Background and aims Caudal block is the commonest regional anaesthetic technique in children. Our department regularly performs caudals to provide peri-operative analgesia for hypospadias repairs. The last four years have seen a change in our practice with increasing addition of clonidine to the caudal mixture which has been shown to prolong the duration of analgesia. We wished to audit our practice to see if this change has improved patient outcomes.
Methods Following authorization from the local audit team we performed a retrospective data collection. Patients under 16 years of age who had undergone a hypospadias repair over a 12-month period were identified (22 patients, median age 14 months) and their notes reviewed. Data was compared with a previous audit performed in 2014.
Results Twenty patients received a caudal; 90% of which included clonidine at an average dose of 1.2mcg/kg. In comparison just 7% received clonidine in 2014. Additionally, 70% of patients received IV paracetamol intra-operatively. One patient received intra-operative fentanyl. All of the patients woke up in recovery pain free, with no need for additional analgesia. In 2014, 23% of patients required rescue opiates intra-operatively or immediately post-operatively. Opiate administration on the ward reduced 22% from 2014. There were no complications or delays in discharge related to the caudal.
Conclusions In our experience caudal anaesthesia provides safe, effective and reliable analgesia for hypospadias repair. Furthermore, the increasing use of clonidine as an adjunct appears to have resulted in a reduced rate of failed block and a reduction in the need for opiates post-operatively.
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