Taicher Brad M, Routh Jonathan C, Eck John B, Ross Sherry S, Wiener John S, Ross Allison K
Division of Pediatric Anesthesia, Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA.
Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC, USA.
Paediatr Anaesth. 2017 Jul;27(7):688-694. doi: 10.1111/pan.13119. Epub 2017 Mar 27.
Recent reports have suggested that caudal anesthesia may be associated with an increased risk of postoperative surgical complications. We examined our experience with caudal anesthesia in hypospadias repair to evaluate for increased risk of urethrocutaneous fistula or glanular dehiscence.
All hypospadias repairs performed by a single surgeon in 2001-2014 were reviewed. Staged or revision surgeries were excluded. Patient age, weight, hypospadias severity, surgery duration, month and year of surgery, caudal anesthesia use, and postoperative complications were recorded. Bivariate and multivariate statistical analyses were performed.
We identified 395 single-stage primary hypospadias repairs. Mean age was 15.6 months; 326 patients had distal (83%) and 69 had proximal (17%) hypospadias. Caudal anesthetics were used in 230 (58%) cases; 165 patients (42%) underwent local penile block at the discretion of the surgeon and/or anesthesiologist. Complications of urethrocutaneous fistula or glanular deshiscence occurred in 22 patients (5.6%) and were associated with caudal anesthetic use (OR 16.5, 95% CI 2.2-123.8, P = 0.007), proximal hypospadias (OR 8.2, 95% CI 3.3-20.0, P < 0.001), increased surgical duration (OR 1.01, 95% CI 1.01-1.02, P < 0.001), and earlier year of practice (OR 3.0, 95% CI 1.2-7.9, P = 0.03 for trend). After adjusting for confounding variables via multivariable logistic regression, both caudal anesthetic use (OR 13.4, 95% CI 1.8-101.8, P = 0.01) and proximal hypospadias (OR 6.8, 95% CI 2.7-16.9, P < 0.001) remained highly associated with postoperative complications.
In our experience, caudal anesthesia was associated with an over 13-fold increase in the odds of developing postoperative surgical complications in boys undergoing hypospadias repair even after adjusting for urethral meatus location. Until further investigation occurs, clinicians should carefully consider the use of caudal anesthesia for children undergoing hypospadias repair.
最近的报告表明，骶管麻醉可能与术后手术并发症风险增加有关。我们回顾了我们在尿道下裂修复术中使用骶管麻醉的经验，以评估尿道皮肤瘘或龟头裂开风险是否增加。
回顾了2001年至2014年由单一外科医生进行的所有尿道下裂修复手术。排除分期手术或翻修手术。记录患者年龄、体重、尿道下裂严重程度、手术时间、手术月份和年份、骶管麻醉使用情况及术后并发症。进行双变量和多变量统计分析。
我们确定了395例单阶段原发性尿道下裂修复手术。平均年龄为15.6个月；326例患者为远端尿道下裂（83%），69例为近端尿道下裂（17%）。230例（58%）使用了骶管麻醉；165例患者（42%）由外科医生和/或麻醉师酌情进行了阴茎局部阻滞。22例患者（5.6%）发生了尿道皮肤瘘或龟头裂开并发症，且与骶管麻醉使用有关（比值比16.5，95%置信区间2.2 - 123.8，P = 0.007）、近端尿道下裂（比值比8.2，95%置信区间3.3 - 20.0，P < 0.001）、手术时间延长（比值比1.01，95%置信区间1.01 - 1.02，P < 0.001）以及早期执业年份有关（趋势P = 0.03，比值比3.0，95%置信区间1.2 - 7.9）。通过多变量逻辑回归调整混杂变量后，骶管麻醉使用（比值比13.4，95%置信区间1.8 - 101.8，P = 0.01）和近端尿道下裂（比值比6.8，95%置信区间2.7 - 16.9，P < 0.001）仍与术后并发症高度相关。
根据我们的经验，即使在调整尿道口位置后，骶管麻醉与接受尿道下裂修复术的男孩术后手术并发症发生几率增加超过13倍有关。在进一步研究之前，临床医生应谨慎考虑对接受尿道下裂修复术的儿童使用骶管麻醉。
