Enhancement of ropivacaine caudal analgesia using dexamethasone or magnesium in children undergoing inguinal hernia repair

Yousef, Gamal T; Ibrahim, Tamer H; Khder, Ahmed; Ibrahim, Mohamed

doi:10.4103/0259-1162.128895

Cited by 36 publications

(59 citation statements)

References 42 publications

(53 reference statements)

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“…Several studies suggested that the addition of dexamethasone through caudal route[16] or IV route[12171819] as an adjuvant to RA significantly reduced the post-operative pain by prolonging the duration of analgesia with significantly lesser analgesic consumption. Our study results are in line with this, in which we demonstrated that the addition of dexamethasone through caudal or IV route could significantly prolong the mean time to first rescue analgesic with the significant advantage of caudal over IV route in children undergoing inguinal hernia repair.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of caudal and intravenous dexamethasone as adjuvants for caudal epidural block: A double blinded randomised controlled trial

et al. 2016

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Background and Aims:Dexamethasone has a powerful anti-inflammatory action with significant analgesic benefits. The aim of this study was to compare the efficacy of dexamethasone administered through intravenous (IV) and caudal route on post-operative analgesia in paediatric inguinal herniotomy patients.Methods:One hundred and five paediatric patients undergoing inguinal herniotomy were included and divided into three groups. Each patient received a single caudal dose of ropivacaine 0.15%, 1.5 mL/kg combined with either corresponding volume of normal saline (Group 1) or caudal dexamethasone 0.1 mg/kg (Group 2) or IV dexamethasone 0.5 mg/kg (Group 3). Baseline, intra- and post-operative haemodynamic parameters, pain scores, time to rescue analgesia, total analgesic consumption and adverse effects were evaluated for 24 h after surgery. Unpaired Student's t-test and analysis of variance were applied for quantitative data and Chi-square test for qualitative data. Time to first analgesic administration was analysed by Kaplan–Meier survival analysis and log-rank test.Results:Duration of analgesia was significantly longer (P < 0.001), and total consumption of analgesics was significantly lower (P < 0.001) in Group II and III compared to Group I. The incidence of nausea and vomiting was higher in Group I (31.4%) compared to Group II and III (8.6%).Conclusions:Addition of dexamethasone both caudally or intravenously as an adjuvant to caudal 0.15% ropivacaine significantly reduced the intensity of post-operative pain and prolonged the duration of post-operative analgesia with the significant advantage of caudal over IV route.

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Section: Discussionmentioning

confidence: 99%

“…[1620] Even the systemic administration of steroids has to be effective for reducing post-operative pain, but the results are inconclusive. [8212223]…”

Section: Discussionmentioning

confidence: 99%

Comparison of caudal and intravenous dexamethasone as adjuvants for caudal epidural block: A double blinded randomised controlled trial

et al. 2016

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“…[21][22][23][24] The combination of ropivacaine and both particulate and non-particulate steroid agents, has been used for both various spinal and musculoskeletal diagnostic and therapeutic injections, with reports in the literature of such combinations being used for pain injections and infusions. [25][26][27][28][29][30] The combination of concern is that of ropivacaine and alkaline solutions, a category that dexamethasone sodium phosphate falls into with a pH of 8.0. This has been previously described in the literature when evaluating alkalising local anaesthetic agents, with reports of ropivacaine precipitating at a pH of 6.0 and above.…”

Section: Discussionmentioning

confidence: 99%

Ropivacaine and dexamethasone: a potentially dangerous combination for therapeutic pain injections

2015

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Introduction: Targeted spinal steroid injections are effective in reducing back pain in selected patient populations and carry a small risk of significant adverse neurological outcomes. Recent recommendations are for the use of non-particulate steroid agents for all spinal injections to reduce the risk of neurovascular embolic adverse events. Many injections have used a combination of local anaesthetic agent with the steroid. At our institutions, we have recently observed interactions between ropivacaine and dexamethasone combinations ascribed to the incompatibility of the former with alkaline solutions, resulting in rapid crystallisation. This study has further investigated the combinations of commonly used local anaesthetic and steroid combinations to determine if such precipitation effects are more widespread. Methods: The commonly used local anaesthetics (lignocaine, bupivacaine, ropivacaine) and the non-particulate steroid dexamethasone sodium phosphate combinations were evaluated macroscopically, microscopically, and pH values measured. Where crystallisation was observed the rate of precipitation and crystal size was measured. Contamination of ropivacaine with sodium bicarbonate solution was also evaluated. Particulate size of the particulate steroid agent betamethasone acetate was evaluated as a comparison. Results: All mixtures of ropivacaine and the non-particulate dexamethasone sodium phosphate assessed demonstrated a pH-dependent crystallisation of the solution. No precipitation was demonstrated with the combinations of dexamethasone and lignocaine or bupivacaine. Contamination of ropivacaine with residual sodium bicarbonate in a drawing up needle following air clearing had a precipitation effect. Conclusion: We describe the effect of crystallisation with the combination of ropivacaine and the non-particulate steroid, dexamethasone sodium phosphate, a mixture that has been used in the literature for targeted pain injections. As this may be considered a non-particulate steroid/anaesthetic injectate, this would potentially carry increased risk if inadvertent intravascular injection occurred during a targeted spinal injection, as has been described with particulate steroid agents. This is due to the elevated pH of dexamethasone and the incompatibility of ropivacaine with alkaline solutions.

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“…The time of first analgesic request was significantly longer in magnesium groups (500 ± 190 min) compared with ropivacaine group (260 ± 65 min). Ropivacaine group patients achieved significantly higher Children's Hospital of Eastern Ontario Pain Scale and Faces Legs Activity Cry CONSOL ability scores (4th hourly) compared with magnesium group (8th hourly) (17) . In contrast to our study Birbicer et al, compared bupivacaine 0.5% plus 50 mg magnesium to bupivacaine 0.5% alone for caudal anesthesia in children.…”

Section: Discussionmentioning

confidence: 99%

“…Many studies suggested that epidurally administered magnesium as an adjuvant to local anesthetics could reduce the postoperative pain in adults. But few studies are available about its use as an adjuvant in caudal block for such purpose (5) . We designed this study to compare the intensity, safety and duration of postoperative pain relief using caudal magnesium sulfate as adjuvant with isobaric bupivacaine 0 .5% in pediatric patients undergoing lower abdominal surgeries.…”

Section: Introductionmentioning

confidence: 99%

Effect of Adding Magnesium Sulphate to Pediatric Caudal Bupivacaine on Hemodynamics Parameters and Surgical Stress: Randomized Double-Blind Control Study

Aşkar¹,

Ahmed²,

Hassan³

2017

IAM

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Background: Caudal anesthesia/analgesia is simple to perform, reliable and safe. Various adjuvants have been utilized with local anesthetic to prolong duration of post-operative analgesia of caudal block in pediatric patients, but with variable results. Aim and Objective: This study is conducted to evaluate the hemodynamics effects and surgical stress response of caudal magnesium sulfate with bupivacaine in children undergoing lower abdominal surgeries. Methods: The study was approved by the local ethics committee, and a written consent was obtained for each subject, and included 60 children ASA classification I and II, aged 1 year to 6 years scheduled for lower abdominal surgeries randomized into one of two groups. after inhalation induction of general anesthesia, standard caudal block was done the participants were randomized into one of two groups either receive 1ml volume containing 50mg of magnesium sulfate (group Mg) added to 1ml /kg bupivacaine 0.25% or 1ml saline as placebo added to the same dose of bupivacaine in group (C). Postoperative pain assessed by FLACC score (acronym for Face, Legs, Activity, Cry and CONSOL ability) and duration of analgesia, postoperative sedation as well as hemodynamic parameters were compared between the two groups. Results: Group Mg had significantly lower FLACC score than group C in the first six postoperative hours. The sedation score was significantly higher only during the first postoperative hours in group Mg compared to group C. There was no statistically significant difference between groups about hemodynamic parameters at any time during the study period. Conclusion: Caudal magnesium sulfate 50mg enhance caudal block and prolongs duration of analgesia with bupivacaine in pediatric patient undergoing lower abdominal surgeries under general anesthesia with minimum adverse effects.

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Enhancement of ropivacaine caudal analgesia using dexamethasone or magnesium in children undergoing inguinal hernia repair

Cited by 36 publications

References 42 publications

Comparison of caudal and intravenous dexamethasone as adjuvants for caudal epidural block: A double blinded randomised controlled trial

Comparison of caudal and intravenous dexamethasone as adjuvants for caudal epidural block: A double blinded randomised controlled trial

Ropivacaine and dexamethasone: a potentially dangerous combination for therapeutic pain injections

Effect of Adding Magnesium Sulphate to Pediatric Caudal Bupivacaine on Hemodynamics Parameters and Surgical Stress: Randomized Double-Blind Control Study

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