Ümit Hüseyin TOPAL, Selcan YEREBAKAN AKESEN, Belgin YAVAŞCAOĞLU

Pediyatrik Kaudal Anestezi Uygulamalarının Değerlendirilmesi: Ulusal Anket Çalışması

Kaudal blok pediyatrik rejyonal anestezi pratiğinde çok sık kullanılan bir tekniktir. Ancak klinik pratikte kaudal blok uygulamaları hakkında çok az bilgi mevcuttur. Bu çalışmada Türkiye’de anestezistler tarafından yaygın olarak kullanılan kaudal blok ile ilgili; anestezistin deneyimini, uygulanan teknikleri, kullanılan ilaçları ve kaudal epidural kateter tekniğinin kullanım sıklığını değerlendirmeyi amaçladık. Anket çalışmasına, etik kurul onayı sonrası, 553 Anesteziyoloji ve Reanimasyon uzmanı ve araştırma görevlisi katıldı. Formlar ilgili kişilere posta yoluyla veya elden iletildi. Katılımcıların büyük kısmı uzman anestezi doktoru olarak görev yapmaktaydı ve genelde 5 yıldan az pediyatrik anestezi deneyimine sahiplerdi. Sıklıkla 22- veya 24-gauge mandrenli kaudal iğne kullandıkları, kaudal epidural boşluğa dermoid doku implantasyonu riskinin yüksek olduğunu düşündükleri, aynı zamanda epidural aralığa yerleşimin doğrulanması için klinik belirteçleri kullandıkları saptandı. Lokal anestezik olarak sıklıkla % 0,125-0,25’lik bupivakain ve additif ilaç olarak çoğunlukla opioid kullandıkları, kaudal kateter kullanım oranının çok düşük olduğu ve asepsi yöntemi olarak genelde yalnızca eldiven kullanıldığı görüldü. Genellikle kaudal bloğun indüksiyon sonrası yapıldığı ve anestezi idamesinde inhalasyon anestezisi kullanıldığı, aynı zamanda kaudal bloğun en sık ürogenital operasyonlarda tercih edildiği saptandı. Sonuç olarak, pediyatrik anestezide kaudal bloğun güvenli olarak uygulanması için kullanılan teknik ve ilaçların değerlendirileceği uluslararası katılımlı çok merkezli çalışmalara gereksinim olduğu kanısına vardık.

Anahtar Kelimeler:

pediyatri, kaudal anestezi, epidural anestezi

Evaluation of Pediatric Caudal Anesthesia Administration: A National Survey Trial

Caudal block is the most commonly used regional technique in pediatric anesthesia but very little information is available about clinical practice of applications. The aim of the study is to evaluate a widely used technique caudal block; the experience of the anesthesiologist, applied techniques, the use of drugs and addivies and caudal epidural catheter in Turkey. 553 Anesthesiology and Reanimation expert or research assistant joined the survey after getting the approval of Ethic Committee. A questionnaire form delivered by hand or mail to the relevant people. The majority of participants were expert anesthesiologists, and they generally had a pediatric anesthesia experience <5 years. It was founded that most commonly used needle is 22 or 24 gauge styled caudal needle, the anesthetists considered that the risk of dermoid tissue implantation to the caudal epidural space exists in a high rate, also it was detected that they were using clinical markers for verification of epidural space exists in a high rate. It was founded that bupivacaine 0,125-0,25 % as a local anesthetic was the commonly used drug, opioids were the most frequent drugs as additive. Also caudal catheter usage rates were very low and only sterile gloves were usually used as aseptic technique and that caudal block was usually performed after induction and anesthesia was maintained usually with inhalational anesthesia. Also caudal block was preferred most common in urogenital surgery. In conclusion, a lot of international multicenter studies should be considered to evaluate that used drugs and techniques for the safety of caudal block in pediatric anesthesia.

Keywords:

Pediatric anesthesia, caudal block, caudal anesthesia,

PDF

___

Dalens BJ. Regional anesthesia in children. In: Miller RD.ed.,Anesthesia. 5th edition Volume II. Philedelphia: Churchill Livingstone ; 2000. 1549-85.
Cyna AM, Middleton P. Caudal epidural block versus other methods of postoperative pain relief for circumcision in boys. Cochrane Database of Systematic Reviews 2008, Issue 4. Art. No.: CD003005.
Shukla U, Prabhakar T, Malhotra K. Postoperative analgesia in children when using clonidine or fentanyl with ropivacaine given caudally. J Anaesthesiol Clin Pharmacol 2011; 27: 205-10.
Singh R, Kumar N, Singh P. Randomized controlled trial comparing morphine or clonidine with bupivacaine for caudal analgesia in children undergoing upper abdominal surgery. Br J Anaesth 2011; 106: 96- 100.
Beyaz SB. Comparison of preemptive intravenous paracetamol and caudal block in terms of analgesic and hemodynamic parameters in children. J Clin Exp Invest 2012; 3: 202- 8.
Karacalar, K. S., Korfalı, G. Pediyatrik olgulardaki kaudal blok uygulamalarında bupivakain solüsyonuna eklenen klonidinin hemodinami, postoperatif analjezi ve sedasyon üzerine etkileri. Uludağ Üniversitesi Tıp Fakültesi Dergisi 2006; 32: 71- 5.
Çelik JB, Apilioğulları S, İnci Kara İ. ve ark. A comparison of the effects of caudal anesthesia with constant dosage of levobupivacaine in different volumes and concentrations in children. Erciyes Med J 2013; 35: 42-5.
Ingelmo P, Frawley G, Astuto M et al. Relative analgesic potencies of levobupivacaine and ropivacaine for caudal anesthesia in children. Anesth Analg 2009; 108: 805-13.
Dalens B Cudal Anesthesia. In:Dalens B (ed). Regional Anesthesia in Infants, Chidiren and Adolescents 1st edition. London: Williams &Wilkins ; 1995. 171-94.
Ivani G. Caudal block: the ‘no turn technique. Pediatr Anesth 2005; 15: 80–4.
Menzies R, Congreve K, Herodes V, et al. A survey of pediatric caudal extradural anesthesia practice. Paediatr Anaesth 2009; 19: 829-36.
Fahy CJ, Costi DA, Cyna AM. A survey of aseptic precautions and needle type for paediatric caudal block in Australia and New Zealand. Anaesth Intensive Care. 2013; 41: 102-7.
Baris S, Guldogus F, Baris YS et al. Is tissue coring a real problem after caudal injection in children? Pediatr Anesth 2004; 14: 755–8.
Jeong IH, Lee JK, Kim JH. Iatrogenic intraspinal epidermoid tumor. J Korean Neurosurg Soc 2004; 36: 254–6.
Jöhr M, Berger TM. Caudal blocks. Paediatr Anaesth 2012; 22: 44-50.
Orme RM, Berg SJ. The ‘swoosh’ test – an evaluation of a modified ‘whoosh’ test in children. Br J Anaesth 2003; 90: 62–5.
Talwar V, Tyagi R, Mullick P, et al. Comparison of 'whoosh' and modified 'swoosh' test for identification of the caudal epidural space in children. Paediatr Anaesth 2006; 16: 134-9.
Raghunathan K, Schwartz D, Connelly NR. Determining the accuracy of caudal needle placement in children: a comparison of the swoosh test and ultrasonography. Paediatr Anaesth 2008; 18: 606-12.
Sanders JC. Paediatric regional anaesthesia, a survey of practice in the United Kingdom. Br J Anaesth 2002; 89: 707–10.
Hill P. Off licence and off label prescribing in children: litigation fears for physicians. Arch Dis Child 2005; 90: i17–i18.
Bhandal N, Rogers R, Berg S et al. Paediatric caudal extradural catheterisation: an evaluation of a purpose designed equipment set. Anaesthesia 2006; 61: 277– 81.
Apthorp M, Challands J, Visram A. A survey of the usage of caudal catheters amongst paediatric anaesthetists practising in the UK. Paediatr Anesth 2000; 10: 692- 5.
Goodman NW. Evidence based medicine: cautions before using. In: Tramer M, ed. Evidence Based Resource in Anaesthesia and Analgesia. London: BMJ Books, 2000: 3–25.
Cook TM, R Mihai, Wildsmith JAW. A national census of central neuraxial block in the UK: results of the snapshot phase of the Third National Audit. Anaesthesia 2008; 63: 143– 6.
Gemmell L, Birks R, Radford P et al. Guidelines: Infection control in anaesthesia. Anaesthesia 2008; 63: 1027– 36.
Maddock A, Ball DR, Jefferson P. Aseptic precautions for caudal anaesthesia. Anaesthesia 2015; 70: 233-4.
Polaner DM, Taenzer AH, Walker BJ, et al.Pediatric Regional Anesthesia Network (PRAN): a multi-institutional study of the use and incidence of complications of pediatric regional anesthesia. Anesth Analg 2012; 115: 1353-64.
Morrison K, Herbst K, Corbett S, Herndon CD. Pain management practice patterns for common pediatric urology procedures. Urology 2014; 83: 206-10
Wang T, Xiang Q, Liu F, et al. Effects of caudal sufentanil supplemented with levobupivacaine on blocking spermatic cord traction response in pediatric orchidopexy. J Anesth 2013; 27: 650-6.
Ahuja S, Aggarwal M, Joshi N, et al. Efficacy of caudal clonidine and fentanyl on analgesia, neuroendocrine stress response and emergence agitation in children undergoing lower abdominal surgeries under general anaesthesia with sevoflurane. J Clin Diagn Res 2015; 9: UC01-5.
Schloss B, Martin D, Tripi J, et al. Caudal epidural blockade for major orthopedic hip surgery in adolescents. Saudi J Anaesth 2015; 9: 128-31.
Tamai H, Sawamura S, Kanamori Y et al. Thoracic epidural catheter insertion using the caudal approach with an electrical nerve stimulator in young children. Reg Anesth Pain Med 2004; 2: 92– 5.
Beyaz SG, Tokgöz O, Tüfek A. Regional anaesthesia in paediatric surgery: results of 2200 children. J Pak Med Assoc 2011; 61: 782-6.