014 Caudals and complications in hypospadias repairs: correlation or causation?. (December 2018)

• Record Type: Journal Article
• Authors: Nielsen, D; Johnson, M; O'Donnell, C; Afzal, S; Thomas, ML
• Is Part Of: Archives of disease in childhood. Volume 103(2018)Supplement 2
• Page Start: A6
• Page End: A7
• Publication Date: 2018-12
• Subjects: Children -- Diseases -- Periodicals; Infants -- Diseases -- Periodicals; 618.920005
• DOI: 10.1136/goshabs.14
• Languages: English
• ISSNs: 0003-9888

Abstract

Abstract : Introduction: Regional anaesthesia, usually in the form of caudal epidural, is a foundation of analgesia for hypospadias repairs. Recent publications have demonstrated a strong association between caudal blockade and fistula formation or glanular dehiscence. If caudals were causing complications, abandonment of caudals would necessitate a plausible and efficacious alternative that may itself be associated with side effects. We sought to review our own institutions' outcomes in this area. Methods: Retrospective case note review in partnership with University College Hospital (UCH). Data analysed in Microsoft Excel using XLSTAT. Results: A total of 177 boy's notes were reviewed; 116 from Great Ormond Street Hospital (GOSH). Median age was 18 months (IQR 11) and median weight 11.5 kg (IQR 3.5). Median duration of surgery was 90 min (IQR 48.25). 94% received caudal anaesthesia with a median volume of 0.7 ml/kg (IQR 0.2). Clonidine was an adjunct in 41% of caudals but was only used at GOSH. There were 40 wound complications including 21 fistulae and 7 dehisced wounds. 5 were lost to follow-up. OR for wound complication with caudal anaesthetic was 0.41 (95% CI −0.1–1.5). Significantly less intra-operative fentanyl was administered to boys receiving caudals, p<0.005. Conclusion: Complication rates were similar to previously published studies with respect to urethrocutaneous fistula. Surgical duration was markedly lower. Usage of caudal block was much greater than in previously published work; 58% and 63%. The complication rate for caudal recipients was in line with other studies. The use of clonidine to prolong analgesia was not universal, despite strong evidence to support its use. The complication rate was higher for the children that did not receive any regional anaesthesia. The efficacy of caudal anaesthesia in hypospadias repair is demonstrated by the significantly lower opioid doses received in the caudal group. Our results do not support the abandonment of caudal anaesthesia for hypospadias repair.