Comparison of adjuvant pharmaceuticals for caudal block in pediatric lower abdominal and urological surgeries: A network meta-analysis

Xiong, Chang; Han, Chengpeng; Lv, Huayan; Xu, Duojia; Peng, Wenyong; Zhao, Dong; Lan, Zhijian

doi:10.1016/j.jclinane.2022.110907

Cited by 6 publications

(3 citation statements)

References 109 publications

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“…A study performed by Singh J et al (46) comparing the effects of fentanyl, clonidine, and ketamine on the duration of caudal analgesia in adjuvant with 0.25% bupivacaine in children revealed that the mean duration of analgesia was even shorter in the fentanyl group (507.75 ± 222.64 min) than plain bupivacaine (529.07 ± 166.00 min). In contrast, Xiong (47) suggested fentanyl is weakly superior to the placebo in this regard.…”

Section: Opioidsmentioning

confidence: 93%

Methods of prolonging the effect of caudal block in children

Xu,

Wei,

Zhang

2024

Front. Pediatr.

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Caudal epidural blockade is one of the most frequently administered regional anesthesia techniques in children. It is a supplement during general anesthesia and for providing postoperative analgesia in pediatrics for sub-umbilical surgeries, especially for genitourinary surgeries. However, the duration of the analgesic effect is occasionally unsatisfactory. In this review, we discuss the main advantages and disadvantages of different techniques to prolong postoperative analgesia for single-injection caudal blockade in children. A literature search of the keywords “caudal”, “analgesia”, “pediatric”, and “children” was performed using PubMed and Web of Science databases. We highlight that analgesic quality correlates substantially with the local anesthetic's type, dose, the timing relationship between caudal block and surgery, caudal catheterization, and administration of epidural opioids or other adjuvant drugs.

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Section: Opioidsmentioning

confidence: 93%

Methods of prolonging the effect of caudal block in children

Xu,

Wei,

Zhang

2024

Front. Pediatr.

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“…As one of the most common anesthetic techniques, subarachnoid block can be used as the anesthetic of choice for lower extremity surgery such as knee arthroscopy, both for surgical needs and patient comfort. Due to the short duration of knee arthroscopy and the disadvantages of epidural tubing such as catheter migration, breakage, infection, and inadvertent entry into blood vessels and the subarachnoid space [4] , many techniques have been proposed to prolong the duration of anesthesia, such as the administration of drugs intravenously or the addition of local anesthetic adjuvants [5] . Local anesthetic adjuvants have been clinically explored by many anesthesiologists for their ability to provide good perioperative analgesia and reduce local anesthetic concentrations, and more and more clinical studies on local anesthetic drug adjuvants, both opioid and non-opioid, have emerged.…”

Section: Introductionmentioning

confidence: 99%

“…Local anesthetic adjuvants have been clinically explored by many anesthesiologists for their ability to provide good perioperative analgesia and reduce local anesthetic concentrations, and more and more clinical studies on local anesthetic drug adjuvants, both opioid and non-opioid, have emerged. Dexmedetomidine as an α2-adrenergic receptor agonist with sedative, anxiolytic and analgesic characteristics determines that it is a drug that cannot be ignored, and several meta-analyses [5][6] have shown that intrathecal dexmedetomidine accelerates the onset of sensory-motor blockade, prolongs the duration of sensory and motor blockade and the time to the rst request for analgesia, and has few hemodynamic alterations, showing a superior potential to be considered as an adjunct to intrathecal local anesthetics in lower extremity surgery. In addition, it has also been suggested [7][8][9] that intraoperative intravenous infusion of dexmedetomidine can reduce postoperative opioid analgesic dosage and decrease the risk of postoperative stress and postawakening adverse events.…”

Section: Introductionmentioning

confidence: 99%

Comparison of the effect of dexmedetomidine intrathecal injection and intravenous infusion on subarachnoid blockade during knee arthroscopy procedures

Liu,

Sun,

Wang

et al. 2023

Preprint

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Background: Comparison of whether intrathecal dexmedetomidine prolongs spinal anesthesia-associated sensorimotor blockade more than intravenous infusion during knee arthroscopy procedures performed under subarachnoid block. Methods: Ninety patients aged 18-75 years, ASA class I-II, who underwent knee arthroscopy between October 2022 and April 2023 were randomized into intrathecal、intravenous and control groups.Subjects received three modes of administration: an intrathecal group (2ml of 1% ropivacaine + 5μg of dexmedetomidine，with saline pumped intravenously at a dose of 0.5μg/kg/h), an intravenous group (intrathecal 2ml of 1% ropivacaine +1ml of 0.9% saline, with dexmedetomidine pumped intravenously at a dose of 0.5μg/kg/h), and a control group (intrathecal 2ml of 1% ropivacaine + 1ml of 0.9% saline, with saline pumped intravenously at a dose of 0.5μg/kg/h). Total analgesic duration, duration of sensory and motor blockade, Ramsay sedation score, Visual Analogue Score (VAS) at different postoperative time points, and occurrence of adverse effects were recorded. Results：The total analgesia duration was significantly longer in the intrathecal group than in the intravenous and control groups (352.13±51.70min VS 273.47±62.57min VS 241.41±59.22min，P<0.001).The duration of sensory block was shorter in the intrathecal group than in the intravenous and control groups (4 [3-4]min VS 5 [4-5]min VS 5 [4-5]min；P<0.001);the duration of motor block was shorter in the intrathecal group than in the intravenous group and the control group (5 [4-5]min VS 5 [5-6]min VS 6[5.5-7]min；P<0.001).Sedation scores were higher in the intravenous group than in the intrathecal and control groups (P < 0.001). At 5 hours postoperatively, the VAS score in the intrathecal group was smaller than that in the intravenous and control groups (P<0.001). At 24 hours postoperatively, the VAS score in the intrathecal group was smaller than that in the control group (P < 0.001). In addition, the incidence of bradycardia was significantly higher in the intravenous group than in the intrathecal and control groups (30%, 6.5%, and 3.4%, respectively; P=0.018，P=0.007). Conclusions：Intrathecal administration of dexmedetomidine did prolong the total analgesia duration, as well as accelerate the onset of sensory-motor blockade compared with intravenous pumping, and did not result in any hemodynamic instability or other adverse events at the doses studied. Trial registration:This single-center, prospective, RCT has completed the registration of the Chinese Clinical Trial Center at 26/09/2023 with the registration number ChiCTR2300076170.

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