Caudal extradural catheterization in pediatric renal transplant and its effect on perioperative hemodynamics and pain scoring: a prospective randomized study.
OBJECTIVE
'Hockey stick incision' used in renal transplant is large enough to cause severe postoperative morbidity especially in pediatric recipients. Although epidural analgesia is known to be effective in pain control, the resulting sympathectomy might affect hemodynamics interfering with the transplant process. In our study, we evaluated 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.


METHODS
After approval from the ethical committee at Kasr Al Ainy University Hospital and consent from parents/legal guardians, sixty patients aged 3-12 years who were scheduled for renal transplant were randomly divided into two equal groups. Group I (epidural group) received continuous caudal epidural bupivacaine 0.125 % with fentanyl together with intravenous (IV) fentanyl and paracetamol. Group II (control group) received only IV fentanyl and paracetamol. Intraoperative data included heart rate (HR), mean arterial blood pressure (MAP) and central venous pressure (CVP). Postoperative variables included HR, MAP, CVP, pain score and complications.


RESULTS
Threading failure via the caudal route occurred in 6.67 % of cases. Intraoperative differences in hemodynamics and CVP were not clinically significant between groups. Postoperative HR, MAP, and CVP were generally higher in the control group. Pain control was more satisfactory and postoperative complications were less in the epidural group.


CONCLUSIONS
Caudal epidural anesthesia in pediatric renal transplant is a valuable addition to general anesthesia as it provides stable perioperative hemodynamics, excellent postoperative analgesia and is associated with fewer complications than narcotic-dependent analgesia.


BACKGROUND
NCT02037802.
Division of Pediatric Anesthesia, Department of Anesthesia, ICU, and Pain Management, Faculty of Medicine, Abu El-Reesh Children's Hospital, Cairo University, Cairo, Egypt. sherif_soaida@hotmail.com.|Department of Anesthesia, Kasr al Ainy hospital, Cairo University, Kasr al Ainy street, Cairo, 11562, Egypt. sherif_soaida@hotmail.com.
Sherif M
SM
Soaida
Division of Pediatric Urology, Faculty of Medicine, Abu El-Reesh Children's Hospital, Cairo University, Cairo, Egypt.
Mohammed S
MS
ElSheemy
Division of Pediatric Urology, Faculty of Medicine, Abu El-Reesh Children's Hospital, Cairo University, Cairo, Egypt.
Ahmed M
AM
Shouman
Division of Pediatric Urology, Faculty of Medicine, Abu El-Reesh Children's Hospital, Cairo University, Cairo, Egypt.
Ahmed I
AI
Shoukry
Division of Pediatric Urology, Faculty of Medicine, Abu El-Reesh Children's Hospital, Cairo University, Cairo, Egypt.
Hany A
HA
Morsi
Pediatric Nephrology, Faculty of Medicine, Abu El-Reesh Children's Hospital, Cairo University, Cairo, Egypt.
Doaa M
DM
Salah
Pediatric Nephrology, Faculty of Medicine, Abu El-Reesh Children's Hospital, Cairo University, Cairo, Egypt.
Fatina I
FI
Fadel
Pediatric Nephrology, Faculty of Medicine, Abu El-Reesh Children's Hospital, Cairo University, Cairo, Egypt.
Hafez M
HM
Bazaraa
D015360:Analgesia, Epidural / Q000379:methods; D000767:Anesthesia, Epidural / Q000379:methods; D000768:Anesthesia, General / Q000379:methods; D000779:Anesthetics, Local / Q000627:therapeutic use*; D002045:Bupivacaine / Q000627:therapeutic use*; D002404:Catheterization; D002648:Child; D002675:Child, Preschool; D005260:Female; D005283:Fentanyl / Q000627:therapeutic use*; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D010149:Postoperative Pain / Q000517:prevention & control; D011446:Prospective Studies
D000779:Anesthetics, Local; D005283:Fentanyl; D002045:Bupivacaine
Anesthesia; Caudal; Epidural; Pediatrics; Renal; Transplant