Iranian Journal of Pediatric Surgery

Introduction: Surgical wounds require appropriate management to prevent complications and promote healing. The Mölndal technique combines hydrofiber wound dressing with polyurethane film to maintain a moist environment and optimize healing conditions. While this technique has demonstrated benefits in adults, its efficacy in children remains unclear.

Materials and Methods: A prospective study was conducted from September 2020 to November 2022 in children undergoing laparoscopic surgery. Patients younger than 15 years of age who received Mölndal dressings on all incisions and completed evaluation and satisfaction questionnaires were included. Patients with allergies, concurrent open surgery, or non-wound-related complications were excluded. Wound dressings were evaluated daily and were removed on the eighth postoperative day. Patients were classified according to their surgical wound classification (clean, clean-contaminated, contaminated or infected). The sample size was calculated for a 2% margin of error at a 95% confidence level.

Results:  A total of 189 patients (63% male; median age, 9.4 years) were included. Appendectomy was the most common procedure (77.2%). The surgical site infection rate was 3.7%. Dressing changes were required in 12.2% of patients, most frequently in the umbilical region. Family satisfaction was very high, and all families recommended the technique. There were no significant differences in the surgical site infection rates according to wound classification.

 Conclusion: The Mölndal technique seems to be effective and safe for preventing postoperative wound infection in pediatric laparoscopic surgery. Dressing changes were infrequent and significantly associated with older age and male sex. High family satisfaction and universal recommendation support its clinical acceptability.

Introduction:  Caudal blockade remains a widely utilized regional anesthetic technique in pediatric practice, employed both for the provision of surgical anesthesia and for the management of perioperative pain. Caudal block is a safe and easily administered regional technique in children, associated with low postoperative pain scores. When combined with general anesthesia, it reduces the need for inhaled medications, opioids, improved postoperative analgesia, and more rapid endotracheal tube removal. Historically, the landmark-guided approach has served as the standard method for this block, offering ease of performance and acceptable efficacy, albeit with recognized complications including unintentional dural perforation and vascular injection. Ultrasound-guided caudal blockade, by contrast, is associated with superior success rates and a lower incidence of these complications.

Materials and Methods:  This narrative review synthesizes evidence comparing ultrasound-guided and landmark-based techniques for caudal block in pediatric patients, with respect to success rate, safety, and complications.

Results:  Current clinical data and meta-analyses indicate that while overall success rates can be high for both, ultrasound offers significant advantages in precision. Ultrasound consistently results in a higher first-puncture success rate and a reduced number of needle manipulations. Regarding safety real-time visualization significantly lowers the risk of vascular punctures, accidental dural punctures, and rectal perforation. Clinical considerations highlight that ultrasound is especially beneficial for patients with obesity or anatomical anomalies where palpable landmarks are unreliable. Although the landmark technique is sometimes faster by a matter of seconds, the immediate confirmation of injectate spread provided by ultrasound enhances overall reliability.

Conclusion: ultrasound provides superior accuracy and safety, supporting its routine use to optimize pediatric anesthetic outcomes.