Combination of clonidine–bupivacaine in caudal epidural anesthesia for hypospadias surgery in children: prospective, randomized, blind study

Bonisson, Ana Cláudia Mota; Fernandes, Magda Lourenço; Araújo, Guilherme Freitas; Vieira, Fabrício Eduardo; Noronha, Luíza Melo; Gomez, Renato Santiago

doi:10.1016/j.bjane.2018.09.008

Cited by 3 publications

(3 citation statements)

References 18 publications

(25 reference statements)

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“…Sedation is common with clonidine administration during regional blocks (15,16). In our study, when the sedation score was evaluated at the postoperative 1st, 6th, 12th, and 24th hours, we encountered the highest (3.10) sedation score at the 1st hour in the intravenous morphine group.…”

Section: Discussionmentioning

confidence: 49%

“…Caudal epidural block application is a reliable technique widely used in pediatric surgery, especially in sub umbilical and genitourinary operations, and is routinely applied in many clinical centers (6,7,9,10,11,13,14). In studies performed using caudal morphine and clonidine in different doses in children, the results show variability (13,15,16). In our retrospective file review study, the postoperative pain score was significantly lower in the group with caudal levobupivacaine (2mg/kg) + caudal clonidine (2mg/kg).…”

Section: Discussionmentioning

confidence: 70%

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The Outcomes of Caudal or Intravenous Addition of Morphine and Clonidine into The Caudal Block Performed with Levobupivacaine In Children; A Retrospective Study

YAŞAR

Tütüncü

Kaya

2023

Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi

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98 pediatric patients aged 6months to 12years who underwent caudal levobupivacaine for hypospadias surgery were evaluated retrospectively.Patients with intravenous morphine added group 1; patients with intravenous clonidine added group 2, caudal morphine added group 3, and caudal clonidine added group 4patients. When the CHEOPS pain scores of 6 or higher were assessed according to the groups at the 1st hour, there were 8 cases in the intravenous morphine group(40%), 5cases in the intravenous clonidine group (25%), and 3 cases in the caudal morphine group (15%).When the CHEOPS pain scores of 6 or higher were assessed according to the groups at the 12th hour, there were 5cases in the intravenous morphine group(25%), 10cases in the intravenous clonidine group (50%), and 4 cases in the caudal morphine group(20%).When the CHEOPS pain scores of 6 or higher were assessed according to the groups at the 24th hour, there were 10 cases in the intravenous morphine group(50%), 10cases in the intravenous clonidine group (50%), 9 cases in the caudal morphine group(45%) and 2 cases in the caudal clonidine group (10%) (p0.05). The lowest pain scores at the 1st, 12th, and 24th hours were recorded in the caudal clonidine group.It has the lowest, best pain scores at 6hours.By these methods, in favor of the clonidine group, we agreed that the analgesia lasts for 12 hours postoperatively, so the postoperative stress that the children and their families have can be minimized.

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Section: Discussionmentioning

confidence: 49%

Section: Discussionmentioning

confidence: 70%

The Outcomes of Caudal or Intravenous Addition of Morphine and Clonidine into The Caudal Block Performed with Levobupivacaine In Children; A Retrospective Study

YAŞAR

Tütüncü

Kaya

2023

Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi

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“…A previous meta-analysis of only four trials showed that clonidine is as effective as morphine and with a more beneficial adverse effect profile in children (17), but it did not assess other anesthetics as controls and mainly focused on the side effects. A study compared clonidine vs. dexmedetomidine and showed that adjuvant dexmedetomidine was better than clonidine in terms of sedation, analgesia, and side effects (18), but El-Hennawy et al (19) reported no differences between the two drugs in pediatric patients undergoing abdominal surgery, and Mota Bonisson et al (20) reported no change in morphine consumption when adding clonidine to bupivacaine, but the sedation level was higher. Saini et al (21) reported that clonidine was better than fentanyl as an adjuvant to ropivacaine for infraumbilical pediatric surgery.…”

Section: Introductionmentioning

confidence: 99%

Clonidine as an Additive to Local Anesthetics in Caudal Block for Postoperative Analgesia in Pediatric Surgery: A Systematic Review and Meta-Analysis

Wang

Guo

et al. 2021

Front. Med.

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Background: Clonidine is an anesthetic with favorable efficacy and safety profiles for caudal epidural block, but comparisons with other adjuvants need to be confirmed in pediatric patients.Aim: To investigate the effects of clonidine as an adjuvant in caudal epidural block to improve the intraoperative and postoperative analgesia in pediatric surgery.Methods: PubMed, Embase, and the Cochrane Library were searched for available papers published up to February 2021. The outcomes were pain score, duration of analgesia, complications, and number of analgesic requirements. The meta-analysis was performed using random-effects models.Results: Fifteen randomized controlled trials (RCTs) were included. There were no differences between clonidine and the control drug regarding the duration of analgesia (SMD = −0.71, 95%CI: −1.64, 0.23; I2 = 95.5%, Pheterogeneity < 0.001), pain score (SMD = 0.35, 95%CI: −0.28, 0.98; I2 = 80.8%, Pheterogeneity < 0.001), and requirement for additional analgesia (OR = 8.77, 95%CI: 0.70, 110.58, I2 = 81.9%, Pheterogeneity = 0.004), but using clonidine resulted in fewer complications than the control drugs (OR = 0.33, 95%CI: 0.20, 0.54, I2 = 21.8%, Pheterogeneity = 0.217). The sensitivity analysis showed that the results were robust. A publication bias was observed.Conclusion: Clonidine has the same efficacy as the other adjuvants for caudal epidural block for pediatric surgery but fewer complications. These results support clonidine as an adjuvant to local anesthetic, but additional studies should be conducted.

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Analgesic Efficacy of Adjuvant Medications in the Pediatric Caudal Block for Infraumbilical Surgery: A Network Meta-Analysis of Randomized Controlled Trials

Shah¹,

Karuppiah²,

Karapetyan³

et al. 2022

Cureus

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Various adjuvants are added to local anesthetics in caudal block to improve analgesia. The comparative analgesic effectiveness and relative rankings of these adjuvants are unknown. This network meta-analysis (NMA) sought to evaluate the comparative analgesic efficacy and relative ranking of caudal adjuvants added to local anesthetics (versus local anesthetics alone) in pediatric infraumbilical surgery. We searched the United States National Library of Medicine database (MEDLINE), PubMed, and Excerpta Medica database (Embase) for randomized controlled trials (RCTs) comparing caudal adjuvants (clonidine, dexmedetomidine, ketamine, magnesium, morphine, fentanyl, tramadol, dexamethasone, and neostigmine) among themselves, or to no adjuvant (control). We performed a frequentist NMA and employed Cochrane's 'Risk of Bias' tool to evaluate study quality. We chose the duration of analgesia (defined as 'the time from caudal injection to the time of rescue analgesia') as our primary outcome. We also assessed the number of analgesic dose administrations and total dose of acetaminophen within 24 h.The duration of analgesia [87 randomized control trials (RCTs), 5285 patients] was most prolonged by neostigmine [mean difference: 513 min, (95% confidence interval, CI: 402, 625)]. Dexmedetomidine reduced the frequency of analgesic dose administrations within 24 h [29 RCTs, 1765 patients; -1.2 dose (95% CI: -1.6, -0.9)] and the total dose of acetaminophen within 24 h [18 RCTs, 1156 patients; -350 mg (95% CI: -467, -232)] the most.Among caudal adjuvants, neostigmine (moderate certainty), tramadol (low certainty), and dexmedetomidine (low certainty) prolonged the duration of analgesia the most. Dexmedetomidine also reduced the analgesic frequency and consumption more than other caudal adjuvants (moderate certainty).

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Combination of clonidine–bupivacaine in caudal epidural anesthesia for hypospadias surgery in children: prospective, randomized, blind study

Cited by 3 publications

References 18 publications

The Outcomes of Caudal or Intravenous Addition of Morphine and Clonidine into The Caudal Block Performed with Levobupivacaine In Children; A Retrospective Study

The Outcomes of Caudal or Intravenous Addition of Morphine and Clonidine into The Caudal Block Performed with Levobupivacaine In Children; A Retrospective Study

Clonidine as an Additive to Local Anesthetics in Caudal Block for Postoperative Analgesia in Pediatric Surgery: A Systematic Review and Meta-Analysis

Analgesic Efficacy of Adjuvant Medications in the Pediatric Caudal Block for Infraumbilical Surgery: A Network Meta-Analysis of Randomized Controlled Trials

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