Patient Information Leaflets for Children

What is a caudal block?

A caudal block is a pain-relieving injection of local anaesthetic at the base of the back that this performed while your child is under general anaesthetic. The local anaesthetic numbs the nerves that go to the area of the operation, providing a good form of pain relief for surgery below the belly button, such as inguinal hernia repair, hypospadias repair, circumcision, and operations on the legs.

It usually provides pain relief for about 6 – 8 hours, but this is variable.

What are the benefits of having a caudal block?

Your child will feel little or no pain after his operation. This reduces the need for strong medications which can have side effects like nausea and vomiting, feeling itchy, and making your child feel sleepy.

Are there any risks to my child having a caudal block?

Hundreds of thousands of caudal blocks have been performed around the world for several decades with an excellent safety record. Large studies have confirmed that caudal blocks are very safe.

Side effects include:

• Weak or heavy legs – this is the most common feeling and will wear off as the effect of the local anaesthetic wears off, usually about 3 to 12 hours. During this time your child should be supervised if they are walking or crawling. Be careful with hot baths as your child may not be able to sense the temperature in the same way as normal during this time.
• Inadequate pain relief – in some children the caudal block may not work. If this happens your child will be given other medicine to keep them comfortable.
• Difficulty passing urine – a small number of children might struggle to pass urine for a few hours before the effects of the block wear off. This may require the insertion of a catheter to empty their bladder.
• More serious complications like nerve damage, infection and bleeding are extremely rare (less than one in ten thousand patients) and monitored for.

If you have any other questions about your child’s caudal block, please feel free to discuss them with your anaesthetist, who will be happy to discuss any concerns you may have.

Published 2016 by PACSA (Paediatric Anaesthesia Community of South Africa)

Download pdf here

As paediatric anaesthetists we often get asked, “Will this anaesthetic cause damage to my child’s brain”? Children’s brains are continually developing and changing in response to the environment in which they find themselves; surely it is imperative to know whether the medications we give could alter the way in which children perceive and interact with that environment? Unfortunately there s no simple answer.

The controversy arose when studies showed that giving anaesthesia to baby rats and primates caused damage to some nerve cells in the brain, affecting their development and causing difficulties with learning and memory.

Why can we not extrapolate these results to human babies and children?

First, despite how you may sometimes feel, children are not animals. Their brains don’t grow at the same rate or in comparable stages of development as a rat’s, and the mechanisms they have to repair themselves are different.

Second, the anaesthetics these newborn rats and monkeys received were not comparable with the anaesthetic your child will receive. The doses of medicines used in the studies were far larger and the duration of exposure far longer (by multiples) than those used in clinical practice. The type of monitoring and anaesthetic care was also nowhere near the level of the care your child receives during surgery.

So the animal studies, while raising concern, needed to be taken a little further.

All the human studies done up until now have been what is called “retrospective”, i.e. have looked backwards at patient files and educational records to try to see if there is a link between anaesthesia and learning or emotional difficulties later in life. So far, they have been able to show an ASSOCIATION between receiving anaesthesia, particularly for numerous procedures, and learning or emotional difficulties later on, but no study has been able to show that the anaesthetic CAUSES these problems.

This may be because children coming for numerous surgeries are likely to have underlying problems that could predispose them to learning or emotional difficulties, like being born prematurely, having a congenital heart defect, having a longterm illness like cancer or kidney disease, or having poor hearing that requires grommets. (i.e. the anaesthetic may well just be a marker for illness or a problem requiring surgery)

Newer studies have been designed specifically with this question in mind. While they are still underway, their early results show that there is no difference in cognitive ability between a child who has an anaesthetic as a baby and their twin sibling who didn’t. Reassuring indeed!

Where does this leave us, both as parents and as paediatric anaesthetists?

• There is no recommendation to delay surgery unnecessarily, and it may indeed be dangerous to do so. We would not perform surgery and give anaesthesia if it wasn’t absolutely necessary.
• Where more than one procedure is required, it may be worth doing these in one sitting if that is appropriate and feasible.
• Surgery without anaesthesia and pain relief is both unimaginable and unethical.

A well conducted anaesthetic with all the appropriate monitoring, conducted by a well-trained anaesthetist, experienced in paediatric anaesthesia, is the best way to mitigate against these currently unknown risks.

Should you require any further information or have any other questions around this important issue, please feel free to speak to your anaesthetist.

Published 2016 by PACSA (Paediatric Anaesthesia Community of South Africa)

Download pdf here

What is a general anaesthetic?

A general anaesthetic is medication given so that your child is not conscious and cannot see, hear or feel anything during his procedure or operation.

What is an anaesthetist?

An anaesthetist (sometimes called an anaesthesiologist) is a specialist doctor who gives the anaesthetic and looks after your child throughout their procedure. Our role is to make sure that your child is safe and comfortable, and receives the pain relief he needs.

Before you come to hospital:

Your child should be prepared for his procedure in words he can understand.

You should receive clear instructions about when your child can eat and drink before his procedure. It is important to follow these instruc- tions, as any food or liquid in your child’s stomach could come up into his throat and damage his lungs during the anaesthetic. To make this easier for your child please do not eat or drink in front of them.

Your child can have a light meal or cow’s milk / formula milk up to SIX HOURS before surgery.

Babies can be breastfed up to FOUR HOURS before surgery.

Children can drink CLEAR LIQUIDS (i.e. anything you could read a newspaper through) like water, apple juice or Oros up to TWO HOURS before surgery, but not fizzy drinks or anything containing dairy, e.g. Tropica, or particles e.g. orange juice.

Before the operation:

Your anaesthetist will visit you in the ward before coming to theatre. Please tell us about any relevant medical problems, allergies and previous operations your child may have had. If your child has had a recent cough or cold or chicken pox, please let us know. We will

discuss any concerns or questions you may have, and will talk through options of pain relief for your child where required.

Occasionally we may need to delay a procedure to make it safer for your child, for example if he has a chest infection, or has eaten too recently.

Some children may benefit from having medicine before they come to theatre to make them less anxious. This can be discussed with your anaesthetist.

Going to “sleep”

You will be able to come into theatre with your child. Please feel free to bring something that makes him feel comfortable, like a favourite blanket, book or a dummy. You are welcome to bring something to dis- tract him while he goes off to sleep, like his favourite game or movie on your iPad or phone.

The general anaesthetic is given either by medication injected into a vein or as gas to breathe. Your anaesthetist will discuss the best option for your child with you before coming to theatre.

Please let us know if your child has any preferences – some children have had procedures before and may prefer one thing over another.

If your child decides to have the injected anaesthetic, we will put local anaesthetic numbing cream onto his hands before you come to theatre.

If the anaesthetic medicine is breathed in, we use a mask that fits over your child’s mouth and nose. The gases can smell a bit, like nail polish remover or koki pens, but they are not painful. This method takes a little longer to work and your child might make some funny wriggling movements as they go off to sleep. These are normal and we will talk you through them.

We understand that not all parents feel able to come into theatre with their child. There is no pressure on you to come into theatre if you don’t feel up to it. We are there to take care of your child for you.

During the operation:

The anaesthetist will be with your child throughout the procedure, monitoring him continuously and giving whatever fuid, medication and pain relieving medicine he requires.

Afterwards

After the procedure, your child will be taken to the Recovery Room where he will be looked after by trained recovery nurses. When your child is awake enough, you will be called into the Recovery Room

to be with him. Please bring anything he may find comforting, like a favourite toy, blanket, or a bottle. Be aware that your child might seem confused by the unfamiliar environment and the effects of the medica- tion and may not recognize you at first. This is common and will pass.

When you get home, some children are a little clingier than usual and have disturbed sleep patterns for a couple of days. Your reassurance is all that is required.

Side effects and complications

The most common side effects are mild, resolve quickly, and can be treated. They include nausea (with or without vomiting), a sore throat and a headache. Your child might also feel “jetlagged” or generally out of sorts for a while.

More serious problems like allergic reactions to medication are rare and monitored for.

Any specific complication relating to your child’s procedure will be

discussed with you.

Risk

As with driving your car, no procedure can be guaranteed to be risk free; however, modern anaesthetic techniques, medication, monitoring and training continue to make anaesthesia safer.

If you have any questions about your child’s procedure, please feel free to raise them with your anaesthetist.

Published by PACSA (Paediatric Anaesthesia Community of South Africa)

Download pdf here