Caudal Additives Do Not Improve the Analgesia Afforded by Levobupivacaine After Hypospadias Repair

Davies, Kay E.; Wilson, Graham; Engelhardt, Thomas

doi:10.5812/aapm.2629

Cited by 7 publications

(4 citation statements)

References 21 publications

(17 reference statements)

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“…On the other hand pain intensity is in direct association to inflammatory system activity and cytokines levels which create complications in patients; however, pain relief can result in very good results ( 2 ). Therefore pain management, as one of the main factors of postoperative care, has always been noteworthy to anesthesiologists ( 6 , 7 ).…”

Section: Introductionmentioning

confidence: 99%

Analgesic Efficacy of Diclofenac and Paracetamol vs. Meperidine in Cesarean Section

et al. 2013

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Background:One of the most important complications in cesarean surgery is postoperative pain, and different ways have been proposed to control it.Objectives:The purpose of this study was to determine the efficacy of Diclofenac and Paracetamol combination in comparison with Meperidine on postoperative pain after cesarean surgery.Patients and Methods:One hundred and twenty women candidates for elective cesarean section under spinal anesthesia categorized as ASA class I were selected and randomly assigned to receive either Diclofenac suppository at the end of the operation and thereafter 1 gram infused bolus of Paracetamol (group A), or 20 mg bolus of Meperidine after transition to recovery room (group B) to control postoperative pain.Results:Postoperative pain was present in recovery in 38.3% and 23.3% in groups B and A, respectively (P = 0.009). Postoperative pain was seen after six hours of operation in 38.7% and 16.7% in groups B and A, respectively (P = 0.010). Postoperative pain was present after 12 hours of operation in 38.3% and 15% in groups B and A, respectively (P = 0.002). The additive Meperidine use was the same between the two groups in recovery (P > 0.05). The additive Meperidine use was seen after six hours of operation in 26.7% and 6.7% in groups B and A, respectively (P = 0.013). The additive Meperidine use was seen after 12 hours of operation in 16.7% and none of the patients in groups B and A, respectively (P = 0.004). The frequency of drug adverse effects was the same between the two groups (P > 0.05).Conclusions:Totally, according to the obtained results it may be concluded that Paracetamol and Diclofenac combination would have a better efficacy in postoperative pain control and need reduction to additive analgesia compared to Meperidine.

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Section: Introductionmentioning

confidence: 99%

Analgesic Efficacy of Diclofenac and Paracetamol vs. Meperidine in Cesarean Section

et al. 2013

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“…Different tools are recommended according to the verbal/non-verbal status of the patients (50). In addition, the included studies used various pain scale assessments, including OPS (24,(26)(27)(28)(29), CHEOPS (30,31), FLACC (6,9,19,(32)(33)(34), CHIPPS (35), pinprick at each dermatome (36), or a VAS (30), participating in heterogeneity. Even if all these assessments assess pain, they use different indicators (51).…”

Section: Discussionmentioning

confidence: 99%

“…The pain was evaluated using the Objective Pain Score (OPS) (24, 26-29), Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) (30,31), Face, Legs, Activity, Cry, and Consolability (FLACC) (6,9,19,(32)(33)(34), Children and Infants Postoperative Pain Scale (CHIPPS) ( 35), pinprick at each dermatome (36), or a visual analog scale (30). When possible, the pain was evaluated as a continuous variable for comparisons between the two groups.…”

Section: Pain Evaluationmentioning

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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“…In different centers, various concentrations of different LAs are used, while general anesthesia is administered empirically or based on cardiovascular responses during the surgery without knowing the depth of anesthesia. Several studies have shown that some drugs can be used instead of opioids and anesthetics ( 3 - 6 ), and have also evaluated the effects of different LA agents on anesthetic requirements during CGEA using bispectral index (BIS) monitoring; the optimal combination and dose, however, have not been yet reported ( 4 , 5 , 7 , 8 ).…”

Section: Introductionmentioning

confidence: 99%

The Effect of Epidural Bupivacaine on BIS Levels in the Awake Phase and on the Maintenance Doses of Propofol and Fentanyl During General Anesthesia

et al. 2013

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BackgroundSimultaneous administration of epidural local anesthetic agents (LA) and general anesthetics (intravenous or inhaled) is a common procedure in patients undergoing major operations. The effects of epidural anesthesia during combined general-epidural anesthesia on the alertness level (CGEA) in the awake phase and the doses of anesthetics have been reported.ObjectivesThe present study was designed to determine the effects of epidural bupivacaine on the alertness level measured by bispectral index (BIS) in the awake phase and the maintenance doses of propofol and fentanyl during general anesthesia for vascular operation on the lower limb.Patients and MethodsA double-blinded randomized clinical trial was conducted on patients awaiting vascular surgery on lower extremities in a teaching hospital from October 2007 to October 2008. During the epidural anesthesia, the control group received 0.9% NS while 0.125% bupivacaine was injected in the case group via the epidural route. No sedative drug was utilized for epidural catheter placement. The BIS measurement was performed in both groups during the awake phase, before performing epidural anesthesia, and 10 minutes after epidural injection at 1-min intervals for 15 min. After induction of general anesthesia in both groups, anesthesia maintenance was established using the infusion of propofol with the aim of keeping the BIS level between 40 and 50 throughout the anesthesia. At the end of the study period, maintenance dose requirements of propofol and fentanyl were measured.ResultsThirty-two patients were enrolled in the study. There was no difference in BIS levels of the two groups in the awake phase. There was a significant difference between the propofol and fentanyl requirements of the two groups.ConclusionsPerforming CGEA using bupivacaine was reported to reduce propofol and fentanyl doses required to maintain BIS levels between 40 and 50 considerably.

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Caudal Additives Do Not Improve the Analgesia Afforded by Levobupivacaine After Hypospadias Repair

Abstract: The addition of clonidine and/ or S (+)-ketamine to caudal analgesia does not appear to offer additional benefits for children undergoing hypospadias repair.

Cited by 7 publications

References 21 publications

Analgesic Efficacy of Diclofenac and Paracetamol vs. Meperidine in Cesarean Section

Analgesic Efficacy of Diclofenac and Paracetamol vs. Meperidine in Cesarean Section

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

The Effect of Epidural Bupivacaine on BIS Levels in the Awake Phase and on the Maintenance Doses of Propofol and Fentanyl During General Anesthesia

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