Abstract：
The aim of this narrative review is to evaluate the literature describing the use of caudal anesthetic-based techniques in premature and ex-premature infants undergoing lower abdominal surgery.
All available literature from inception to August 2023 was retrieved according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines from Medline, PubMed, Embase, and the Cochrane Library. Two authors reviewed all references for eligibility, abstracted data, and appraised quality.
Of the 211 articles identified, 45 met our inclusion criteria yielding 1548 cases with awake caudal anesthesia. The review included 558 (36.0%) cases of awake caudal anesthesia, 837 cases (54.1%) of \"awake\" caudal anesthesia with sedation, and 153 cases (9.9%) of combined spinal caudal epidural anesthesia without sedation. The overall anesthetic failure rate was 7.2% (71.9:1000 caudals). Failure rates were highest for CSEA (13.7%, 7.7-18.4), intermediate for awake caudal (6.6%, 5.26-9.51), and lowest for sedated caudal anesthesia (5.85%, 4.48-7.82). The incidence (range) of perioperative apnea was highest for sedated caudal anesthesia (8.16, 0%-24%), intermediate for awake caudal (7.62%, 0%-60%), and lowest for CSEA (5.53%, 0%-14.3%). High spinal anesthesia occurred in 0.84%, or 8.35:1000 caudals overall. The incidence was highest in awake caudal anesthesia cases (1.97% or 19.7:1000 caudals), intermediate with caudal with sedation (1.07% or 10.7:1000 caudals), and lowest in CSEA (0.7% or 6.6:1000 caudals). Our review was confounded by incomplete data reporting and small sample sizes as most were case reports. There were no high-quality randomized controlled trials, and the eight single-center retrospective data reviews lacked sufficient data to perform meta-analysis.
There is insufficient evidence to validate or refute the benefits of the use of \"awake\" caudal anesthesia in premature and ex-premature infants. The high doses of local anesthetics used, the high failure rate, and the increased incidence of high spinal anesthesia would suggest that the techniques offer no real advantages over awake spinal anesthesia or general anesthesia with a regional block.
All available literature from inception to August 2023 was retrieved according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines from Medline, PubMed, Embase, and the Cochrane Library. Two authors reviewed all references for eligibility, abstracted data, and appraised quality.
Of the 211 articles identified, 45 met our inclusion criteria yielding 1548 cases with awake caudal anesthesia. The review included 558 (36.0%) cases of awake caudal anesthesia, 837 cases (54.1%) of \"awake\" caudal anesthesia with sedation, and 153 cases (9.9%) of combined spinal caudal epidural anesthesia without sedation. The overall anesthetic failure rate was 7.2% (71.9:1000 caudals). Failure rates were highest for CSEA (13.7%, 7.7-18.4), intermediate for awake caudal (6.6%, 5.26-9.51), and lowest for sedated caudal anesthesia (5.85%, 4.48-7.82). The incidence (range) of perioperative apnea was highest for sedated caudal anesthesia (8.16, 0%-24%), intermediate for awake caudal (7.62%, 0%-60%), and lowest for CSEA (5.53%, 0%-14.3%). High spinal anesthesia occurred in 0.84%, or 8.35:1000 caudals overall. The incidence was highest in awake caudal anesthesia cases (1.97% or 19.7:1000 caudals), intermediate with caudal with sedation (1.07% or 10.7:1000 caudals), and lowest in CSEA (0.7% or 6.6:1000 caudals). Our review was confounded by incomplete data reporting and small sample sizes as most were case reports. There were no high-quality randomized controlled trials, and the eight single-center retrospective data reviews lacked sufficient data to perform meta-analysis.
There is insufficient evidence to validate or refute the benefits of the use of \"awake\" caudal anesthesia in premature and ex-premature infants. The high doses of local anesthetics used, the high failure rate, and the increased incidence of high spinal anesthesia would suggest that the techniques offer no real advantages over awake spinal anesthesia or general anesthesia with a regional block.
摘要：
目的：这篇叙述性综述的目的是评估描述在接受下腹部手术的早产儿和早产儿中使用尾麻醉技术的文献。
方法：从开始到2023年8月的所有可用文献均根据Medline的系统评价和荟萃分析指南的首选报告项目进行检索，PubMed,Embase,还有Cochrane图书馆.两位作者审查了所有参考文献的资格，抽象数据，和评价质量。
结果：在确定的211篇文章中，45例符合我们的纳入标准，产生1548例清醒的尾部麻醉。回顾包括558例（36.0％）清醒的尾部麻醉，837例（54.1%）的“清醒”尾麻醉与镇静，153例（9.9％）的腰硬联合麻醉无镇静。总体麻醉失败率为7.2％（71.9：1000尾）。CSEA的故障率最高(13.7%，7.7-18.4),清醒尾端的中级(6.6%，5.26-9.51),镇静尾部麻醉最低(5.85%，4.48-7.82)。镇静后麻醉的围手术期呼吸暂停发生率（范围）最高（8.16，0％-24％），尾端清醒的中级(7.62%，0%-60%)，CSEA最低(5.53%，0%-14.3%）。高脊髓麻醉发生率为0.84%,或8.35:总共1000尾。在清醒的尾部麻醉病例中发生率最高（1.97％或19.7：1000尾），尾部中间带镇静（1.07%或10.7:1000尾部），CSEA最低（0.7%或6.6：1000尾）。我们的审查被不完整的数据报告和小样本量所混淆，因为大多数是病例报告。没有高质量的随机对照试验，8项单中心回顾性数据综述缺乏足够的数据进行荟萃分析.
结论：没有足够的证据证实或反驳在早产儿和前早产儿中使用“清醒”尾管麻醉的益处。使用的高剂量局部麻醉药，高故障率，高脊髓麻醉发生率的增加表明，与清醒脊髓麻醉或局部阻滞全身麻醉相比，该技术没有真正的优势。
方法：从开始到2023年8月的所有可用文献均根据Medline的系统评价和荟萃分析指南的首选报告项目进行检索，PubMed,Embase,还有Cochrane图书馆.两位作者审查了所有参考文献的资格，抽象数据，和评价质量。
结果：在确定的211篇文章中，45例符合我们的纳入标准，产生1548例清醒的尾部麻醉。回顾包括558例（36.0％）清醒的尾部麻醉，837例（54.1%）的“清醒”尾麻醉与镇静，153例（9.9％）的腰硬联合麻醉无镇静。总体麻醉失败率为7.2％（71.9：1000尾）。CSEA的故障率最高(13.7%，7.7-18.4),清醒尾端的中级(6.6%，5.26-9.51),镇静尾部麻醉最低(5.85%，4.48-7.82)。镇静后麻醉的围手术期呼吸暂停发生率（范围）最高（8.16，0％-24％），尾端清醒的中级(7.62%，0%-60%)，CSEA最低(5.53%，0%-14.3%）。高脊髓麻醉发生率为0.84%,或8.35:总共1000尾。在清醒的尾部麻醉病例中发生率最高（1.97％或19.7：1000尾），尾部中间带镇静（1.07%或10.7:1000尾部），CSEA最低（0.7%或6.6：1000尾）。我们的审查被不完整的数据报告和小样本量所混淆，因为大多数是病例报告。没有高质量的随机对照试验，8项单中心回顾性数据综述缺乏足够的数据进行荟萃分析.
结论：没有足够的证据证实或反驳在早产儿和前早产儿中使用“清醒”尾管麻醉的益处。使用的高剂量局部麻醉药，高故障率，高脊髓麻醉发生率的增加表明，与清醒脊髓麻醉或局部阻滞全身麻醉相比，该技术没有真正的优势。
