Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
J Pediatr Urol. 2023 Aug;19(4):374-379. doi: 10.1016/j.jpurol.2023.03.019. Epub 2023 Mar 18.
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.
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.
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.
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.
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.
After controlling for possible confounders, caudal nerve block was not associated with increased risk of postoperative complications following distal hypospadias repair.
在进行尿道下裂修复时使用骶管麻醉仍然存在争议，因为一些先前的研究报告称，骶神经阻滞与术后并发症发生率增加有关。然而，由于混杂因素和异质研究组的存在，这些结果受到了质疑。
鉴于确定与尿道下裂并发症发生率增加相关的真正风险因素的重要性，我们检查了我们使用骶管麻醉的经验，将分析仅限于远端修复。我们假设骶管麻醉不会增加术后并发症。
我们回顾性地审查了我们机构从 2007 年 6 月至 2021 年 1 月的尿道下裂数据库。所有接受一期远端尿道下裂修复的男孩，包括接受骶管或阴茎阻滞麻醉且至少随访 1 个月的男孩，均纳入研究。对记录进行了回顾，以确定局部麻醉的类型、尿道下裂修复的类型、所有并发症和并发症发生的时间。通过单变量和多变量逻辑回归分析评估任何并发症与局部麻醉类型之间的关联，同时控制手术时的年龄和修复类型。对≤30 天内发生的并发症进行了亚分析。
总体而言，纳入了 1008 名男孩，其中 832 名（82.5%）接受了骶管麻醉，176 名（17.5%）接受了阴茎阻滞麻醉。手术时的中位年龄为 8.1 个月，中位随访时间为 13 个月。总体并发症发生率为 16.4%，需要再次手术的患者比例为 13.8%。中位并发症发生时间为 10.59 个月，骶管组明显较短（8.45 与 25.2 个月）。单变量分析显示，骶管麻醉与更高的并发症发生率相关；然而，当控制年龄和修复类型时，多变量分析结果并非如此。骶管麻醉与 30 天内的并发症发生率增加无关。
自首次提出骶管麻醉与尿道下裂并发症之间的关联以来，已有几项研究试图回答这个问题，但结果各不相同。我们的研究结果进一步证实，在短期或长期内，骶管麻醉与尿道下裂并发症的增加均无关联。本研究的主要优势在于研究人群庞大、同质、随访时间长，并且纳入了 14 位医生在 14 年中的数据。研究的局限性包括研究的回顾性以及研究期间缺乏标准化的随访方案。
在控制可能的混杂因素后，神经阻滞麻醉与远端尿道下裂修复后并发症的风险增加无关。
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