Pain Management in Paediatric Patients

Lloyd-Thomas, A.R.

doi:10.1093/bja/64.1.85

Cited by 152 publications

(102 citation statements)

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“…This confirms previous studies as a 2 agonists have no clinical respiratory effect. 25 Although bradycardia and hypotension are considered to be the most prominent adverse effects of a 2 -adrenoreceptor agonists, these side effects appear to be less pronounced in children than in adults.…”

Section: Discussionsupporting

confidence: 92%

“…Even bupivacaine, a long-acting local anesthetic drug, can provide only 4-8 h of analgesia. 2 Prolongation of caudal analgesia has been achieved by the addition of various additives. 3 Clonidine is an a 2 -receptor agonist successfully used as an adjuvant in caudal regional anesthesia to reduce the need for additional pain treatment without significant hemodynamic or respiratory effects.…”

mentioning

confidence: 99%

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Effect of dexmedetomidine on the characteristics of bupivacaine in a caudal block in pediatrics

Saadawy

Boker

El-Shahawy

et al. 2009

Acta Anaesthesiol Scand

166

182

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Background: Dexmedetomidine (DEX) is a highly selective a 2 -adrenoceptor agonist that has been used increasingly in children. However, the effect of caudal DEX has not been evaluated before in children. This prospective randomized double-blinded study was designed to evaluate the analgesic efficacy of caudal DEX with bupivacaine in providing pain relief over a 24-h period. Methods: Sixty children (ASA status I) aged 1-6 years undergoing unilateral inguinal hernia repair/orchidopexy were allocated randomly to two groups (n 5 30 each). Group B received a caudal injection of bupivacaine 2.5 mg/ml, 1 ml/kg; Group BD received the same dose of bupivacaine mixed with DEX 1 mg/kg during sevoflurane anesthesia. Processed electroencephalogram (bispectral index score), heart rate, blood pressure, pulse oximetry and end-tidal sevoflurane were recorded every 5 min. The characteristics of emergence, objective pain score, sedation score and quality of sleep were recorded post-operatively. Duration of analgesia and requirement for additional analgesics were noted.

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Section: Discussionsupporting

confidence: 92%

mentioning

confidence: 99%

Effect of dexmedetomidine on the characteristics of bupivacaine in a caudal block in pediatrics

Saadawy

Boker

El-Shahawy

et al. 2009

Acta Anaesthesiol Scand

166

182

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“…CPNB avoids the use of opiates in the postoperative period, and thus decreases their related side effects. 20 Sixty-one patients presented with a persistent insensate extremity and 22 had paresthesia or dysesthesia during the postoperative period. Persistent insensate extremity was significantly associated with continuous popliteal nerve block.…”

Section: Adverse Eventsmentioning

confidence: 99%

Continuous peripheral nerve blocks for postoperative analgesia in children: feasibility and side effects in a cohort study of 339 catheters

Dadure

Bringuier

Raux³

et al. 2009

Can J Anesth/J Can Anesth

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Introduction Perioperative continuous peripheral nerve blocks (CPNB) are increasingly being used in children. Only one previous study has reported adverse events of CPNB in a high number of pediatric cases. We evaluated the indications, block efficacy, and adverse events related to CPNB in children. Methods All CPNBs that were performed in children for postoperative analgesia over a 5-year period at the Montpellier University Hospital in France were included in this study. The first bolus dose and the continuous doses of local anesthetic were not standardized. In the postoperative period, demographic data, quality of analgesia, amount of rescue analgesic medication, child/parent satisfaction, and adverse events were recorded in our Departmental Regional Anesthesia registry. Results A total of 339 catheters were evaluated in 292 children ASA physical status I to III. The median age was 8 yr (0.6-17 yr) and the median weight was 28 kg (7-116 kg). The main surgical indications were hip, femoral, or tibial osteotomies (44.5%) and club foot repair (27.4%). The local anesthetics used were either bupivacaine or ropivacaine. The mean volume of the local anesthetic bolus dose was 0.49 ± 0.16 mL Á kg -1 , and the mean regimen of local anesthetic continuous infusion was 0.11 ± 0.04 mL Á kg -1 Á hr -1 . The median duration of CPNB was 61.6 hr (range 0-264 hr). Pain relief, which was evaluated with the children at rest, was considered optimal in the majority of patients throughout the study period. The Children and Infants Postoperative Pain Scale (CHIPPS) was used in children age 0-6 yr and the Visual Analog Pain Scale (VAS) was used in children 7 yr and older. There were no major adverse events. There were 211 minor adverse events recorded in 153 CPNBs (45.1%). The most frequently reported complication (20.1%) involved mechanical problems with the catheter, followed by nausea and vomiting (14.7%). Conclusion CPNBs are indicated after orthopedic surgery in children. Our results demonstrate that CPNBs are feasible in the pediatric setting, and in skilled hands, they promote prolonged analgesia in the majority of patients without major adverse events. The most common minor adverse events are catheter-related mechanical problems and postoperative nausea and vomiting.

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“…The main disadvantage of epidural block is the short duration of action after a single injection (Lloyd-Thomas, 1990). Thus, the use of combinations in epidural anesthesia is considered.…”

Section: Discussionmentioning

confidence: 99%

Comparative Evaluation of the Epidural Dexmedetomidine, Ketamine or Fentanyl in Combination With Bupivacaine in Dogs

Nour¹,

Othman²,

Karrouf³

et al. 2013

American Journal of Animal and Veterinary Sciences

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Castration is one of the most common procedure. It is a potential source of mild to moderate pain which is enough to induce inflammatory process, necessitate the incorporation of analgesics. This study was designed to evaluate the effect of epidural bupivacaine alone or in association with fentanyl, ketamine or dexmedetomidine on analgesia for the first 24 h post surgical castration. Forty male mongrel dogs were randomly allocated into 4 groups received bupivacaine 0.25% (1.5 mg kg ) into the lumbosacral space. Dogs were scored for sedation using numeric descriptive scale. Analgesia was assessed subjectively through Modified University of Melbourne Pain Scale score and objectively by following up the circulating level of interleukins 6 and 10. The bupivacaine-dexmedetomidine group showed the greatest sedation score, the lowest pain score without neuroendocrine modulation in contrast with bupivacaine or bupivacaine-fentanyl groups. From these result, it is concluded that bupivacaine-dexmedtomidine group provide long term analgesia last for the first 24 h post operative without additional analgesics.

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Pain Management in Paediatric Patients

Cited by 152 publications

References 0 publications

Effect of dexmedetomidine on the characteristics of bupivacaine in a caudal block in pediatrics

Effect of dexmedetomidine on the characteristics of bupivacaine in a caudal block in pediatrics

Continuous peripheral nerve blocks for postoperative analgesia in children: feasibility and side effects in a cohort study of 339 catheters

Comparative Evaluation of the Epidural Dexmedetomidine, Ketamine or Fentanyl in Combination With Bupivacaine in Dogs

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