Effects of intrathecal fentanyl on quality of spinal anesthesia in children undergoing inguinal hernia repair

Abstract

Intrathecal fentanyl at a dose of 0.2 microg.kg(-1) added to bupivacaine significantly improves the quality of intraoperative analgesia and prolongs postoperative analgesia in children undergoing inguinal hernia repair with spinal anesthesia.

Caudal dexmedetomidine combined with bupivacaine inhibit the response to hernial sac traction in children undergoing inguinal hernia repair

“…Ten minutes later, patients received i.v. ketamine at 2 mg kg 21 . Oxygen was delivered at a rate of 5 litre min 21 (FI O 2 ¼1.0).…”

“…ketamine at 2 mg kg 21 . Oxygen was delivered at a rate of 5 litre min 21 (FI O 2 ¼1.0). The children were placed in the left lateral decubitus position, and a single-dose caudal block was achieved via a 22 G caudal needle.…”

“…Adequate intraoperative analgesia was defined by haemodynamic stability, as reflected by ≤20% fluctuation of HR or SAP from the preoperative baseline. Inadequate anaesthesia was defined as .20% increase in HR or SAP upon hernial sac traction, and was treated with a rescue dose of ketamine (2 mg kg 21 ). An intraoperative decline of HR and SAP by .30% from the preoperative value was defined as hypotension and bradycardia, respectively, and was managed accordingly with fluid bolus, ephedrine injection, and/or atropine.…”

“…Postoperative pain was assessed by an experienced nurse who was unaware of the patient's allocation using Children's and Infant's Postoperative Pain Scale (CHIPPS), 9 every 2 h for the first 6 h, every 3 h for the following 12 h, and once at 24 h. Fentanyl (i.v. bolus of 0.5 mg kg 21 , with a 60 min lockout period) was administered as needed (if the CHIPPS exceeded 3) using a nurse-controlled analgesia pump. Sedation was assessed using a sedation score: 0, awake, alert; 1, mild sedation, easy to rouse; 2, asleep, easy to rouse; 3, moderate sedation, unable to remain awake; 4, difficult to rouse.…”

Spinal anesthesia is a blessing for children

“…We are using spinal anesthesia not only as an alternative to general anesthesia but also as the first choice for suitable surgery in children with or without co‐morbidity (2). We started to believe that spinal anesthesia has the potential in becoming the gold standard for children undergoing lower abdominal and lower extremity surgery and low dose spinal opioids to be an effective method for postoperative pain relief for children (2,3). Moreover, Rochette et al.…”