Goel Prabudh, Jain Shikha, Bajpai Minu, Khanna Puneet, Jain Vishesh, Yadav Devendra Kumar
Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India.
Department of Anesthesiology, All India Institute of Medical Sciences, New Delhi, India.
Indian J Urol. 2019 Jul-Sep;35(3):222-229. doi: 10.4103/iju.IJU_252_18.
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.
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 (I) were calculated. Funnel plot was used to assess for publication bias.
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), ( = 0.0004) and other urethroplasty-related complications (RR 2.01; 95% CI: 1.48-2.74), ( < 0.00001) after hypospadias surgery. Funnel plots indicate some publication bias.
In patients undergoing hypospadias repair, administration of caudal analgesia is associated with a higher risk of UCF formation and other urethroplasty-related complications.
在尿道下裂手术中，实施骶管阻滞镇痛可降低全身麻醉药和吸入麻醉药的用量。然而，近期所有集中在短时间内的报告在评估骶管阻滞作为尿道下裂修复术后尿道成形术相关并发症的独立危险因素时，得出了相互矛盾且有争议的结果。关于骶管阻滞镇痛在尿道下裂手术后尿道皮肤瘘（UCF）形成中的作用，尚无共识声明。我们对评估接受骶管阻滞镇痛与未接受骶管阻滞镇痛的患者在尿道下裂手术后UCF形成的相对发生率的研究进行了系统评价和荟萃分析。
使用PubMed、PubMed Central、谷歌学术、Ovid和Cochrane图书馆进行电子检索。采用固定效应模型进行统计分析，计算比值比、风险比（RR）和异质性（I）。使用漏斗图评估发表偏倚。
纳入了7项研究，共1706例患者。骶管阻滞镇痛与尿道下裂手术后UCF形成风险显著升高相关（RR：1.81；95%置信区间[CI]：1.30 - 2.53），（ = 0.0004），以及与其他尿道成形术相关并发症相关（RR 2.01；95% CI：1.48 - 2.74），（ < 0.00001）。漏斗图显示存在一些发表偏倚。
在接受尿道下裂修复的患者中，实施骶管阻滞镇痛与UCF形成及其他尿道成形术相关并发症的风险较高有关。
