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Abstract

Caudal Anesthesia in Surgical Interventions of the Lower Extremities in Children

Aim of the study: Comparative study of the effects of bupivacaine and ropivacaine in caudal anesthesia in surgical interventions of the lower extremities in children.

Material and methods of the study: The study included 59 children operated on for congenital dislocation of the hip, correction of various deformities of the pelvic bones, clubfoot, etc. All patients were divided into 2 groups depending on the type of local anesthetic used: Group I (n=39) was anaesthetized with caudal with ropivacaine and intravenous anesthesia with propofol, group II (n=20) - caudal block was performed with bupivacaine.

Results of the study: At the first stage of the study, the indices of central hemodynamics in both groups after the corresponding preoperative preparation were stable and corresponded to their mean age values. At the II and III stages of the study (skin incision and the most traumatic moment of the operation), the decrease in heart rate was observed at 13-16%, respectively, and the SI and AD mean declined unreliably. These changes are due to a sympathetic blockade caused by caudal administration of local anesthetics, which did not cause a significant reduction in SI because children were given infusion therapy at a rate of 10-12 ml/kg/h. At the third stage of the study (12 hours after the operation), the hemodynamic parameters remained stable in patients of the I group, did not differ significantly from the baseline data, which was explained with prolonged action by the action of the caudal block with ropivacaine. And in group II patients (caudal block with bupivacaine) at the third stage of the study (after 12 hours after the operation) a significant increase in heart rate was observed by 38%, SI - by 27% and ADDred. - by 11%. Therefore, patients of this group for the purpose of anesthesia in the postoperative period were prescribed tramadol in age dosages. The level of cortisol in patients of both groups in the II and III stages of the study was reduced by 26% and 23%, respectively, which confirmed the adequacy of these anesthesia techniques for surgical interventions of the lower extremities.

Conclusions

1. Caudal anesthesia with 0.75% solution of ropivacaine is a highly effective, reliable and safe method of anesthesia in traumatic operations of the lower extremities in children.

2. Caudal administration of a 0.75% solution of ropivacaine provides a prolonged sensory and motor block.

3. The superiority of caudal anesthesia with a 0.75% solution of ropivacaine over anesthesia with a 0.5% solution of bupivacaine is due to its more potent local anesthetic effect, as evidenced by a wider sensory block and deeper motor blockade with ropivacaine.


Author(s):

Nasibova EM



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