Anaesthesia and analgesia for bladder exstrophy correction. Case reports
Abstract
Introduction: Neonatal bladder exstrophy repairs imply correcting the genitourinary malformation, and closing and stabilizing the pelvic girdle with external fixation and traction. Successful results are achieved in terms of reduced urinary incontinence, adequate aesthetic appearance, improved quality of life, reduction of the risk associated with neonatal surgery and minimization of the number of procedures associated with multistage repairs. In such procedures, prolonged perioperative anaesthesia is key for the patient to tolerate the traction and external fixation, to help osteotomy healing, and to reduce tension in the surgical wound. Patients' age and weight have an effect on the risk of toxicity from local anaesthetics and respiratory depression from opioid analgesics. The prolonged use of caudal catheters in the management of these cases is associated with infection at the insertion site.
Case presentation: The article presents the cases of three infants between 7 months and 1 year of age taken to bladder exstrophy repair and pelvic osteotomy with tunnelled caudal catheter and continuous local anaesthetic infusion as perioperative anaesthetic management technique. The use of these techniques was aimed at reducing the risk of infection at the insertion site and the risks associated with prolonged pain management in infants.
Conclusion: The cases suggest that tunnelled caudal catheter placement and continuous local anaesthetic infusion are safe techniques in the management of prolonged anaesthesia in infants, decreasing the risk of insertion site infection.
References
2. Massanyi E, Gearhart J, Sabine K. Perioperative management of classic bladder exstrophy. Res Rep Urol. 2013;5:67-75.
3. Husmann DA. Surgery insight: advantages and pitfalls of techniques for the correction of bladder exstrophy. Nat Clin Pract Urol. 2006;3:95-100.
4. Kost-Byerly S, Jackson E, Yaster M, Kozlowski L, Mathews R, Gearhart J. Perioperative anesthetic and analgesic management of newborn bladder exstrophy repair. J Pediatr Urol. 2008;4:280-5.
5. Todd Purves J, Gearhart J. Pelvic osteotomy in the modern treatment of the exstrophy - epispadias complex. Eur Assoc Urol Update Ser. 2007;5:188-96.
6. Elsayed E, et al. Closure of bladder exstrophy with bilateral anterior pubic osteotomy: Revival of an old technique. Arab J Urol. 2011;9:203-7.
7. Laxmikant S, Borwankar S. Factors responsible for successful primary closure in bladder exstrophy. Pediatr Surg Int. 2000;16:194-8.
8. Aram L, Krane E, Kozloski L, Yaster M. Tunneled epidural catheters for prolonged analgesia in pediatric patients. Anesth Analg. 2001;92:1432-8.
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