Regional anaesthesia in paediatric practice

Moores, Anthony; Fairgrieve, Ross

doi:10.1016/j.cacc.2004.08.013

Cited by 9 publications

(6 citation statements)

References 76 publications

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“…For provision of postoperative pain relief in inguinal surgeries in children, regional procedures are preferred because of several advantages over parenteral analgesics [ 36 ]. Caudal analgesia has been widely used, and, because of the ease of administration, it is the most commonly used neuraxial block for children [ 37 ].…”

Section: Discussionmentioning

confidence: 99%

A Systematic Review and Meta-Analysis of Caudal Block as Compared to Noncaudal Regional Techniques for Inguinal Surgeries in Children

Shanthanna

Singh

Guyatt

2014

BioMed Research International

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This systematic review and meta-analysis were designed to compare the analgesic effectiveness and adverse effects with the use of caudal analgesia as compared to noncaudal regional analgesia techniques in children undergoing inguinal surgeries. MEDLINE, EMBASE, and CENTRAL (Cochrane) databases were searched for randomized control trials published in English language from 1946 up to 2013. Use of rescue analgesia and adverse effects were considered as primary and secondary outcomes, respectively. Outcomes were pooled using random effects model and reported as risk ratio (RR) with 95% CI. Out of 3240 hits and 24 reports for final selection, 17 were included in this review. Caudal analgesia was found to be better in both early (RR = 0.81 [0.66, 0.99], P = 0.04) and late (RR = 0.81 [0.69, 0.96], P = 0.01) periods, but with a significant risk of motor block and urinary retention. According to GRADE, the quality of evidence was moderate. Although potentially superior, caudal analgesia increases the chance of motor block and urinary retention. There are limited studies to demonstrate that the technical superiority using ultrasound translates into better clinical success with the inguinal nerve blocks.

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Section: Discussionmentioning

confidence: 99%

A Systematic Review and Meta-Analysis of Caudal Block as Compared to Noncaudal Regional Techniques for Inguinal Surgeries in Children

Shanthanna

Singh

Guyatt

2014

BioMed Research International

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“…[ 4 ] Needle entry in USG blocks is more parallel to the skin than in the nerve-stimulated technique, and hence the needle traverses more structures under the ultrasound beam resulting in offsetting all anatomical landmarks and skin markings of the conventional method; an anesthesiologist has to learn to manipulate longer needles. [ 5 6 ]…”

Section: Introductionmentioning

confidence: 99%

Ultrasound-guided peripheral and truncal blocks in pediatric patients

Delvi

2011

Saudi J Anaesth

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Ultrasound has added a feather in the cap of the anesthesiologists as real-time nerve localization and drug deposition around the nerve structure under real-time guidance is now a reality, as the saying “seeing is believing” has been proven true with the advent of ultrasound in anesthesia. Pediatric patients are a unique group regarding their anatomical and physiological features in comparison with adults; regional blocks in adults with the anatomical landmark and surface marking are almost uniform across the adult population. The landmark technique in pediatric patients is not reliable in all patients due to the variability in the age and size; the advent of ultrasound in assisting nerve localization has changed the way regional blocks are achieved in children and the range of blocks performed on adults can now be performed on pediatric patients; with advances in the technology and dexterity of ultrasound equipment, the chances of success of blocks has increased with a smaller dose of the local anesthetic in comparison to the traditional methods. Anesthesiologists are now able to perform blocks with more accuracy and avoid complications like intravascular injection and injury to the pleura and peritoneum during routine practice with the assistance of high-frequency transducers and top of the range portable ultrasound machines; catheters can be inserted to provide a continuous analgesia in the postoperative period. This review article describes the common peripheral blocks in pediatric patients; the readers are encouraged to gain experience by attending workshops, hands-on practice under supervision, and conduct random controlled trials pertaining to ultrasound-guided blocks in the pediatric age group. The recent literature is encouraging and further research is promising; a wide range of blocks being described in detail by many prominent experts from all over the world.

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“…[ 6 ] CB remains the most popular and frequently performed block in infants and children undergoing surgical procedures, due to its long-standing familiarity amongst anaesthesiologists, a high success rate and a good safety profile. [ 7 ] The main disadvantage is that the effectiveness of this technique is limited by the duration of action of the local anaesthetics. Various additives to local anaesthetics have been used as adjuncts to improve the quality and the duration of the block.…”

Section: Discussionmentioning

confidence: 99%

Comparison between two doses of dexmedetomidine added to bupivacaine for caudal analgesia in paediatric infraumbilical surgeries

2016

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Background and Aims:Caudal block (CB) with adjuvants is routinely used in children for anaesthesia. We evaluated the efficacy of the α2 adrenergic agonist, dexmedetomidine at two different doses as an adjuvant to bupivacaine in CB.Methods:This study was conducted on ninety children. Control group BD0 received 0.25% bupivacaine 1 ml/kg, whereas, the study groups BD1 and BD2 received 1 μg/kg and 2 μg/kg dexmedetomidine, respectively, with 0.25% bupivacaine 1 ml/kg as a single shot CB. Adequacy of the block, haemodynamic changes, duration of analgesia and side effects were compared. Analysis of Variance was used for between-group comparisons of numerical variables. Student's t-test and Mann–Whitney U-test were used for quantitative data.Results:The demography was comparable. Anal sphincter 5 min after administration of the CB was relaxed in 89.3%, 82.1% and 75% of cases in BD0, BD1 and BD2 groups, respectively. The sphincter was relaxed at the end of surgery in all the cases. Comparable haemodynamics was noted with significantly prolonged duration of analgesia in the groups BD1 (964.2 ± 309 min) and BD2 (1152.6 ± 380.4 min) compared to control (444.6 ± 179.4 min). While no complications were encountered in groups BD0 and BD1, bradycardia was observed in four cases of BD2 group with accompanied hypotension in one of them.Conclusion:Dexmedetomidine as an adjuvant to bupivacaine improves the quality of CB, provides good operating conditions and increases the duration of post-operative analgesia. We conclude that 1 μg/kg is as effective as 2 μg/kg of dexmedetomidine and with a better safety profile.

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Regional anaesthesia in paediatric practice

Cited by 9 publications

References 76 publications

A Systematic Review and Meta-Analysis of Caudal Block as Compared to Noncaudal Regional Techniques for Inguinal Surgeries in Children

A Systematic Review and Meta-Analysis of Caudal Block as Compared to Noncaudal Regional Techniques for Inguinal Surgeries in Children

Ultrasound-guided peripheral and truncal blocks in pediatric patients

Comparison between two doses of dexmedetomidine added to bupivacaine for caudal analgesia in paediatric infraumbilical surgeries

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