hypospadias (OR 1.31; 95% CI 0.59-2.88). CONCLUSIONS Our meta-analysis of poor-quality evidence may have revealed a significant association between caudal block and postoperative complications following hypospadias repair. However, subgroup analysis demonstrated that hypospadias severity is important in determining complication rates, suggesting that confounding factors and selection bias may play a central role in characterizing the true effect of the anesthesia approach.
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Affiliation(s)
| | | | - Michael Erlano Chua
- Institute of Urology, St. Luke’s Medical Center, Quezon City, NCR, Philippines
- The Hospital for Sick Children, Toronto, ON, Canada
| | | | - Jin Kyu Kim
- The Hospital for Sick Children, Toronto, ON, Canada
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Armando J. Lorenzo
- The Hospital for Sick Children, Toronto, ON, Canada
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Goel P, Jain S, Bajpai M, Khanna P, Jain V, Yadav DK. Does caudal analgesia increase the rates of urethrocutaneous fistula formation after hypospadias repair? Systematic review and meta-analysis. Indian J Urol 2019; 35:222-229. [PMID: 31367075 PMCID: PMC6639986 DOI: 10.4103/iju.iju_252_18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 06/21/2016] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Caudal block analgesia is administered to lower the requirements of systemic and inhaled anesthetic drugs during hypospadias surgery. However, recent reports, all clustered in a short time-span have generated controversial and mutually opposing results while evaluating caudal block as an independent risk factor for urethroplasty-related complications after hypospadias repair. There is no consensus statement on the role of caudal block analgesia in formation of urethrocutaneous fistula (UCF) after hypospadias surgery. We performed a systematic review and meta-analysis of the studies evaluating the relative rates of UCF formation after hypospadias surgery in patients who were administered caudal block analgesia versus in those who were not. METHODS Electronic searches were performed using PubMed, PubMed Central, Google Scholar, Ovid, and the Cochrane library. Statistical analysis was performed using a fixed-effect model, odds ratios, risk ratios (RR), and heterogeneity (I2) were calculated. Funnel plot was used to assess for publication bias. RESULTS Seven studies with 1706 patients were included. Caudal block analgesia is associated with a significantly higher risk of UCF formation (RR: 1.81; 95% confidence interval [CI]: 1.30-2.53), (P = 0.0004) and other urethroplasty-related complications (RR 2.01; 95% CI: 1.48-2.74), (P < 0.00001) after hypospadias surgery. Funnel plots indicate some publication bias. CONCLUSIONS In patients undergoing hypospadias repair, administration of caudal analgesia is associated with a higher risk of UCF formation and other urethroplasty-related complications.
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Affiliation(s)
- Prabudh Goel
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Shikha Jain
- Department of Anesthesiology, All India Institute of Medical Sciences, New Delhi, India
| | - Minu Bajpai
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Puneet Khanna
- Department of Anesthesiology, All India Institute of Medical Sciences, New Delhi, India
| | - Vishesh Jain
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Devendra Kumar Yadav
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
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Splinter WM, Kim J, Kim AM, Harrison MA. Effect of anesthesia for hypospadias repair on perioperative complications. Paediatr Anaesth 2019; 29:760-767. [PMID: 31063627 DOI: 10.1111/pan.13657] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 04/18/2019] [Accepted: 04/25/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Recent publications from the United States, India, and Korea report that children undergoing hypospadias repair with caudal regional anesthesia/analgesia could have increased postoperative surgical complications. AIMS The purpose of this retrospective cohort study was to assess the impact between caudal regional anesthesia, other regional anesthesia, and no regional anesthesia on complications after hypospadias repair at a tertiary care children's hospital in Ottawa, Canada, with an expectation to changing practices if a link was found. METHOD We reviewed the health records of 827 children with hypospadias undergoing penile surgery from January 1991-June 2017. The final sample size for the analysis consisted of 764 patients and 825 procedures. RESULTS The overall complications were almost identical when considering anesthesia effects, and this similarity persisted when we assessed specifically for only surgical complications. We had 716, 94, and 15 subjects who had a caudal block, penile block, and general anesthesia only, respectively, and their complication rates were 28, 31, and 27%, respectively, and their fistula formation rates were 10, 6, and 0%, respectively, and their stricture formation rates were 8, 7, and 20%,, respectively. Hypospadias type and surgical repair technique were marked predictors of complications in the postoperative period. CONCLUSION Anesthesia technique appears to have minor impact on complications after hypospadias repair, while surgical technique and type of hypospadias impact complications after hypospadias surgery in children. Based upon these results, we will not change our current practice of using a variety of regional anesthesia techniques for children undergoing hypospadias repair.
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Affiliation(s)
- William M Splinter
- Department of Anesthesiology and Pain Medicine, University of Ottawa and Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Jarmila Kim
- Department of Anesthesiology and Pain Medicine, University of Ottawa and Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Alexa M Kim
- Department of Anesthesiology and Pain Medicine, University of Ottawa and Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Mary-Ann Harrison
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
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Alizadeh F, Heydari SM, Nejadgashti R. Effectiveness of caudal epidural block on interaoperative blood loss during hypospadias repair: A randomized clinical trial. J Pediatr Urol 2018; 14:420.e1-420.e5. [PMID: 29858133 DOI: 10.1016/j.jpurol.2018.03.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Accepted: 03/26/2018] [Indexed: 10/16/2022]
Abstract
BACKGROUND Intraoperative blood loss is considered to be an important issue in hypospadias surgery. Some studies have demonstrated the utility of caudal epidural block (CEB) in this regard among pediatric patients with hypospadias. Though there is evidence in favor of the use of CEB as the only anesthetic method for pediatric surgeries, it is usually used in combination with general anesthesia. In this form of use, it could have more favorable outcomes for both intra- and postoperative periods. There are few studies regarding the effectiveness of CEB on intraoperative blood loss. OBJECTIVE We aimed to evaluate the utility of CEB on blood loss, operation time, and analgesic use during hypospadias repairs of pediatric population referred to our university hospitals. STUDY DESIGN In this randomized clinical trial, consecutive patients with hypospadias who were candidate for surgery were enrolled and randomly allocated to one of the two groups: group A received caudal epidural block (CEB) plus general anesthesia (GA) before surgery and group B received only GA. Intraoperative blood loss, operation time, and dose of fentanyl used during the procedure were recorded and compared. All surgeries were performed by a single pediatric urologist in two different university hospitals that was not blinded to the study groups. RESULTS In this study, 57 pediatric patients with hypospadias who underwent surgical repair were studied, from which 29 and 28 patients were allocated to receive or not to receive preoperative CEB, respectively. The patients' age, weight, ASA, score and severity of hypospadias were not significantly different between the two groups. The operation time was significantly lower in the CEB before surgery group (p < 0.05). The mean dose of fentanyl and volume of blood loss during procedure were lower in the CEB group, although for fentanyl it approached but did not reach statistical significance. CONCLUSION The findings of current study indicated that caudal epidural anesthesia in addition to general anesthesia has a favorable effect on reducing blood loss during operation, operation time, and analgesic use. Our data confirm the findings of previous studies in this field. Further studies are recommended to evaluate the effect of this type of analgesia in other outcomes of hypospadias repair surgery. Our results could be used for revising existing surgical guidelines for better management of hypospadias.
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Affiliation(s)
- Farshid Alizadeh
- Kidney Transplantation Research Center, Isfahan University of Medical Sciences, Department of Urology, Isfahan, Iran.
| | - Seyed Morteza Heydari
- Department of Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Reza Nejadgashti
- Kidney Transplantation Research Center, Isfahan University of Medical Sciences, Department of Urology, Isfahan, Iran
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