背景:尿道下裂手术中的硬膜外阻滞(CEB)具有减少术后疼痛和可能的术中出血的益处。一些研究,然而,已经表明,这种技术可能会增加术后并发症的发生率。考虑到CEB对尿道下裂修复手术并发症影响的不确定性,进行了本研究.
目的:这项随机临床试验的目的是比较尿道下裂术后接受CEB的患者和未接受CEB的患者的并发症发生率。
方法:这项双盲随机对照试验对6-35个月的男孩进行,从2018年3月至2019年3月,他在大学医院接受了尿道下裂修复手术。将60例患者随机分为两组(A组:31例,B组:29例)。B组,CEB被执行,使用0.5mg/kg的0.125%布比卡因(Marcaine)。术后并发症包括瘘,肉孔狭窄,开裂,并在术后6个月内评估出血的发生情况.
结果:患者在24小时时评估可能的并发症,一个星期,一,手术后三个月和六个月。两组患者在裂开频率方面无显著差异,瘘管,肠狭窄(P>0.05)。此外,近端和远端尿道下裂患者的并发症发生率差异无统计学意义(P=0.549).
结论:对并发症的评估显示两个研究组在裂开方面没有显著差异,瘘管,和气孔狭窄(ClavienIII型)。此外,根据尿道下裂的严重程度,两组的并发症发生率无明显差异。我们的研究有局限性,如随访时间短,样本量小,这导致近端和远端尿道下裂的并发症发生率差异不显著。这些局限性要求进行长期随访的大型研究。
结论:目前的研究表明,与全身麻醉相比,使用尾阻滞麻醉并未增加手术并发症,批准CEB方案作为尿道下裂修复的安全方法。
Caudal epidural block (CEB) in hypospadias surgery has the benefit of reducing post-operative pain and possibly intra-operative bleeding. Some studies, however, have suggested that this technique may increase the rate of post-operative complications. Considering the uncertainty about the effect of CEB on surgical complications of hypospadias repair, the current
study was performed.
The aim of this randomized clinical
trial was to compare the complication rates between patients who receive CEB after hypospadias surgery and those who did not.
This double-blind randomized controlled
trial was conducted on boys aged 6-35 months, who underwent hypospadias repair surgery in a university hospital from March 2018 to March 2019. Sixty patients were randomly divided into two groups (group A: 31 and group B: 29). In group B, CEB was performed, using 0.5 mg/kg of 0.125% bupivacaine (Marcaine). Postoperative complications including fistula, meatal stenosis, dehiscence, and occurrence of bleeding were assessed during six months after surgery.
The patients were assessed for possible complications at 24 h, one week, one, three and six months after surgery. No remarkable differences were observed between the patients in the two groups in terms of the frequency of dehiscence, fistula, and meatal stenosis (P > 0.05). Moreover, the difference in complication rates between the patients with proximal and distal hypospadias did not reach statistical significance (P = 0.549).
Assessment of complications showed no significant difference between the two
study groups in terms of dehiscence, fistula, and meatal stenosis (Clavien type III). In addition, complication rate was not significantly different according to severity of hypospadias between the two groups. Our
study had limitations such as short follow up and small sample size, which resulted in insignificant difference in complication rate between proximal and distal hypospadias. These limitations request large studies with long term follow up.
The current study showed that the use of caudal block anesthesia in comparison with general anesthesia did not increase surgical complications, which approved CEB protocol as a safe method in hypospadias repair.