Caudal extradural catheterization in pediatric renal transplant and its effect on perioperative hemodynamics and pain scoring: a prospective randomized study.
Soaida SM, ElSheemy MS, et al.J Anesth 2015 [record in progress].
Aims
To evaluate the feasibility and safety of inserting an epidural catheter to the thoracic level via the caudal route, and the effect of using epidural local anesthetics at low concentrations on hemodynamics.
Interventions
Patients were randomized into two groups where one group (epidural group) received continuous caudal epidural bupivacaine 0.125% with fentanyl together with intravenous (IV) fentanyl and paracetamol, while the second group (control group) received only IV fentanyl and paracetamol.
Participants
60 patients aged 3–12 years scheduled for renal transplant
Outcomes
The primary outcome measured was changes in blood pressure. Secondary outcomes were intraoperative and postoperative hemodynamic changes, central venous pressure (CVP), pain score, total amount of rescue analgesia needed for pain control postoperatively on the first postoperative day, and the onset of the first dose of rescue analgesia.
Follow-up
24 hours
CET Conclusions
This single-centre RCT from Egypt investigated the feasibility and safety of inserting an epidural catheter to the thoracic level via the caudal route, and the effect of low-dose epidural local anaesthetics on hemodynamics in 60 children aged 3-12 years undergoing renal transplantation. The epidural group received continuous caudal epidural bupivacaine with fentanyl together with intravenous (IV) fentanyl and paracetamol whilst the control group received only IV fentanyl and paracetamol. A sample size calculation was conducted and the study achieved a power of 80%. Assessment of outcomes including postoperative pain was not blinded. Results for the primary outcome of blood pressure changes and secondary outcomes including intraoperative and postoperative hemodynamic changes, central venous pressure changes, postoperative pain and need for analgesia show that inserting an epidural catheter to the thoracic level through the caudal route was feasible and safe with minimal complications.
Data analysis
Per protocol analysis
Trial registration
Clinicaltrials.gov - NCT02037802