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Tamang K, Baral BK, Shah Malla S, KC B, Kuikel S, Shrestha D, Pathak N. Study of caudal ropivacaine with or without dexmedetomidine for postoperative analgesia in paediatric genitourinary infraumbilical surgery: a double-blinded randomized controlled trial. Ann Med Surg (Lond) 2024; 86:1997-2003. [PMID: 38576959 PMCID: PMC10990384 DOI: 10.1097/ms9.0000000000001919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 02/25/2024] [Indexed: 04/06/2024] Open
Abstract
Various studies have described the use of Dexmedetomidine with local anaesthetic drugs in caudal blocks for the management of postoperative pain in children. This study was designed to determine the analgesic effect of caudal Dexmedetomidine with Ropivacaine in paediatric genitourinary infraumbilical surgeries. Postoperative analgesic effects of caudal Ropivacaine with or without Dexmedetomidine in paediatric genitourinary infraumbilical were evaluated. This study was a prospective, interventional, comparative study conducted after ethical approval from the institute. Informed expressed consent was taken from each patient's guardians. The sample size was calculated to be 31 in each group. The two groups were randomly assigned and the intervention involved caudal epidural injection with either Ropivacaine combined with Dexmedetomidine or Ropivacaine with Normal Saline. Children receiving Ropivacaine with Dexmedetomidine had a significantly prolonged duration of analgesia compared to those receiving Ropivacaine alone (840.35 ± 149.97 vs. 412.90 ± 93.46 min, P < 0.001). Postoperative rFLACC scores were consistently lower in the Dexmedetomidine group, indicating better pain control (P < 0.05 at 6, 12, and 24 h). Total analgesic consumption was lower in the Dexmedetomidine group (500.67 ± 212.92 vs. 741.75 ± 268.06 mg, P < 0.01). No significant differences in adverse effects were observed between the groups. The addition of Dexmedetomidine to Ropivacaine in caudal epidural significantly prolongs analgesia, improves pain control, and reduces analgesic consumption in paediatric genitourinary infraumbilical surgeries.
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Affiliation(s)
| | | | | | | | - Sandip Kuikel
- Maharajgunj Medical Campus, Tribhuvan University Institute of Medicine, Kathmandu, Nepal
| | | | - Nibesh Pathak
- Maharajgunj Medical Campus, Tribhuvan University Institute of Medicine, Kathmandu, Nepal
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Quan S, Lu Y, Huang Y. Analgesic effect of ropivacaine combined with dexmedetomidine in the postoperative period in children undergoing ultrasound-guided single-shot sacral epidural block: A systematic review and meta-analysis. Front Pediatr 2023; 11:1099699. [PMID: 37063658 PMCID: PMC10090670 DOI: 10.3389/fped.2023.1099699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 03/03/2023] [Indexed: 04/18/2023] Open
Abstract
Objective This study aims to evaluate the efficacy of dexmedetomidine as an adjuvant to ropivacaine in prolonging postoperative analgesia and reducing pain scores in children undergoing surgery. Methods Five online databases were searched for RCTs on postoperative analgesia of pediatric patients undergoing ultrasound-guided single-shot sacral epidural block with dexmedetomidine as an adjuvant to ropivacaine up to January 2, 2023. Pain score and sedation score at 2, 4, 8, 12, and 24 h after the operation, the time of first receiving additional analgesic drugs, and the number of postoperative adverse effects were selected to compare the efficacy and safety of combined treatment with ropivacaine alone for pediatrics. The standard mean difference (SMD) or odds ratio (OR) and the corresponding 95% confidence interval (95%CI) were calculated by using a random-effects model. Results A total of 295 articles were retrieved, but only 20 records were included in this meta-analysis. The results showed that dexmedetomidine combined with ropivacaine for sacral epidural block in children undergoing ultrasound-guided single-shot sacral epidural block had a more prolonged analgesia effect (SMD = 3.47, 95%CI: 2.80, 4.14). There were lower analgesia scores at 2 h(T1), 4 h(T2), 8 h(T3), 12 h(T4), and 24 h(T5) in postoperative period (T1 : SMD = -1.02, 95%CI: -1.31, -0.72; T2 : SMD = -1.02, 95%CI: -1.32, -0.72; T3 : SMD = -0.84, 95%CI: -1.12, -0.56; T4 : SMD = -0.61, 95%CI: -1.03, -0.20; T5 : SMD = -1.03, 95%CI: -1.28, -0.78). And the incidence of adverse effects was similar between the two groups (OR = 0.84, 95%CI: 0.59, 1.18). Conclusions The results of this review and meta-analysis support that dexmedetomidine, as an adjuvant to ropivacaine, can improve postoperative analgesia of surgery and significantly prolong the analgesic time in children, with a similar incidence rate of adverse symptoms when compared with ropivacaine alone.
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Affiliation(s)
- Shoubo Quan
- Department of Anesthesiology, Songshan Lake Central Hospital of Dongguan City, Dongguan, China
| | - Yuexia Lu
- Department of Anesthesiology, Haikou Hospital of Traditional Chinese Medicine, Haikou, China
| | - Yujie Huang
- Department of Anesthesiology, Nantong Haimen District People's Hospital, Nantong, China
- Correspondence: Yujie Huang
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Eizaga Rebollar R, García Palacios MV, Fernández Riobó MC, Torres Morera LM. Dexmedetomidine and perioperative analgesia in children. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2022; 69:487-492. [PMID: 36100555 DOI: 10.1016/j.redare.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 03/25/2021] [Indexed: 06/15/2023]
Abstract
Dexmedetomidine (DEX) is an anaesthetic agent that mimics natural deep sleep and produces minimal cardiorespiratory depression. As such, it is a very valuable option in the management of such a challenging population as paediatric patients. The main objective of this mini review was to evaluate the role of DEX as a perioperative analgesic in children receiving anaesthesia. We searched Google, Pubmed, Embase and the Cochrane Library for articles published between 2010 and 2021, and reviewed various of aspects of DEX, such as pharmacology, effectiveness, safety, and the most recent evidence on its clinical use as an analgesic in paediatric anaesthesia. We also include a cost estimate of perioperative analgesia with DEX.
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Affiliation(s)
- R Eizaga Rebollar
- Servicio de Anestesiología y Reanimación, Hospital Universitario Puerta de Mar, Cádiz, Spain.
| | - M V García Palacios
- Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Puerta de Mar, Cádiz, Spain
| | - M C Fernández Riobó
- Servicio de Anestesiología y Reanimación, Hospital Universitario Puerta de Mar, Cádiz, Spain
| | - L M Torres Morera
- Servicio de Anestesiología y Reanimación, Hospital Universitario Puerta de Mar, Cádiz, Spain
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Shah UJ, Karuppiah N, Karapetyan H, Martin J, Sehmbi H. Analgesic Efficacy of Adjuvant Medications in the Pediatric Caudal Block for Infraumbilical Surgery: A Network Meta-Analysis of Randomized Controlled Trials. Cureus 2022; 14:e28582. [PMID: 36185831 PMCID: PMC9521396 DOI: 10.7759/cureus.28582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2022] [Indexed: 11/05/2022] Open
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Xiong C, Han C, Lv H, Xu D, Peng W, Zhao D, Lan Z. Comparison of adjuvant pharmaceuticals for caudal block in pediatric lower abdominal and urological surgeries: A network meta-analysis. J Clin Anesth 2022; 81:110907. [PMID: 35728381 DOI: 10.1016/j.jclinane.2022.110907] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 06/04/2022] [Accepted: 06/10/2022] [Indexed: 10/18/2022]
Abstract
STUDY OBJECTIVE Caudal block helps relieve pain after sub-umbilical surgery in pediatric patients; however, the duration for which it exerts its analgesic effect is limited. The addition of certain adjuvant agents to local anesthetics (LAs) that are used to administer caudal block can prolong postoperative analgesia. Therefore, we aimed to compare the efficiencies and side effects of caudal adjuvants in the settings of pediatric lower abdominal and urological surgeries. DESIGN A network meta-analysis (NMA). PATIENTS One hundred and twelve randomized controlled trials (RCTs) involving 6800 pediatric patients were included in the final analysis. INTERVENTIONS Different adjuvant agents, namely clonidine, dexamethasone, dexmedetomidine, fentanyl, ketamine, magnesium, midazolam, morphine, neostigmine, and tramadol. MEASUREMENTS The primary outcome was the duration of analgesia. The secondary outcomes included the requirement for additional analgesia, analgesic consumption, and postoperative complications. The effects and rankings were evaluated using NMA and the surface under the cumulative ranking curve scores, respectively. RESULTS Neostigmine, dexmedetomidine, and dexamethasone were found to be the three most effective adjuvants that prolong the duration of analgesia for caudal block, and these adjuvants extended this duration by 8.9 h (95% confidence interval [CI], 7.1-10.7), 7.3 h (95% CI, 6.0-8.6), and 5.9 h (95% CI, 4.0-7.7), respectively. Caudal neostigmine was associated with an increase in the incidence of postoperative nausea and vomiting, whereas dexmedetomidine and dexamethasone showed no postoperative complications. CONCLUSIONS This NMA provided evidence and suggested that dexmedetomidine and dexamethasone may be the most beneficial adjuvant pharmaceutics adding to LAs for caudal block in children. However, given the off-label status of caudal dexmedetomidine and dexamethasone, further high-quality RCTs are still warranted, especially to determine whether delayed neurological complications will occur.
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Affiliation(s)
- Chang Xiong
- Department of Anesthesiology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang Province, People's Republic of China
| | - Chengpeng Han
- Department of Children's Rehabilitation, Jinhua Maternal and Child Health Care Hospital, Jinhua, Zhejiang Province, People's Republic of China
| | - Huayan Lv
- Department of Anesthesiology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang Province, People's Republic of China
| | - Duojia Xu
- Department of Anesthesiology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang Province, People's Republic of China
| | - Wenyong Peng
- Department of Anesthesiology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang Province, People's Republic of China
| | - Dong Zhao
- Department of Anesthesiology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang Province, People's Republic of China.
| | - Zhijian Lan
- Department of Anesthesiology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang Province, People's Republic of China.
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Sun Y, Wu Z, Sun S, Chen R, Dai M, Dou X, Lin Y. Evaluation of the Efficacy of Dexmedetomidine as A Local Anesthetics Adjuvant in Children: A Meta Analysis of Randomized Controlled Trials. J Clin Pharmacol 2022; 62:935-947. [PMID: 35220587 DOI: 10.1002/jcph.2039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 02/22/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Yan Sun
- Department of Anesthesiology Union Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan 430022 China
| | - Zhilin Wu
- Department of Anesthesiology Union Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan 430022 China
| | - ShuJun Sun
- Department of Anesthesiology Union Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan 430022 China
| | - Rui Chen
- Department of Anesthesiology Union Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan 430022 China
| | - Maosha Dai
- Department of Anesthesiology Union Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan 430022 China
| | - Xiaoke Dou
- Department of Anesthesiology Union Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan 430022 China
| | - Yun Lin
- Department of Anesthesiology Union Hospital Tongji Medical College Huazhong University of Science and Technology Wuhan 430022 China
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Eizaga Rebollar R, García Palacios MV, Del Carmen Fernández Riobó M, Torres Morera LM. Dexmedetomidine & perioperative analgesia in children. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2021; 69:S0034-9356(21)00144-4. [PMID: 34049712 DOI: 10.1016/j.redar.2021.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/24/2021] [Accepted: 03/25/2021] [Indexed: 10/21/2022]
Abstract
Dexmedetomidine (DEX) is an anaesthetic agent that mimics natural deep sleep and produces minimal cardiorespiratory depression. As such, it is a very valuable option in the management of such a challenging population as paediatric patients. The main objective of this mini review was to evaluate the role of DEX as a perioperative analgesic in children receiving anaesthesia. We searched Google, Pubmed, Embase and the Cochrane Library for articles published between 2010 and 2021, and reviewed various of aspects of DEX, such as pharmacology, effectiveness, safety, and the most recent evidence on its clinical use as an analgesic in paediatric anaesthesia. We also include a cost estimate of perioperative analgesia with DEX.
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Affiliation(s)
- R Eizaga Rebollar
- Servicio de Anestesiología y Reanimación, Hospital Universitario Puerta de Mar, Cádiz, España.
| | - M V García Palacios
- Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Puerta de Mar, Cádiz, España
| | | | - L M Torres Morera
- Servicio de Anestesiología y Reanimación, Hospital Universitario Puerta de Mar, Cádiz, España
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Zhao J, Liao C, Wu Q, Wang L, Deng F, Zhang W. Evaluation of ropivacaine combined with dexmedetomidine versus ropivacaine alone for epidural anesthesia: A meta-analysis. Medicine (Baltimore) 2021; 100:e25272. [PMID: 33832091 PMCID: PMC8036061 DOI: 10.1097/md.0000000000025272] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 03/05/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Ropivacaine is considered the most commonly used for epidural anesthesia. We compared the efficiency and safety of ropivacaine alone (R group) and ropivacaine combined with dexmedetomidine (RD group). METHOD PubMed, the Cochrane Library, Google Scholar, Ovid Medline, the Web of Science, Scopus, Embase, and ScienceDirect were searched. We considered sensory and motor block, duration of anesthesia, time to rescue, hemodynamics, and adverse effects as the primary endpoints. RESULTS Eleven randomized controlled trials were included with 337 patients in the R group and 336 patients in the RD group. The RD group had a shorter time to onset of sensory (mean difference [MD]: 3.97 [1.90-6.04] minutes; P = .0002) and motor (MD: 2.43 [0.70-4.16] minutes; P = .006) block and a longer duration of anesthesia (MD: -164.17 [-294.43 to -33.91]; P = .01) than the R group. Comparison of the time to rescue between the groups showed no significant difference (MD: -119.01[-254.47-16.46] minutes; P = 0.09). The R group showed more stable hemodynamics than the RD group in heart rate and arterial pressure at 10 minutes. The R group had a lower incidence of bradycardia and a higher incidence of shivering than the RD group. CONCLUSION RD may be a more suitable choice for epidural anesthesia with better anesthetic outcomes than R alone. However, the safety of the combination must be carefully assessed.
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Affiliation(s)
- Jiani Zhao
- Department of Thoracic Surgery
- Department of Anesthesiology, The Second Affiliated Hospital of Nanchang University
- Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Chen Liao
- Department of Anesthesiology, The Second Affiliated Hospital of Nanchang University
- Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Qian Wu
- Department of Anesthesiology, The Second Affiliated Hospital of Nanchang University
- Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Li Wang
- Department of Anesthesiology, The Second Affiliated Hospital of Nanchang University
- Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Fumou Deng
- Department of Anesthesiology, The Second Affiliated Hospital of Nanchang University
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Kour L, Mehta A, Gandotra S, Aziz Z. Comparison of Analgesic Efficacy of Dexamethasone versus Tramadol in Combination with Ropivacaine in Caudal Anesthesia for Children Undergoing Lower Abdominal Surgeries. Anesth Essays Res 2021; 14:515-520. [PMID: 34092868 PMCID: PMC8159036 DOI: 10.4103/aer.aer_110_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/22/2021] [Accepted: 01/22/2021] [Indexed: 01/25/2023] Open
Abstract
Background: Caudal anesthesia has emerged as a reliable and effective anesthetic technique in the pediatric age group. However, the limited duration of action of the local anesthetic drugs proves to one of the major hindrances in the complete utilization of caudal block as an effective analgesic technique. To overcome this shortcoming, adjuvant drugs were introduced into clinical practice. Aim: Our aim was to determine which of the two drugs – dexamethasone and tramadol – serves as a better adjuvant for caudal analgesia in pediatric patients. Settings and Design: This was a prospective, randomized, double-blind study that comprised 90 American Society of Anesthesiologist (ASA) physical status I and II pediatric patients posted for lower abdominal surgeries. Materials and Methods: Ninety ASA physical status I and II children aged 5–12 years posted for lower abdominal surgeries were chosen. They were randomly divided into three groups – Group R received 0.5 ml.kg−1 of 0.2% ropivacaine plus 0.9% normal saline; Group T received 0.5 ml.kg−1 of 0.2% ropivacaine plus 2 mg.kg−1 tramadol; and Group D received 0.5 ml.kg−1 of 0.2% ropivacaine plus 0.1 mg.kg−1 dexamethasone. Postoperative pain was assessed using a modified objective pain score and time to first rescue analgesia (duration of sensory block) was recorded. Postoperative sedation and any other postoperative adverse effects were noted. Statistical Analysis: Student's independent t-test was employed for comparing continuous variables and Chi-square test for categorical variables. Kruskal–Wallis test was used for postoperative pain and sedation score data. Results: The duration of sensory block was significantly longer with dexamethasone than tramadol. No significant postoperative sedation or any other adverse effect was noted in any patient. Conclusion: Dexamethasone is superior to tramadol as an adjuvant to ropivacaine for pediatric lower abdominal surgeries.
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Affiliation(s)
- Loveleen Kour
- Department of Anaesthesia and Intensive Care, GMC, Jammu, Jammu and Kashmir, India
| | - Anjali Mehta
- Department of Anaesthesia and Intensive Care, GMC, Jammu, Jammu and Kashmir, India
| | - Supriya Gandotra
- Department of Anaesthesia and Intensive Care, GMC, Jammu, Jammu and Kashmir, India
| | - Zahida Aziz
- Department of Anaesthesia and Intensive Care, GMC, Jammu, Jammu and Kashmir, India
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Caudal and Intravenous Anesthesia Without Airway Instrumentation for Laparoscopic Inguinal Hernia Repair in Infants: A Case Series. A A Pract 2020; 14:e01251. [PMID: 32633923 DOI: 10.1213/xaa.0000000000001251] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
We report a series of 20 neonates and infants (18 born preterm) who underwent laparoscopic inguinal hernia repair with caudal anesthesia, oxygen via nasal cannula, and intravenous anesthesia. Surgery was successful in all cases without airway instrumentation or intraoperative complications. Sedation was provided with dexmedetomidine, propofol, and remifentanil. Two patients had apnea in the following 24 hours. There were no unplanned intensive care admissions. Laparoscopy allowed unplanned bilateral repair in 2 cases. Caudal with intravenous anesthesia without airway instrumentation is a viable technique for laparoscopic inguinal hernia repair. Avoiding general endotracheal anesthesia may reduce perioperative complications and influence postoperative disposition.
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Anupriya J, Kurhekar P. Randomised Comparison between the Efficacy of Two Doses of Nebulised Dexmedetomidine for Premedication in Paediatric Patients. Turk J Anaesthesiol Reanim 2019; 48:314-320. [PMID: 32864647 PMCID: PMC7434347 DOI: 10.5152/tjar.2019.78889] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 06/14/2019] [Indexed: 12/20/2022] Open
Abstract
Objective Nebulised dexmedetomidine can be an easy alternative for preoperative sedation in paediatric patients, but data regarding its efficacy are very limited. Methods This prospective, randomised, double-blind study included 66 patients aged between 1 and 8 years. Patients were divided into two groups as D2 and D3. The D2 group received 2 μg kg−1 of nebulised dexmedetomidine, and the D3 group received 3 μg kg−1 of nebulised dexmedetomidine preoperatively. All the patients received general anaesthesia and caudal epidural analgesia with 0.75 mL kg−1 of 0.2% ropivacaine. Parental Separation Anxiety Scale at 30 min after the end of nebulisation, Mask Acceptance Score (MAS) during induction, haemodynamic variables, emergence agitation and duration of caudal analgesia were compared between the groups. Statistical analysis was done using Mann-Whitney U test and chi-square test. A p-value <0.05 was accepted as significant. Results All the parameters were comparable between the D2 and D3 groups; however, significantly more number of younger children was observed in the D3 group. Hence, further analysis was done after division into the lower age (1–3 years) and higher age (4–8 years) groups. In lower age group children, satisfactory parental separation was achieved in 100% of the patients in the D3 group compared to 20% of those in the D2 group (p=0.00). MAS was significantly better in the D3 group in both the lower (p=0.019) and higher (p=0.036) age groups. Conclusion We conclude that nebulised dexmedetomidine in a dose of 3 μg kg−1 provides better parental separation and mask acceptance in younger children.
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Affiliation(s)
- Jindal Anupriya
- Department of Anaesthesiology, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth (Deemed to-be University), Kancheepuram, Tamilnadu, India
| | - Pranjali Kurhekar
- Department of Anaesthesiology, Shri Sathya Sai Medical College and Research Institute, Sri Balaji Vidyapeeth (Deemed to-be University), Kancheepuram, Tamilnadu, India
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Kaye AD, Green JB, Davidson KS, Gennuso SA, Brown ML, Pinner AM, Renschler JS, Cramer KD, Kaye RJ, Cornett EM, Helmstetter JA, Urman RD, Fox CJ. Newer nerve blocks in pediatric surgery. Best Pract Res Clin Anaesthesiol 2019; 33:447-463. [PMID: 31791563 DOI: 10.1016/j.bpa.2019.06.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 06/11/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE OF THE REVIEW The purpose of this manuscript is to provide a brief discussion of the current direction in pediatric regional anesthesia, highlighting both newer nerve blocks and techniques and traditional nerve blocks. RECENT FINDINGS The number of nerve blocks performed in pediatric patients continues to increase. This growth is likely related in part to the recent focus on perioperative multimodal analgesia, in addition to growing data demonstrating safety and efficacy in this patient population. Multiple studies by the Pediatric Regional Anesthesia Network (PRAN) and the French-Language Society of Pediatric Anesthesiologists (ADARPEF) have demonstrated lack of major complications and general overall safety with pediatric nerve blocks. The growing prevalence of ultrasound-guided regional anesthesia has not only improved the safety profile, but also increased the efficacy of both peripheral nerve blocks and perineural catheters. SUMMARY As the push for multimodal analgesia increases and the breadth of pediatric regional anesthesia continues to expand, further large prospective studies will be needed to demonstrate continued efficacy and overall safety.
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Affiliation(s)
- Alan D Kaye
- Department of Anesthesiology, LSU Health Sciences Center, Room 656, 1542 Tulane Ave., New Orleans, LA 70112, United States.
| | - Jeremy B Green
- Department of Anesthesiology, LSU Health Sciences Center, 1542 Tulane Ave., Suite 659, New Orleans, LA, 70112, United States.
| | - Kelly S Davidson
- Department of Anesthesiology, LSU Health New Orleans, 1542 Tulane Avenue, Suite 659, New Orleans, LA 70112, United States.
| | - Sonja A Gennuso
- Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA 71103, United States.
| | - Morgan L Brown
- LSU Health Sciences Center New Orleans, 1901 Perdido Street, New Orleans, LA 70112, United States.
| | - Allison M Pinner
- Ochsner LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA 71103, United States.
| | - Jordan S Renschler
- LSU Health Sciences Center New Orleans, 1901 Perdido Street, New Orleans, LA 70112, United States.
| | - Kelsey D Cramer
- LSU Health Sciences Center New Orleans, 1901 Perdido Street, New Orleans, LA 70112, United States.
| | - Rachel J Kaye
- Medical University of South Carolina, Charleston, SC 29425, United States.
| | - Elyse M Cornett
- Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA 71103, United States.
| | | | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Brigham and Women's Hospital, 75 Francis St., Boston, MA 02115, United States.
| | - Charles J Fox
- Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA 71103, United States
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Sayed JA, Kamel EZ, Riad MAF, Abd-Elshafy SK, Hanna RS. Dexmedetomidine with magnesium sulphate as adjuvants in caudal block to augment anaesthesia and analgesia in paediatric lower abdominal surgeries. EGYPTIAN JOURNAL OF ANAESTHESIA 2019. [DOI: 10.1016/j.egja.2018.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
| | | | | | | | - Ragai Sobhi Hanna
- Department of Surgery, Faculty of Medicine, Assiut University, Assiut, Egypt
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Tu Z, Tan X, Li S, Cui J. The Efficacy and Safety of Dexmedetomidine Combined with Bupivacaine on Caudal Epidural Block in Children: A Meta-Analysis. Med Sci Monit 2019; 25:165-173. [PMID: 30613099 PMCID: PMC6338250 DOI: 10.12659/msm.913098] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND This meta-analysis was conducted to evaluate the analgesics effect and safety of dexmedetomidine (DEX) combined with bupivacaine (BU) on caudal epidural block. MATERIAL AND METHODS Published studies were identified using the PubMed, EMBASE, Web of Science, and the Cochrane Library from inception until October 2017. Relative risk (RR), the standardized mean difference (SMD), and the corresponding 95% confidence interval (CI) were calculated using the STATA 12.0. RESULTS Ten randomized controlled trials (RCTs) were selected for this meta-analysis, involving a total of 691 patients. There was a longer duration of postoperative analgesia in children receiving DEX (SMD=3.19, 95% CI: 2.16-4.22, P<0.001). Furthermore, there was a lower number of patients requiring rescue analgesics in the (BU) + (DEX) group (6 hours: RR=0.09, 95% CI: 0.05-0.17, P<0.001; 12 hours: RR=0.50, 95% CI: 0.32-0.79, P=0.003; 24 hours: RR=0.66, 95% CI: 0.51-0.85, P=0.002). Finally, the occurrence of adverse events, between BU and DEX + BU group, was not statistically significant (RR=0.96, 95% CI: 0.58-1.58, P>0.05). CONCLUSIONS DEX seems to be a promising adjuvant to BU increase duration of caudal analgesia without an increase in side effects in children. However, the result may be influenced by clinical heterogeneity. More large-scale, multicenter, approaching, double-blinded RCTs are required to confirm our results.
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Affiliation(s)
- Zhenzhen Tu
- Department of Anesthesiology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China (mainland).,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China (mainland).,Chongqing Key Laboratory of Pediatrics, Chongqing, China (mainland)
| | - Xingqin Tan
- Department of Anesthesiology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China (mainland).,China International Science and Technology Cooperation base of Child development and Critical DisordersChina International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China (mainland).,Chongqing Key Laboratory of Pediatrics, Chongqing, China (mainland)
| | - Shangyingying Li
- Department of Anesthesiology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China (mainland)
| | - Jie Cui
- Department of Anesthesiology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China (mainland)
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Xu D, Xiu M, Zhang X, Zhu P, Tian L, Feng J, Wu Y, Zhao Z, Luan H. Effect of dexmedetomidine added to ropivicaine for caudal anesthesia in patients undergoing hemorrhoidectomy: A prospective randomized controlled trial. Medicine (Baltimore) 2018; 97:e11731. [PMID: 30142760 PMCID: PMC6112935 DOI: 10.1097/md.0000000000011731] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND To assess the effect of dexmedetomidine added to ropivaccaine on the onset and duration of sensory block, as well as postoperative analgesia during caudal anesthesia in patients undergoing hemorrhoidectomy. METHODS Fifty adult patients scheduled for hemorrhoidectomy were divided into 2 groups. The group R received caudal anesthesia using 18 mL 0.3% ropivacaine plus 2 mL normal saline. The group RD received 18 mL 0.3% ropivacaine plus 2 mL 1 μg/kg dexmedetomidine. Heart rate, mean blood pressure, onset time and duration of sensory block, and duration of analgesia were observed. RESULTS The onset time of sensory block was shortened (9.2 ± 1.3 vs 7.2 ± 1.2), and the duration of sensory block (3.0 ± 0.7 vs 3.8 ± 0.8) and duration of analgesia (3.9 ± 0.7 vs 5.3 ± 0.8) were prolonged in group RD compared with group R (P < .05). The heart rate and the mean blood pressure were also lower in the group RD compared with group R at each observation time points, except the baseline (P < .05). No bradycardia or hypotension was reported. CONCLUSION Dexmedetomidine as an adjuvant to ropivacaine prolonged the duration of caudal block and improved postoperative analgesia without significant side effects in adult patients undergoing hemorrhoidectomy.
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Sridhar RB, Kalappa S, Nagappa S. Nonopioid (Dexmedetomidine, Dexamethasone, Magnesium) Adjuvant to Ropivacaine Caudal Anesthesia in Pediatric Patients Undergoing Infraumbilical Surgeries: A Comparative Study. Anesth Essays Res 2017; 11:636-641. [PMID: 28928562 PMCID: PMC5594781 DOI: 10.4103/0259-1162.206853] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Background: Desirable adjuvants to caudal ropivacaine are the one which prolongs analgesia and free of side effects. We compared nonopioid drugs dexmedetomidine, dexamethasone, and magnesium as adjuvants to ropivacaine caudal analgesia in pediatric patients undergoing infraumbilical surgeries. Materials and Methods: This study was done on 128 pediatric patients (3–12-year olds) undergoing infraumbilical surgeries; they were randomly allocated to four groups to receive normal saline, dexmedetomidine 1 μg/kg, dexamethasone 0.1 mg/kg, and magnesium sulfate 50 mg with injection ropivacaine 0.2% in the dose 0.5 ml/kg caudally. Modified Objective Pain Score and Ramsay Sedation Score, duration of analgesia, hemodynamic changes, and side effects were assessed. ANOVA test was used for numerical values as data were expressed in mean and standard deviation. Kruskal–Wallis test was used for postoperative pain and sedation score as data were expressed as median and range. Results: The demographic data and hemodynamics were comparable. There was a significant prolongation of duration of analgesia in all study groups, dexmedetomidine (406.2 ± 45.5 min), dexamethasone (450.0 ± 72.6 min), and magnesium (325.0 ± 45.8 min) as compared to ropivacaine (285.9 ± 52.7 min) group. None of the adjuvants resulted in either excess or prolonged sedation. No side effects were encountered. Conclusion: The adjuvants dexmedetomidine, dexamethasone, and magnesium added to ropivacaine prolong caudal analgesic duration without any sedation or side effect.
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Affiliation(s)
| | - Sandhya Kalappa
- Department of Anaesthesia, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - Saraswathi Nagappa
- Department of Anaesthesia, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
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Gupta S, Sharma R. Comparison of analgesic efficacy of caudal dexmedetomidine versus caudal tramadol with ropivacaine in paediatric infraumbilical surgeries: A prospective, randomised, double-blinded clinical study. Indian J Anaesth 2017; 61:499-504. [PMID: 28655957 PMCID: PMC5474920 DOI: 10.4103/ija.ija_712_16] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background and Aims: Caudal epidural analgesia is commonly practised regional block technique in children undergoing infraumbilical surgeries but has a short duration of action after single shot local anaesthetic injection. The aim of this study was to compare ropivacaine 0.25% with dexmedetomidine and tramadol in caudal anaesthesia in paediatric infraumbilical surgeries. Methods: In a randomised, prospective, double-blinded study, sixty children (1–8 years) belonging to American Society of Anesthesiologists’ physical status I or II scheduled for infraumbilical surgeries were included. They were randomly assigned into two groups: Group ropivacaine with tramadol (RT) (n = 30) received 0.25% ropivacaine 1 mL/kg with 2 mg/kg of tramadol, and Group ropivacaine with dexmedetomidine (RD) (n = 30) received 0.25% ropivacaine 1 mL/kg with dexmedetomidine 2 μg/kg. The primary outcome variable was the duration of analgesia, and the secondary outcome variables included motor block, sedation score, time from caudal block to skin incision, emergence time and adverse effects. Results: The mean duration of analgesia was 654.20 ± 78.38 min in Group RT, while in Group RD, it was 780.29 ± 71.21 min (P = 0.0001). The difference between the mean sedation score and mean emergence time between the two groups were statistically significant (P = 0.0001 and 0.0411, respectively). No significant difference was observed in the incidence of haemodynamic changes or side effects. Conclusion: Caudal dexmedetomidine with ropivacaine prolongs post-operative analgesia compared to caudal tramadol with ropivacaine.
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Affiliation(s)
- Savita Gupta
- Department of Anesthesiology and Critical Care, Santosh Medical and Dental College and Hospital, Ghaziabad, Uttar Pradesh, India
| | - Rashmi Sharma
- Department of Anesthesiology and Critical Care, Santosh Medical and Dental College and Hospital, Ghaziabad, Uttar Pradesh, India
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