Atasever Ayşe Gülşah, Ermiş Okan, Demir Bilge Şencan, Kaşali Kamber, Karadeniz Meltem Savran
Clinic of Anesthesia, Ayancık State Hospital, Sinop, Turkey.
Department of Anesthesia, Gazi University School of Medicine, Ankara, Turkey.
Turk J Urol. 2019 Nov 29;46(3):243-248. doi: 10.5152/tud.2019.19191. Print 2020 May.
Optimal analgesia following ambulatory surgery is an important matter in patient satisfaction, and it reduces unnecessary hospital admissions. This study investigated whether a caudal block with bupivacaine alone or in a combination with lidocaine can alter postoperative pain scores, complications, and peroperative and postoperative analgesic consumption.
This is a retrospective study that included children who underwent elective circumcision surgery under general anesthesia and caudal analgesia between January and June 2018. Among the 103 children, 17 cases were not analyzed due to an unsuccessful caudal block and procedures simultaneously underwent another operation unrelated to circumcision. We divided the study participants into two groups according to the type of local anesthetic applied: 0.5 mL/kg 0.25% bupivacaine (Group B) and 0.5 mL/kg 0.25% bupivacaine + 3 mg/kg 1% lidocaine (Group BL) caudally.
Pain scores were similar between these groups and remained in the mild-to-moderate range throughout the hospitalization (p>0.05). There were significant differences regarding the rescue analgesic use, first micturition, and mobilization times (p<0.001). In addition, we applied the multivariable logistic regression for fentanyl consumption adjusted for first mobilization and micturition time, unlike mobilization, a significantly increased risk for postoperative delayed micturition (OR, 1.06; 95% CI, 1.0-1.12; p=0.038) was found with intra-operative intravenous fentanyl use.
Our results suggest that the caudal block with a lidocaine+bupivacaine combination decreases rescue analgesic consumption at day-case surgery. In circumcision procedures, the caudal block is an effective and safe analgesic method for intraoperative and postoperative pain control with no side effects. This trial was registered at Clinicaltrals.gov, NCT03911648.
门诊手术后的最佳镇痛对于患者满意度而言是一个重要问题，并且它能减少不必要的住院。本研究调查了单独使用布比卡因或与利多卡因联合进行骶管阻滞是否会改变术后疼痛评分、并发症以及术中和术后的镇痛药物消耗量。
这是一项回顾性研究，纳入了2018年1月至6月期间在全身麻醉和骶管镇痛下接受择期包皮环切手术的儿童。在这103名儿童中，17例因骶管阻滞失败且同时进行了与包皮环切无关的另一项手术而未被分析。我们根据所应用的局部麻醉剂类型将研究参与者分为两组：0.5 mL/kg的0.25%布比卡因（B组）和0.5 mL/kg的0.25%布比卡因 + 3 mg/kg的1%利多卡因（BL组）进行骶管注射。
这些组之间的疼痛评分相似，并且在整个住院期间都保持在轻度至中度范围内（p>0.05）。在补救性镇痛药物使用、首次排尿和活动时间方面存在显著差异（p<0.001）。此外，我们对首次活动和排尿时间进行调整后，对芬太尼消耗量应用了多变量逻辑回归分析，与活动情况不同，术中静脉使用芬太尼会使术后排尿延迟的风险显著增加（比值比，1.06；95%置信区间，1.0 - 1.12；p = 0.038）。
我们的结果表明，利多卡因 + 布比卡因联合进行骶管阻滞可减少日间手术时的补救性镇痛药物消耗量。在包皮环切手术中，骶管阻滞是一种有效且安全的用于术中和术后疼痛控制的镇痛方法，且无副作用。本试验已在Clinicaltrals.gov注册，注册号为NCT03911648。
