Postoperative analgesia in children when using clonidine or fentanyl with ropivacaine given caudally

Shukla, Usha; Prabhakar, T; Malhotra, Kiran Preet

doi:10.4103/0970-9185.81842

Cited by 33 publications

(44 citation statements)

References 30 publications

(47 reference statements)

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“…One study that compared the efficacy of IV clonidine or fentanyl in conjunction with ropivacaine given caudally for postoperative pain relief resulted in no significant difference in oxygen saturation (Spo 2 ) (p>0.05). 17 An RCT studied caudal blockade with single dose clonidine, hydromorphone, or morphine combined with ropivacaine with epinephrine in children undergoing ureteral implantation. 18 No postoperative respiratory events were identified in this patient population.…”

Section: Resultsmentioning

confidence: 99%

Opioid Use and the Risk of Respiratory Depression and Death in the Pediatric Population

Whittaker

2013

The Journal of Pediatric Pharmacology and Therapeutics

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BACKGROUND Pediatric patients may be at an increased risk of adverse effects from various medications. Recently, there have been a number of serious adverse events, including several pediatric patients experiencing severe respiratory depression and death as a result of the use of codeine for pain control following tonsillectomy and adenoidectomy. OBJECTIVE To assess the safety of opioid agonists in pediatric patients undergoing operative procedures or have experienced trauma and to evaluate the risk of respiratory depression and death among this population. METHODS PubMed and Medline were searched to identify randomized controlled studies from 1994 to 2012 addressing postsurgery/trauma opioid use in pediatric patients. Relative risks and confidence intervals (CIs) were calculated using data available in clinical trials. RESULTS A total of 16 clinical trials were evaluated for this review. Randomized controlled trials included studies comparing opioids versus non-opioids for a variety of painful conditions. The relative risk of respiratory depression associated with opioid use in 1 trial was 1.63 (95% CI: 0.64-6.13). The remaining 15 trials reviewed described no significant difference in respiratory depression or adverse effects associated with treatment. No deaths were attributed to opioid use in any of these studies. CONCLUSION Opioid-associated respiratory depression was very rare and no deaths were reported in the reviewed studies. These findings under the well-defined conditions of controlled studies may not be the best means of determining overall opioid-associated side effects in pediatric patients. INDEX TERMS

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Section: Resultsmentioning

confidence: 99%

Opioid Use and the Risk of Respiratory Depression and Death in the Pediatric Population

Whittaker

2013

The Journal of Pediatric Pharmacology and Therapeutics

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“…Usha Shukla et al [43] in their study on caudal fentanyl 1 mcg/kg found that mean arterial pressures decreased by 10-15% during anaesthesia and increased by 5-15% during recovery. HR also decreased during anaesthesia.…”

Section: Discussionmentioning

confidence: 99%

A Randomised, Double-Blind, Prospective Study of Caudal Ropivacaine Versus Ropivacaine With Fentanyl Versus Ropivacaine With Neostigmine for Combined Epidural and General Anaesthesia in Children

Rao¹,

Babu²,

Patta³

2017

jemds

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BACKGROUNDThere are no studies comparing the outcomes of using Fentanyl or Neostigmine as adjuvants to Ropivacaine in terms of postoperative analgesia for paediatric caudal block. The aim of our study is to compare the outcomes of using Ropivacaine 0.2% vs Ropivacaine 0.2% with Neostigmine 2 mcg/kg vs Ropivacaine with Fentanyl 1 mcg/kg as a single shot caudal block on postoperative analgesic effect in children aged 3 -8 yrs. undergoing subumbilical surgeries. MATERIALS AND METHODSThis is a double-blind, randomised, controlled, prospective study. Our study included 60 paediatric patients undergoing elective lower abdominal surgeries at Rajiv Gandhi Institute of Medical Sciences, Srikakulam, Andhra Pradesh. RESULTSThe patient groups were comparable with respect to age and weight. The mean pain scores at 24 hrs. in R, RF and RN groups are 3.05 ± 0.6, 2 ± 0.5, 2.65 ± 0.67 respectively with a p-value of 0.008, which is statistically significant. The duration of analgesia in R, RF and RN groups are 383, 353 and 680.5 mins. respectively with a p-value of ˂ 0.05, which is statistically significant. CONCLUSIONWe conclude in the present study that the addition of neostigmine to caudal Ropivacaine resulted in prolongation of duration of analgesia, while a Ropivacaine and Fentanyl mixture did not cause any statistically significant increase in the duration of analgesia. KEYWORDSRopivacaine, Fentanyl, Neostigmine, Caudal Analgesia. HOW TO CITE THIS ARTICLE:Rao MP, Babu SP, Saroj P. A randomised, double-blind, prospective study of caudal ropivacaine versus ropivacaine with fentanyl versus ropivacaine with neostigmine for combined epidural and general anaesthesia in children. J. Evolution Med. Dent. Sci. 2017;6(44):3459-3468, DOI: 10.14260/Jemds/2017/748 BACKGROUND Pain is "an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage" as defined by the International Association for the Study of Pain. [1] Pain is always subjective.In children even the definition of pain has been debated. [2] The structural components necessary to perceive pain are already present at about 25 weeks gestation, whereas the endogenous descending inhibitory pathways are not fully developed until mid-infancy. [3,4] It has been recognised for some time that the management of acute pain, especially post-operative pain, has been consistently inadequate. If anything, the situation in children has been even worse, who have long been undermedicated for acute pain. [5] The various drugs used for the treatment of acute postoperative pain are local anaesthetics (local/regional Financial or Other, Competing Interest: None. Submission 21-04-2017, Peer Review 19-05-2017, Acceptance 25-05-2017, Published 01-06-2017. Corresponding Author: Dr. Soumya Panickessery Babu, D/No. 39-6-72, Muralinagar, Visakhapatnam-530007. E-mail: pbsoums.k@gmail.com DOI: 10.14260/jemds/2017 analgesia), opioids, Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) and acetaminophen. The different availab...

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“…Minimum cardiotoxicity and a slighter paralysis of motor nerves and muscles dictate the choice of ropivacaine. An alternative to opioids is the addition of 2 µg kg -1 clonidine or 1 µg kg -1 dexmedetomidine [16]. Continuation of local anaesthetic infusion without opioids is advisable prior to planned extubation.…”

Section: Regional Anaesthesiamentioning

confidence: 99%

Stanowisko Sekcji Anestezjologii i Intensywnej Terapii Dziecięcej Polskiego Towarzystwa Anestezjologii i Intensywnej Terapii w sprawie znieczulania dzieci powyżej 3. roku życia. Część II

Bartkowska-Śniatkowska

Zielińska²,

Cettler³

et al. 2016

Anaesthesiol Intensive Ther

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ANAESTHESIA IN LARYNGOLOGY PreParation for anaesthesiaAnaesthesiologists feel no need to perform additional examinations for typical procedures, such as adenoidectomy and adenotonsillotomy or adenotonsillectomy, in children in good general health with no history of bleeding incidents [1]. Laryngologists often order coagulation tests, which are necessary in patients with a positive bleeding history from the nose, gingivae, ear, etc.. Blood group determinations are useful before tonsillotomy or tonsillectomy because of an increased risk of intra-and postoperative bleeding.It is essential to determine whether patients have symptoms of obstructive sleep apnoea syndrome (OSAS) associated with tonsillar hypertrophy, upper airway structural defects, obesity, or impaired breathing regulation [2,3]. These patients (whose major symptom is snoring) are likely to have cardiovascular disorders (e.g., arterial hypertension and occasionally pulmonary hypertension) that require additional cardiologic evaluation.The chest X-ray should be performed in every child with the suspicion of aspiration of foreign body.

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Postoperative analgesia in children when using clonidine or fentanyl with ropivacaine given caudally

Cited by 33 publications

References 30 publications

Opioid Use and the Risk of Respiratory Depression and Death in the Pediatric Population

Opioid Use and the Risk of Respiratory Depression and Death in the Pediatric Population

A Randomised, Double-Blind, Prospective Study of Caudal Ropivacaine Versus Ropivacaine With Fentanyl Versus Ropivacaine With Neostigmine for Combined Epidural and General Anaesthesia in Children

Stanowisko Sekcji Anestezjologii i Intensywnej Terapii Dziecięcej Polskiego Towarzystwa Anestezjologii i Intensywnej Terapii w sprawie znieczulania dzieci powyżej 3. roku życia. Część II

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