General versus general anaesthesia combined with caudal block in laparoscopic-assisted Soave pull-through of Hirschsprung disease: a retrospective study

Abstract

Background Caudal block is one of the most preferred regional anesthesia for sub-umbilical region surgeries in the pediatric population. However, few studies are available on caudal block performed in laparoscopic-assisted Soave pull-through of Hirschsprung disease (HD). We aimed to compare general anesthesia (GA) and general anesthesia combined with caudal block (GA\u2009+\u2009CA) in laparoscopic-assisted Soave pull-through of HD. Methods A retrospective review was performed in children with HD operated in our hospital between 2017 and 2020. Patients were divided into the GA and GA\u2009+\u2009CA group. The primary outcome was the duration of operation, and secondary outcomes included intraoperative hemodynamic changes, the Face, Legs, Activity, Cry, Consolability (FLACC) scale, dose of anesthetics, and incidence of side effects. Results A total of 47 children with HD were included in the study, including 20 in the GA group and 27 in the GA\u2009+\u2009CA Group. The two groups were similar in age, gender, weight and type of HD ( P \u2009>\u20090.05). The GA\u2009+\u2009CA group had significantly shorter duration of operation (especially the transanal operation time) (median 1.20\xa0h vs. 0.83\xa0h, P \u2009<\u20090.01) and recovery time (mean 18.05\xa0min vs. 11.89\xa0min, P \u2009<\u20090.01). The mean doses of sufentanil and rocuronium bromide during the procedure and FLACC scores at 1\xa0h and 6\xa0h after surgery were also lower in the GA\u2009+\u2009CA group ( p \u2009<\u20090.01). The hemodynamic changes in the GA\u2009+\u2009CA group were more stable at time of t 2 (during transanal operation) and t 3 (10\xa0min after transanal operation), but there was no significant difference in the incidence of postoperative side effects between the two groups ( P \u2009=\u20091.000). Conclusion General anesthesia combined with caudal block can shorten the duration of operation, and provide more stable intraoperative hemodynamics and better postoperative analgesia.