Analgesic effect and adverse events of dexmedetomidine as additive for pediatric caudal anesthesia: a meta‐analysis

Tong, Yao; Ren, Hailong; Ding, Xuan; Jin, Shuqing; Chen, Zhixia; Li, Quan

doi:10.1111/pan.12519

Cited by 52 publications

(44 citation statements)

References 31 publications

(59 reference statements)

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“…For RCTs, two investigators (RW, CEZ) independently used the Cochrane Collaboration’s tool to assess risk of bias as low, unclear or high 14. The ‘risk of bias’ table of a Cochrane review includes sequence generation (selection bias), allocation sequence concealment (selection bias), blinding of participants and personnel (performance bias), blinding of outcome assessment (detection bias), incomplete outcome data (attrition bias), selective outcome reporting (reporting bias), and other potential sources of bias 15. For observational studies, two researchers (HY, JH) independently used the ‘risk of bias in non-randomized studies of interventions’ (ROBINS-I) assessment tool for assessing risk of bias as low, moderate, serious, critical or no information 16.…”

Section: Methodsmentioning

confidence: 99%

Analgesic efficacy and impact of caudal block on surgical complications of hypospadias repair: a systematic review and meta-analysis

Zhu

Rong

Tong

et al. 2019

Regional Anesthesia &Amp; Pain Medicine

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Background and objectivesis commonly used for children undergoing hypospadias repair. However, the safety of caudal block for hypospadias repair in children is controversial in terms of surgical complications such as urethrocutaneous fistula and glans dehiscence. We sought to perform a meta-analysis to estimate the analgesic efficacy and relative complications of caudal block for hypospadias repair in children.MethodsWe identified comparative studies of caudal block versus peripheral nerve block or no caudal block; studies were published or presented through 1 January 2018, and reports of analgesic efficacy or surgical complications of hypospadias repair in children were identified. Peripheral nerve block includes dorsal nerve penile block and pudendal nerve block. Data were abstracted from studies comparing caudal block with peripheral nerve block or no caudal block; original source data were used when available. We prespecified separate assessments of randomized controlled trials (RCTs) and observational studies given the inherent differences between types of study designs. Data from 298 patients in four RCTs and from 1726 patients in seven observational studies were included. RCT and observational data were analyzed separately.ResultsIn RCTs, caudal blocks (compared with peripheral nerve blocks) showed no detectable differences in terms of need for additional analgesia within 24 hours after the surgery (OR 10.49; 95% CI 0.32 to 343.24; p=0.19), but limited data showed lower pain scores 24 hours after the surgery (standardized mean difference (SMD) 1.57; 95% CI 0.29 to 2.84; p=0.02), a significantly shorter duration of analgesia (SMD −3.33; 95% CI −4.18 to −2.48; p<0.0001) and analgesics consumption. No significant differences were observed in terms of postoperative nausea and vomiting (OR 3.08; 95% CI 0.12 to 77.80; p=0.50) or motor weakness (OR 0.01; 95% CI −0.03 to 0.05; p=0.56). Only one randomized study showed that caudal blocks (compared with peripheral nerve blocks) were associated with detectable differences in urethrocutaneous fistula rate (OR 25.27; 95% CI 1.37 to 465.01; p=0.03) and parental satisfaction rate (OR 0.07; 95% CI 0.02 to 0.21; p<0.00001). In observational studies, caudal block was not associated with surgical complications in all types of primary hypospadias repair (OR 1.83; 95% CI 0.80 to 4.16; p=0.15). To adjust for confounding factors and to eliminate potential selection bias involving caudal block indication, we performed subgroup analysis including only patients with distal hypospadias. This analysis revealed similar complication rates in children who received a caudal block and in children not receiving caudal block (OR 1.02; 95% CI, 0.39 to 2.65; p=0.96). This result further confirmed that caudal block was not a risk factor for surgical complications in hypospadias repair. The direction of outcomes in all the other subgroup analyses did not change, suggesting stability of our results.ConclusionsIn RCTs, only limited data showed peripheral nerve blocks providing better analgesic qua...

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Section: Methodsmentioning

confidence: 99%

Analgesic efficacy and impact of caudal block on surgical complications of hypospadias repair: a systematic review and meta-analysis

Zhu

Rong

Tong

et al. 2019

Regional Anesthesia &Amp; Pain Medicine

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“…The use of adjuvants, such as clonidine, opioids, ketamine, and midazolam, with epidural local anesthetics improves the duration and quality of analgesia and decreases the potential risk of systemic toxicity and seizure and the incidence of motor block by decreasing the dose of the local anesthetic 67. However, opioids, such as fentanyl and morphine, which have traditionally been used as adjuvants to epidural local anesthetics, are associated with side effects of pruritus, urinary retention, nausea and vomiting, and respiratory depression.…”

Section: Introductionmentioning

confidence: 99%

“…However, opioids, such as fentanyl and morphine, which have traditionally been used as adjuvants to epidural local anesthetics, are associated with side effects of pruritus, urinary retention, nausea and vomiting, and respiratory depression. Dexmedetomidine, which is a highly selective α-2 adrenergic agonist with sedative and analgesic properties, has recently been used as an adjuvant to general and regional anesthesia in both adults and children 6789. As of yet, dexmedetomidine has not been approved for use in the pediatric population in any country 10.…”

Section: Introductionmentioning

confidence: 99%

“…As of yet, dexmedetomidine has not been approved for use in the pediatric population in any country 10. Nonetheless, adding dexmedetomidine to caudal local anesthetics has been recently reported to prolong postoperative analgesia and decrease requirements for adjuvant postoperative analgesics in pediatric patients undergoing lower abdominal and perineal surgeries 6111213. However, the effects of dexmedetomidine added to epidural local anesthetics are unclear in pediatric patients undergoing major orthopedic surgery.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of Dexmedetomidine and Fentanyl as an Adjuvant to Ropivacaine for Postoperative Epidural Analgesia in Pediatric Orthopedic Surgery

et al. 2017

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PurposeOpioids are commonly used as an epidural adjuvant to local anesthetics, but are associated with potentially serious side effects, such as respiratory depression. The aim of this study was to compare the efficacy and safety of dexmedetomidine with that of fentanyl as an adjuvant to epidural ropivacaine in pediatric orthopedic surgery.Materials and MethodsThis study enrolled 60 children (3–12 years old) scheduled for orthopedic surgery of the lower extremities and lumbar epidural patient-controlled analgesia (PCA). Children received either dexmedetomidine (1 µg/kg) or fentanyl (1 µg/kg) along with 0.2% ropivacaine (0.2 mL/kg) via an epidural catheter at 30 minutes before the end of surgery. Postoperatively, the children were observed for ropivacaine consumption via epidural PCA, postoperative pain intensity, need for rescue analgesics, emergence agitation, and other adverse effects.ResultsThe mean dose of bolus epidural ropivacaine was significantly lower within the first 6 h after surgery in the dexmedetomidine group, compared with the fentanyl group (0.029±0.030 mg/kg/h vs. 0.053±0.039 mg/kg/h, p=0.012). The median pain score at postoperative 6 h was also lower in the dexmedetomidine group, compared to the fentanyl group [0 (0–1.0) vs. 1.0 (0–3.0), p=0.039]. However, there was no difference in the need for rescue analgesia throughout the study period between groups.ConclusionThe use of dexmedetomidine as an epidural adjuvant had a significantly greater analgesic and local anesthetic-sparing effect, compared to fentanyl, in the early postoperative period in children undergoing major orthopedic lower extremity surgery.

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“…When used as an adjuvant to regional anesthesia or a nerve block, dexmedetomidine improves the quality and duration of anesthesia [56]. The current volume of the Korean Journal of Anesthesiology presents an interesting clinical study [7] and a case report [8] about the off-label use of dexmedetomidine.…”

mentioning

confidence: 99%

An introduction to the various role of dexmedetomidine

Kim

2016

Korean J Anesthesiol

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Analgesic effect and adverse events of dexmedetomidine as additive for pediatric caudal anesthesia: a meta‐analysis

Cited by 52 publications

References 31 publications

Analgesic efficacy and impact of caudal block on surgical complications of hypospadias repair: a systematic review and meta-analysis

Analgesic efficacy and impact of caudal block on surgical complications of hypospadias repair: a systematic review and meta-analysis

Comparison of Dexmedetomidine and Fentanyl as an Adjuvant to Ropivacaine for Postoperative Epidural Analgesia in Pediatric Orthopedic Surgery

An introduction to the various role of dexmedetomidine

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