Research Article
Volume 10 Issue 7 - 2021
Regional Analgesia in Complete Primary Repair of Bladder Exstrophy: Single Centre Experience
Alessandra Di Pede1, Francesco Smedile2*, Antonio Zaccara3, Pietro Bagolan1, Irma Capolupo1, Andrea Dotta1, Rosanna Pariante2, Giovanni Giordano4, Serena Ungania1 and Stefania Sgro2
1Department of Medical and Surgical Neonatology, Bambino Gesù Children’s Hospital Research Institute, Rome, Italy
2Department of Anesthesiology, Bambino Gesù Children’s Hospital Research Institute, Rome, Italy
3Department of Pediatric Urology, Bambino Gesù Children’s Hospital Research Institute, Rome, Italy
4Department of Anesthesia and Critical Care Medicine, “Sapienza” University of Rome, Italy
*Corresponding Author: Francesco Smedile, Department of Anesthesiology, Bambino Gesù Children’s Hospital Research Institute, Rome, Italy.
Received: May 24, 2021; Published: June 16, 2021


Introduction: Complete primary repair of exstrophy (CPRE) combines bladder closure, bladder neck reconstruction, epispadias repair and bilateral anterior oblique osteotomy. The single-step repair incorporates in one operative session several very painful procedures, so pain control is a crucial aspect of perioperative care in patients undergoing CPRE.

Purpose of the Study: The purpose of this study is to verify the safeness and efficacy of epidural analgesia even in the complex and painful setting of CPRE patients.

Patients and Methods: Since 2009 in our Institution all bladder exstrophy patients have been operated on with the CPRE technique including anterior oblique osteotomy and subsequent immobilization. Intra- and post-operative analgesia follows a protocol which protocol that includes a single bolus of ropivacaine (2mg/kg), followed by a continuous infusion of it at 0.2% concentration (Naropin©, Astra Zeneca) (0.1 - 0.2 mg/kg/h) via the epidural catheter. Postoperatively, patients are kept paralyzed and sedated in the NICU for 3 to 7 days. Post-operative pain is controlled by infusion of epidural ropivacaine 0.125%; paracetamol is added to baseline therapy when needed.

Results: In 24 months 11 patients underwent CPRE. Epidural catheter was maintained for an average of 13 days (range 1 - 21). Two patients required removal of the epidural catheter prior to the intended date, due to accidental dislocation. Overall, 14 extra-doses of paracetamol were required in 7 patients in association to epidural analgesia in order to achieve a better pain control.

Conclusion: Even in the complex and painful setting of CPRE patients, epidural analgesia seems to be safe and effective in controlling intra- and post-operative pain, facilitating immobilization which that is crucial for success.

Level of Evidence: Level IV.

Keywords: Neonate; NICU; Bladder Exstrophy; Regional Analgesia; Acute Pain


  1. Nelson C P., et al. “Contemporary epidemiology of bladder extrophy in the United States”. The Journal of Urology 173 (2005): 1728.
  2. Grady RW., et al. “Complete primary closure of bladder exstrophy. Epispadias and bladder exstrophy repair”. Urologic Clinics of North America1 (1999): 95-109.
  3. Husmann DA. “Surgery insight: advantages and pitfalls of surgical technique for the correction of the bladder exstrophy”. Nature Clinical Practice Urology2 (2006): 95-100.
  4. Baradaran N., et al. “Delay primary closure of bladder exstrophy: immediate postoperative management leading to successfull outcomes”. Urology (2012): 415-419.
  5. Kost Byerly S., et al. “Perioperative anesthetic and analgesic management of newborn bladder exstrophy repair”. The Journal of Pediatric Urology4 (2008): 280-285.
  6. Stec AA., et al. “The modern staged repair of classic bladder exstrophy. A detailed postoperative management strategy for primary bladder closure”. The Journal of Pediatric Urology 8 (2012): 549-555.
  7. Krechel SW and Bildner J. “CRIES: a new neonatal postoperative pain measurement score. Initial testing of validity and reliability”. Paediatric Anaesthesia1 (1995): 53-61.
  8. Grady RW and Mitchel ME. “Complete primary repair of exstrophy”. The Journal of Urology4 (1999): 1415-1420.
  9. Kozlowski Lori J. “The acute pain service nurse practitioner: a case study in the postoperative care of the child with bladder exstrophy”. Journal of Pediatric Health Care6 (2008): 351-359.
  10. Husmann DA., et al. “Closure of the extrophic bladder: an evaluation of the factors leading to its success and its important on urinary continence”. The Journal of Urology2-2 (1989): 522-524.
  11. Meldrum KK., et al. “Pelvic and extremity immobilization after bladder exstrophy closure: complications and impact on success”. Urology6 (2003): 1109-1113.
  12. Mitchell ME. “Bladder exstrophy repair: complete primary repair of exstrophy”. Urology1 (2005): 5-8.
  13. Messeri A., et al. “Continuous epidural block for pain control in bladder exstrophy: report of a case and description of technique”. Paediatric Anaesthesia4 (1995): 229-232.
  14. Aram L., et al. “Tunneled epidural catheters for prolonged analgesia in pediatric patients”. Anesthesia and Analgesia6 (2001): 1432-1438.
  15. Massanyi EZ., et al. “Perioperative management of classic bladder exstrophy”. Research and Reports in Urology 5 (2013): 67-75.
  16. Mushtaq I., et al. “Primary bladder exstrophy closure in neonates: challenging the traditions”. The Journal of Urology1 (2014): 193-197.
  17. Kost-Byerly S., et al. “Bacterial colonization and infection rate of continuous epidural catheters in children”. Anesthesia and Analgesia4 (1998): 712-716.
  18. Di Pede A., et al. “Comparison of regional vs. systemic analgesia for post-thoracotomy care in infants”. Paediatric Anaesthesia 24.6 (2014): 569-573.
  19. P Bozza., et al. “Stress and ano-colorectal surgery in newborn/infant: role of anesthesia”. Pediatric Surgery International 28 (2012): 821-824.
  20. Bosenberg AT., et al. “Pharmacokinetics and efficacy of ropivacaina for continuous epidural infusion in neonates and infants”. Paediatric Anaesthesia9 (2005): 739-749.
Citation: Francesco Smedile., et al. “Regional Analgesia in Complete Primary Repair of Bladder Exstrophy: Single Centre Experience”. EC Paediatrics 10.7 (2021): 20-25.

PubMed Indexed Article

EC Pharmacology and Toxicology
LC-UV-MS and MS/MS Characterize Glutathione Reactivity with Different Isomers (2,2' and 2,4' vs. 4,4') of Methylene Diphenyl-Diisocyanate.

PMID: 31143884 [PubMed]

PMCID: PMC6536005

EC Pharmacology and Toxicology
Alzheimer's Pathogenesis, Metal-Mediated Redox Stress, and Potential Nanotheranostics.

PMID: 31565701 [PubMed]

PMCID: PMC6764777

EC Neurology
Differences in Rate of Cognitive Decline and Caregiver Burden between Alzheimer's Disease and Vascular Dementia: a Retrospective Study.

PMID: 27747317 [PubMed]

PMCID: PMC5065347

EC Pharmacology and Toxicology
Will Blockchain Technology Transform Healthcare and Biomedical Sciences?

PMID: 31460519 [PubMed]

PMCID: PMC6711478

EC Pharmacology and Toxicology
Is it a Prime Time for AI-powered Virtual Drug Screening?

PMID: 30215059 [PubMed]

PMCID: PMC6133253

EC Psychology and Psychiatry
Analysis of Evidence for the Combination of Pro-dopamine Regulator (KB220PAM) and Naltrexone to Prevent Opioid Use Disorder Relapse.

PMID: 30417173 [PubMed]

PMCID: PMC6226033

EC Anaesthesia
Arrest Under Anesthesia - What was the Culprit? A Case Report.

PMID: 30264037 [PubMed]

PMCID: PMC6155992

EC Orthopaedics
Distraction Implantation. A New Technique in Total Joint Arthroplasty and Direct Skeletal Attachment.

PMID: 30198026 [PubMed]

PMCID: PMC6124505

EC Pulmonology and Respiratory Medicine
Prevalence and factors associated with self-reported chronic obstructive pulmonary disease among adults aged 40-79: the National Health and Nutrition Examination Survey (NHANES) 2007-2012.

PMID: 30294723 [PubMed]

PMCID: PMC6169793

EC Dental Science
Important Dental Fiber-Reinforced Composite Molding Compound Breakthroughs

PMID: 29285526 [PubMed]

PMCID: PMC5743211

EC Microbiology
Prevalence of Intestinal Parasites Among HIV Infected and HIV Uninfected Patients Treated at the 1o De Maio Health Centre in Maputo, Mozambique

PMID: 29911204 [PubMed]

PMCID: PMC5999047

EC Microbiology
Macrophages and the Viral Dissemination Super Highway

PMID: 26949751 [PubMed]

PMCID: PMC4774560

EC Microbiology
The Microbiome, Antibiotics, and Health of the Pediatric Population.

PMID: 27390782 [PubMed]

PMCID: PMC4933318

EC Microbiology
Reactive Oxygen Species in HIV Infection

PMID: 28580453 [PubMed]

PMCID: PMC5450819

EC Microbiology
A Review of the CD4 T Cell Contribution to Lung Infection, Inflammation and Repair with a Focus on Wheeze and Asthma in the Pediatric Population

PMID: 26280024 [PubMed]

PMCID: PMC4533840

EC Neurology
Identifying Key Symptoms Differentiating Myalgic Encephalomyelitis and Chronic Fatigue Syndrome from Multiple Sclerosis

PMID: 28066845 [PubMed]

PMCID: PMC5214344

EC Pharmacology and Toxicology
Paradigm Shift is the Normal State of Pharmacology

PMID: 28936490 [PubMed]

PMCID: PMC5604476

EC Neurology
Examining those Meeting IOM Criteria Versus IOM Plus Fibromyalgia

PMID: 28713879 [PubMed]

PMCID: PMC5510658

EC Neurology
Unilateral Frontosphenoid Craniosynostosis: Case Report and a Review of the Literature

PMID: 28133641 [PubMed]

PMCID: PMC5267489

EC Ophthalmology
OCT-Angiography for Non-Invasive Monitoring of Neuronal and Vascular Structure in Mouse Retina: Implication for Characterization of Retinal Neurovascular Coupling

PMID: 29333536 [PubMed]

PMCID: PMC5766278

EC Neurology
Longer Duration of Downslope Treadmill Walking Induces Depression of H-Reflexes Measured during Standing and Walking.

PMID: 31032493 [PubMed]

PMCID: PMC6483108

EC Microbiology
Onchocerciasis in Mozambique: An Unknown Condition for Health Professionals.

PMID: 30957099 [PubMed]

PMCID: PMC6448571

EC Nutrition
Food Insecurity among Households with and without Podoconiosis in East and West Gojjam, Ethiopia.

PMID: 30101228 [PubMed]

PMCID: PMC6086333

EC Ophthalmology
REVIEW. +2 to +3 D. Reading Glasses to Prevent Myopia.

PMID: 31080964 [PubMed]

PMCID: PMC6508883

EC Gynaecology
Biomechanical Mapping of the Female Pelvic Floor: Uterine Prolapse Versus Normal Conditions.

PMID: 31093608 [PubMed]

PMCID: PMC6513001

EC Dental Science
Fiber-Reinforced Composites: A Breakthrough in Practical Clinical Applications with Advanced Wear Resistance for Dental Materials.

PMID: 31552397 [PubMed]

PMCID: PMC6758937

EC Microbiology
Neurocysticercosis in Child Bearing Women: An Overlooked Condition in Mozambique and a Potentially Missed Diagnosis in Women Presenting with Eclampsia.

PMID: 31681909 [PubMed]

PMCID: PMC6824723

EC Microbiology
Molecular Detection of Leptospira spp. in Rodents Trapped in the Mozambique Island City, Nampula Province, Mozambique.

PMID: 31681910 [PubMed]

PMCID: PMC6824726

EC Neurology
Endoplasmic Reticulum-Mitochondrial Cross-Talk in Neurodegenerative and Eye Diseases.

PMID: 31528859 [PubMed]

PMCID: PMC6746603

EC Psychology and Psychiatry
Can Chronic Consumption of Caffeine by Increasing D2/D3 Receptors Offer Benefit to Carriers of the DRD2 A1 Allele in Cocaine Abuse?

PMID: 31276119 [PubMed]

PMCID: PMC6604646

EC Anaesthesia
Real Time Locating Systems and sustainability of Perioperative Efficiency of Anesthesiologists.

PMID: 31406965 [PubMed]

PMCID: PMC6690616

EC Pharmacology and Toxicology
A Pilot STEM Curriculum Designed to Teach High School Students Concepts in Biochemical Engineering and Pharmacology.

PMID: 31517314 [PubMed]

PMCID: PMC6741290

EC Pharmacology and Toxicology
Toxic Mechanisms Underlying Motor Activity Changes Induced by a Mixture of Lead, Arsenic and Manganese.

PMID: 31633124 [PubMed]

PMCID: PMC6800226

EC Neurology
Research Volunteers' Attitudes Toward Chronic Fatigue Syndrome and Myalgic Encephalomyelitis.

PMID: 29662969 [PubMed]

PMCID: PMC5898812

EC Pharmacology and Toxicology
Hyperbaric Oxygen Therapy for Alzheimer's Disease.

PMID: 30215058 [PubMed]

PMCID: PMC6133268

News and Events

November Issue Release

We always feel pleasure to share our updates with you all. Here, notifying you that we have successfully released the November issue of respective journals and the latest articles can be viewed on the current issue pages.

Submission Deadline for Upcoming Issue

ECronicon delightfully welcomes all the authors around the globe for effective collaboration with an article submission for the upcoming issue of respective journals. Submissions are accepted on/before December 15, 2022.

Certificate of Publication

ECronicon honors with a "Publication Certificate" to the corresponding author by including the names of co-authors as a token of appreciation for publishing the work with our respective journals.

Best Article of the Issue

Editors of respective journals will always be very much interested in electing one Best Article after each issue release. The authors of the selected article will be honored with a "Best Article of the Issue" certificate.

Certifying for Review

ECronicon certifies the Editors for their first review done towards the assigned article of the respective journals.

Latest Articles

The latest articles will be updated immediately on the articles in press page of the respective journals.