Effectiveness of Caudal Epidural Block on Intraoperative Blood Loss During Hypospadias Repair

NCT ID: NCT02752308

Last Updated: 2016-04-26

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE2/PHASE3

Total Enrollment

60 participants

Study Classification

INTERVENTIONAL

Study Start Date

2014-09-30

Study Completion Date

2015-03-31

Brief Summary

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From September 2014 to March 2015, 57 consecutive patients with hypospadias who are candidate for surgery will be enrolled in this randomized clinical trial.

Regional ethics committee of Isfahan University of Medical Sciences approved the protocol of the study and all parents will sign a written informed consent.

Inclusion criteria are age between 6 months to 15 years and hypospadias with any severity. Exclusion criteria are coagulopathy, history of previous failed surgery, skin infection , parents' disagreement with the protocol and any cardiac problem that made epinephrine injection contraindicated.

All selected patients will randomly allocate to one of the two groups: group A will receive caudal epidural block (CEB) plus general anesthesia before surgery and group B will receive general anesthesia before surgery and CEB afterwards. The surgical procedures will be performed by a single pediatric urologist (FA). The surgical technique will be tubularized incised plate in all cases.

Intraoperative blood loss will be determined by weighing all surgical gauzes used during procedure with a digital scale measure to the nearest 0.01 gram, every 10 minutes to minimize the effect of water vaporization on gauzes weights.

In addition to blood loss, operation time, dose of fentanyl used during procedure and length of the urethral plate defect will be recorded for each patient by trained nurses.

Demographics and disease characteristics as well as operation details will be compared in the two studied groups.

Detailed Description

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Conditions

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Hypospadias

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

PREVENTION

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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General anesthesia + caudal block

Patients who receive general anesthesia plus caudal epidural block and dilute epinephrine injection before hypospadias repair, intraoperative fentanyl, intraoperative intravenous fluid and reversing the muscle relaxants' effect at the end of operation

Group Type ACTIVE_COMPARATOR

Bupivacaine

Intervention Type DRUG

Injection of Bupivacaine in the epidural space (0.25%, 0.33mg/Kg)

Dilute epinephrine injection

Intervention Type DRUG

Injection of 1/100000 epinephrine solution along all incision lines

Fentanyl

Intervention Type DRUG

fentanyl 2 mcg /Kg that is repeated during surgery whenever the heart rate or blood pressure increased more than 20% of its baseline

dextrose plus sodium chloride.

Intervention Type DRUG

Four mL/Kg/hr of 5% dextrose plus 0.04 mL/Kg/hr of 20% sodium chloride. Each mL of blood loss was replaced by 3 ml of Ringer's solution

neostigmine and atropine

Intervention Type DRUG

Injection of 0.04 mg/Kg of neostigmine and 0.02 mg/Kg of atropine, intravenously at the end of operation.

Hypospadias repair

Intervention Type PROCEDURE

Surgical repair of hypospadias, using tubularized incised plate technique

General anesthesia only

Patients who receive only general anesthesia and dilute epinephrine injection before hypospadias repair, intraoperative fentanyl, intraoperative intravenous fluid and reversing the muscle relaxants' effect at the end of operation

Group Type ACTIVE_COMPARATOR

General anesthesia

Intervention Type PROCEDURE

Induction with thiopental sodium 5 mg/Kg, atracurium 0.4 mg/Kg and fentanyl 2 mcg/Kg and maintenance with isoflurane and a combination of oxygen and nitrous oxide

Dilute epinephrine injection

Intervention Type DRUG

Injection of 1/100000 epinephrine solution along all incision lines

Fentanyl

Intervention Type DRUG

fentanyl 2 mcg /Kg that is repeated during surgery whenever the heart rate or blood pressure increased more than 20% of its baseline

dextrose plus sodium chloride.

Intervention Type DRUG

Four mL/Kg/hr of 5% dextrose plus 0.04 mL/Kg/hr of 20% sodium chloride. Each mL of blood loss was replaced by 3 ml of Ringer's solution

neostigmine and atropine

Intervention Type DRUG

Injection of 0.04 mg/Kg of neostigmine and 0.02 mg/Kg of atropine, intravenously at the end of operation.

Hypospadias repair

Intervention Type PROCEDURE

Surgical repair of hypospadias, using tubularized incised plate technique

Interventions

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Bupivacaine

Injection of Bupivacaine in the epidural space (0.25%, 0.33mg/Kg)

Intervention Type DRUG

General anesthesia

Induction with thiopental sodium 5 mg/Kg, atracurium 0.4 mg/Kg and fentanyl 2 mcg/Kg and maintenance with isoflurane and a combination of oxygen and nitrous oxide

Intervention Type PROCEDURE

Dilute epinephrine injection

Injection of 1/100000 epinephrine solution along all incision lines

Intervention Type DRUG

Fentanyl

fentanyl 2 mcg /Kg that is repeated during surgery whenever the heart rate or blood pressure increased more than 20% of its baseline

Intervention Type DRUG

dextrose plus sodium chloride.

Four mL/Kg/hr of 5% dextrose plus 0.04 mL/Kg/hr of 20% sodium chloride. Each mL of blood loss was replaced by 3 ml of Ringer's solution

Intervention Type DRUG

neostigmine and atropine

Injection of 0.04 mg/Kg of neostigmine and 0.02 mg/Kg of atropine, intravenously at the end of operation.

Intervention Type DRUG

Hypospadias repair

Surgical repair of hypospadias, using tubularized incised plate technique

Intervention Type PROCEDURE

Other Intervention Names

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Caudal block

Eligibility Criteria

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Inclusion Criteria

age between 6 months to 15 years and hypospadias with any severity

Exclusion Criteria

coagulopathy, history of previous failed surgery, skin infection , parents' disagreement with the protocol and any cardiac problem that made epinephrine injection contraindicated
Minimum Eligible Age

6 Months

Maximum Eligible Age

15 Years

Eligible Sex

MALE

Accepts Healthy Volunteers

No

Sponsors

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Isfahan University of Medical Sciences

OTHER

Sponsor Role lead

Responsible Party

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Farshid Alizadeh

Associate Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Other Identifiers

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393854

Identifier Type: -

Identifier Source: org_study_id

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