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Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva
Minerva Anestesiologica 2013 Dicembre;79(12):1381-8
Ultrasound-guided single shot caudal block anesthesia reduces postoperative urinary catheter-induced discomfort
Tsuchiya M. 1, 2, Kyoh Y. 3, Mizutani K. 4, Yamashita J. 1, 4, Hamada T. 1, 2 ✉
1 Department of Anesthesiology, Osaka City University Medical School, Abeno-Ku, Osaka, Japan;
2 Department of Anesthesia, Osaka Social Medical Center Hospital, Nishinari-Ku, Osaka, Japan;
3 Department of Orthopedic Surgery, Osaka Social Medical Center Hospital, Nishinari-Ku, Osaka, Japan;
4 Department of Anesthesia, Osaka Rosai Hospital, Kita-Ku, Sakai, Japan
Background: Urinary catheter-induced discomfort during the postoperative period can be distressing, and sometimes results in severe restlessness and agitation, especially in middle-aged and elderly male patients. Recent advances in ultrasound technology have increased the consistency, safety, and ease of a caudal block even in older patients. We speculated that an ultrasound-guided caudal block would be reliable and safe as treatment for such postoperative discomfort.
Methods: Adult male patients (ASA I-II) undergoing cervical laminoplasty were allocated to either the caudal block (CB, N.=24) or non-block (NB, N.=24) group. Following anesthesia induction, urinary catheterization was performed using a 16 French Foley catheter. Thereafter, an ultrasound-guided caudal block was performed with 8 ml of 0.3% ropivacaine and 100 µg of fentanyl for patients in group CB, while group NB did not receive a caudal block. We assessed urinary catheter-induced discomfort as mild, moderate, or severe at 0, 2, 6, 10, and 18 hours after surgery, and compared the incidence and severity of discomfort between the groups using a randomized double-blind design.
Results: All caudal blocks were successfully performed with 1 or 2 needle insertions. The incidence of urinary catheter-induced discomfort was significantly reduced in group CB as compared to NB at 0, 2, and 6 hours, while severity was also reduced at 0 and 2 hours. No patient required re-catheterization due to urinary retention after catheter removal. There were no other complications related to the caudal block.
Conclusion: Preoperative ultrasound-guided single shot caudal block anesthesia safely reduced postoperative urinary catheter-induced discomfort in our male patients.