The addition of clonidine to bupivacaine in saphenous/sciatic nerve blocks in children

Trifa, Mehdi; Engelhardt, Thomas; Khalifa, S. Ben

doi:10.1111/pan.12793

Cited by 3 publications

(1 citation statement)

References 5 publications

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“…Such adjuvants as midazolam,28 ketamine,29 clonidine,30 dexmedetomidine,31 epinephrine, or dexamethasone are coadministered with local anesthetics in order to enhance the effect of single-shot peripheral nerve block. Although several meta-analyses4–6 have demonstrated that dexamethasone given perineurally can extend the analgesic duration of common local anesthetics for brachial plexus block, the effectiveness of intravenous dexamethasone has been controversial 12.…”

Section: Discussionmentioning

confidence: 99%

Perineural versus intravenous dexamethasone as an adjuvant in regional anesthesia: a systematic review and meta-analysis

Zhao¹,

Ou²,

Liu³

et al. 2017

JPR

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BackgroundDexamethasone is a common adjuvant for local anesthetics in regional anesthesia, but the optimal route of administration is controversial. Therefore, we did a systematic review and meta-analysis of randomized controlled trials to assess the effect of perineural versus intravenous dexamethasone on local anesthetic regional nerve-blockade outcomes.Materials and methodsMedline (through PubMed), Embase, Cochrane, Web of Science, and Biosis Previews databases were systematically searched (published from inception of each database to January 1, 2017) to identify randomized controlled trials. The data of the selected trials were statistically analyzed to find any significant differences between the two modalities. The primary outcome was the duration of analgesia. Secondary outcomes included duration of motor block, postoperative nausea and vomiting, and postoperative analgesic dose at 24 hours. We conducted a planned subgroup analysis to compare the effects between adding epinephrine or not.ResultsTen randomized controlled trials met the inclusion criteria of our analysis, with a total of 749 patients. Without the addition of epinephrine, the effects of perineural and intravenous dexamethasone were equivalent concerning the duration of analgesia (mean difference 0.03 hours, 95% CI –0.17 to 0.24). However, with the addition of epinephrine, the analgesic duration of perineural dexamethasone versus intravenous dexamethasone was prolonged (mean difference 3.96 hours, 95% CI 2.66–5.27). Likewise, the impact of epinephrine was the same on the duration of motor block. The two routes of administration did not show any significant differences in the incidence of postoperative nausea and vomiting, nor on postoperative analgesic consumption at 24 hours.ConclusionOur results show that perineural dexamethasone can prolong the effects of analgesic duration when compared to the intravenous route, only when epinephrine is coadministered. Without epinephrine, the two modalities show equivalent effect as adjuvants on regional anesthesia.

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Section: Discussionmentioning

confidence: 99%

Perineural versus intravenous dexamethasone as an adjuvant in regional anesthesia: a systematic review and meta-analysis

Zhao¹,

Ou²,

Liu³

et al. 2017

JPR

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Clonidine in pediatric anesthesia

Afshari¹

2019

Current Opinion in Anaesthesiology

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Adjuvant medications to local anesthetics in nerve blockade

Lee

2017

Yeungnam Univ J Med

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Peripheral nerve blocks are commonly used for surgical anesthesia, postoperative analgesia, and to reduce opioid requirements. Although these blocks have traditionally been carried out using local anesthetics, singleinjection techniques can be short-lived and limited by the relatively brief duration of action of currently available local anesthetics. Increasing the dose or concentration of local anesthetics may prolong the duration of analgesia, but may also increase the risk such as unwanted motor weakness or systemic toxicity of local anesthetics. Numerous adjuvant medications have been added to local anesthetics to prolong the durations of anesthesia and analgesia achieved by peripheral nerve blocks, and currently, a number of different adjuvants are used to improve quality of the block. This article will review the several nerve block adjuvants used in combination with local anesthetics to provide blockade of peripheral nerves in clinical practice, describing the rationale for their use in peripheral nerve blocks, and the evidence for their effectiveness.

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The addition of clonidine to bupivacaine in saphenous/sciatic nerve blocks in children

Cited by 3 publications

References 5 publications

Perineural versus intravenous dexamethasone as an adjuvant in regional anesthesia: a systematic review and meta-analysis

Perineural versus intravenous dexamethasone as an adjuvant in regional anesthesia: a systematic review and meta-analysis

Clonidine in pediatric anesthesia

Adjuvant medications to local anesthetics in nerve blockade

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