Caudal dexmedetomidine decreases the required concentration of levobupivacaine for caudal block in pediatric patients: a randomized trial

She, Ying-Jun; Zhang, Zhiyi; Song, Xingrong

doi:10.1111/pan.12278

Cited by 33 publications

(45 citation statements)

References 35 publications

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“…The common side effect in those receiving dexmedetomidine was bradycardia, which had been observed in four studies . There were three trials with 1 μg·kg −1 dexmedetomidine reported no cases had bradycardia .…”

Section: Discussionmentioning

confidence: 97%

“…There were three trials with 1 μg·kg −1 dexmedetomidine reported no cases had bradycardia . Only one included trial had reported that the number of children who suffered bradycardia in CA+DEX group was more than CA group and the addition of 2 μg·kg −1 dexmedetomidine group was more than 1 μg·kg −1 group. However, no cases were reported requiring intervention in these four studies.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

Tong

Ren

Ding

et al. 2014

Pediatric Anesthesia

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

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

Tong

Ren

Ding

et al. 2014

Pediatric Anesthesia

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“…5,27) Caudally administered DEX was also associated with a decreased sevoflurane requirement and increased the duration of postoperative sedation in children. 12,28) The sedative and analgesic properties of The proportion of the patients who did not request oral acetaminophen was significantly higher in the DEX than in Control group (p=0.029).…”

Section: Discussionmentioning

confidence: 99%

The Effect of 1 µg/kg Dexmedetomidine Combined with High-Volume/Low-Concentration Caudal Ropivacaine in Children Undergoing Ambulatory Orchiopexy

Cho

Kim

Park

et al. 2015

Biological & Pharmaceutical Bulletin

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When local anesthetics are used, the administration of dexmedetomidine (DEX) can prolong analgesic duration. However, the effect of caudal DEX on high volume/low concentration (HVLC) local anesthetics has not been studied. We investigated the analgesic effect of DEX added to a HVLC of ropivacaine for caudal block in children. Eighty children (the American Society of Anesthesiologists (ASA) status I; age, 1-6 years) undergoing ambulatory orchiopexy were enrolled in the study. Children were randomly assigned to undergo a caudal block with 1.5 mL/kg of 0.15% ropivacaine and either 1 µg/kg of DEX (DEX group, n 40) or the same amount of saline (Control group, n 40) under general anesthesia. The results showed that the time to first analgesic request was significantly longer in the DEX group than in the control group. The sevoflurane requirement for anesthesia and frequency of emergence agitation (EA) were also significantly lower in the DEX group. There was no difference in adverse events between the two groups. In conclusion, a dose of 1 µg/ kg of caudal DEX prolonged the first analgesic request time, although the immediate postoperative pain scores were comparable in both groups. Furthermore, caudal DEX significantly reduced the sevoflurane requirement and the frequency of EA.Key words dexmedetomidine; caudal block; child; orchiopexy Caudal block is common method for postoperative analgesia in children undergoing infra-umbilical surgery. One major limitation of caudal block is a relatively short analgesic duration owing to the single-injection. Thus, adjuvants such as ketamine, clonidine, or opioids are frequently added to the local anesthetics in order to improve analgesic efficacy and duration.1,2) The effectiveness of local anesthetics using in caudal block is dependent upon the dose, volume, and concentration of the local anesthetic solution, but high-concentration local anesthetics can increase the incidence of motor weakness, delayed micturition, or urinary retention. In children undergoing ambulatory surgery, such adverse effects can prolong the discharge time and may result in inadvertent admission. Recently, high-volume/low-concentration (HVLC) regimens for caudal blocks in children (1.5 mL/kg of 0.1-0.2% local anesthetics) have gained popularity following a report by Silvani et al. that demonstrated that a HVLC regimen provides a longer analgesic duration with less adverse effects than conventional dose/concentration. [3][4][5][6][7][8] However, the analgesic duration is still limited in caudal block with single-injection.Dexmedetomidine (DEX) is a highly selective α 2 adrenoceptor agonist with an α2/α1 selectivity ratio of 1600 : 1, and is eight times more potent than clonidine. 9) DEX is successfully used as an adjuvant in caudal blocks for children in order to reduce pain without inducing any significant respiratory and hemodynamic effects. Several studies have reported that in children, caudal DEX (1-2 µg/kg) with 0.25% bupivacaine (1 mL/kg) prolongs postoperative analgesic duration by 2.5-3 fold comp...

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“…Recent pediatric anesthesia examples of Dixon‐like UDM include investigating the optimal dose of propofol for pediatric tracheal intubation during sevoflurane induction , the effect of age on the dose of remifentanil for tracheal intubation , the size of a rapid bolus dose of dexmedetomidine with acceptable hemodynamic outcomes in children , MAC‐awake of sevoflurane in children , the median effective concentration of propofol during oesophagogastroduodenoscopy , the dose range of levobupivacaine or ropivacaine spinal anesthesia in neonates , the MAC of desflurane with fentanyl for laryngeal mask airway removal , the effect of epidural clonidine on MAC of levobupivacaine for caudal block , the MAC of desflurane with caudal analgesia for laryngeal mask airway removal , the optimum sevoflurane concentration for I‐gel insertion in unpremedicated children , the optimal dose of sevoflurane or desflurane for laryngeal mask airway removal in anesthetized children following cataract surgeries using subtenon block , the dose of caudal dexmedetomidine needed to decrease required concentrations of levobupivacaine for caudal block , or identifying the ropivacaine concentration required for US‐guided ilioinguinal/Iliohypogastric nerve block .…”

Section: Sequential Design Methodsmentioning

confidence: 99%

Sequential allocation trial design in anesthesia: an introduction to methods, modeling, and clinical applications

Görges

Zhou

Brant

et al. 2017

Pediatric Anesthesia

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Summary Estimation of the dose–response curve for new anesthetic protocols typically focuses on identifying minimum effective doses. The application of a sequential experimental method is appropriate, as it minimizes sample size requirements by updating dose assignments based on information accrued from successive subjects. One approach is the up‐and‐down method for estimating the median effective dose in a patient population (ED50). Designs better suited for achieving greater than 50% effectiveness, include the biased coin approach, and continual reassessment method. In this review we introduce different sequential design methods, provide examples of their use, and show through simulation how the method employed influences sample size and the accuracy of the estimated dose. Simulation studies are presented to illustrate the effects of dose parameter and stopping rule choice for up‐and‐down method and biased coin approach. For continual reassessment method, the effects of assumed dose–response model, prior guess, and cohort size are simulated. A binary response regression curve was fit to the data in Saidman and Eger's endtidal halothane dose‐finding study to provide a dose–response curve for generating simulations. A range of options exist when designing a study using sequential allocation with biased coin approach or continual reassessment method. Method choice influences the required sample size and confidence in estimated effect. In the halothane example, up‐and‐down method decreases the required sample size by 20–30% when the choice of design parameters is optimal. For both up‐and‐down method and biased coin approach designs, greater sample sizes, arising from adjusted stopping criteria, might be required to achieve reliable estimates. The continual reassessment method is only efficient if a limited range of doses can be chosen a priori. In conclusion the up‐and‐down method can be more efficient than nonsequential designs for the estimation of the median dose/intervention level for a given intervention (ED50). The biased coin approach or continual reassessment method are preferred for the estimation of higher or lower tail quantiles such as ED90 or ED10. Continual reassessment method may be superior if knowledge of the dose–response relationship is available for the drug of interest.

show abstract

Caudal dexmedetomidine decreases the required concentration of levobupivacaine for caudal block in pediatric patients: a randomized trial

Abstract: Caudal dexmedetomidine reduces the MLAC values of levobupivacaine and improves postoperative analgesia in children without any neurological side effects.

Cited by 33 publications

References 35 publications

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

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

The Effect of 1 µg/kg Dexmedetomidine Combined with High-Volume/Low-Concentration Caudal Ropivacaine in Children Undergoing Ambulatory Orchiopexy

Sequential allocation trial design in anesthesia: an introduction to methods, modeling, and clinical applications

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