The Efficacy and Safety of Dexmedetomidine Combined with Bupivacaine on Caudal Epidural Block in Children: A Meta-Analysis

Tu, Zhenzhen; Tan, Xu; Li, Shangyingying; Cui, Jie

doi:10.12659/msm.913098

Cited by 13 publications

(14 citation statements)

References 30 publications

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“…9,10,20 A recently published meta-analysis that included 10 randomized controlled trials has suggested a promising role of Dexmedetomidine when added to the caudal Bupivacaine in prolonging postoperative analgesia in children without an increase in side effects. 21 Caudal Dexmedetomidine is shown to prolong analgesia comparable to that of caudal Morphine, with the added advantage of absent hypoventilation. 22 With the similar demographic, surgical and anaesthetic characteristics, and despite receiving less intraoperative Fentanyl, group B patients in our study showed a significantly prolonged analgesia compared to group A, which can only be attributed to Dexmedetomidine.…”

Section: Original Articlementioning

confidence: 98%

“…Like our finding, many studies on caudal Dexmedetomidine have not reported a significantly increased need for medications to treat bradycardia and hypotension. 9,10,[20][21][22][23] The strengths of the present study comprised of the inclusion of similar types of surgery and the absence of modifications in the anaesthesia practice at our set up except for one group of children receiving a small-dose of caudal Dexmedetomidine in addition. Neonates and infants were excluded from the study to avoid a potential risk of dural puncture owing to their higher association with anatomic variations of the sacral hiatus and sacral cornua.…”

Section: Original Articlementioning

confidence: 99%

“…Similarly, the FLACC scale, we used, is a well-accepted, reliable, and valid instrument to assess pain in children. 12,21,26 And, a postoperative pain trigger was set at a FLACC score of more than three, which coincides with many of the similar studies included in a meta-analysis. 21 The caudal drug volume and Bupivacaine's dose used in our study were within the current recommendation.…”

Section: Original Articlementioning

confidence: 99%

“…12,21,26 And, a postoperative pain trigger was set at a FLACC score of more than three, which coincides with many of the similar studies included in a meta-analysis. 21 The caudal drug volume and Bupivacaine's dose used in our study were within the current recommendation. 1,3,7 Absence of CB failure and no increment in post-incision hemodynamic parameters in both the groups further demonstrate the proper application of CB (Table 3).…”

Section: Original Articlementioning

confidence: 99%

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Study of Dexmedetomidine in Caudal Block for Children Undergoing Inguino-scrotal Surgery

Gautam¹,

Piya²,

Karki³

2020

Kathmandu Univ. Med. J.

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Background Caudal block is the most common anaesthetic technique employed in children for managing perioperative pain of inguino-scrotal surgery. However, despite using long-acting local anaesthetics, caudal analgesia lasts relatively shorter. Dexmedetomidine, an alpha-2 agonist, augments local anaesthetic action. Objective To assess the analgesic effect of caudal Dexmedetomidine. Method This is a randomized, double-blinded study conducted on otherwise healthy children (one to five years) undergoing elective inguino-scrotal surgery. General anaesthesia was administered and a laryngeal mask airway was inserted for assisting ventilation. The caudal block was applied using 0.8 milliliters/kilogram drug volume comprising either two milligrams/kilogram Bupivacaine in group A (n=42) or two milligrams/ kilogram Bupivacaine mixed with 0.75 micrograms/kilogram Dexmedetomidine in group B (n=42). Intraoperatively, inhaled Halothane, intravenous Fentanyl, fluids, and ventilation were titrated to maintain monitored hemodynamic variables within 15% from baseline values. The primary endpoint comprised the duration of analgesia, defined by a time when postoperative pain score (face, legs, activity, cry, consolability; FLACC scale) reached four out of ten. Perioperative events were studied for 24 hours. Student’s t-test and Chi-square test were used for analysis, with p-value less than 0.05 considered as significant. Result Demographic, surgical, and anaesthetic characteristics were similar between the groups. Duration of analgesia was significantly prolonged in group B (group B, 413±101 minutes; group A, 204±40 minutes). The intraoperative requirement for supplement Fentanyl was significantly reduced in group B. Adverse events were comparable between the groups. Conclusion Dexmedetomidine prolongs the duration of analgesia when mixed with caudal Bupivacaine, without increasing adverse events.

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Section: Original Articlementioning

confidence: 98%

Section: Original Articlementioning

confidence: 99%

Section: Original Articlementioning

confidence: 99%

Section: Original Articlementioning

confidence: 99%

See 2 more Smart Citations

Study of Dexmedetomidine in Caudal Block for Children Undergoing Inguino-scrotal Surgery

Gautam¹,

Piya²,

Karki³

2020

Kathmandu Univ. Med. J.

View full text Add to dashboard Cite

show abstract

“…There were no clinically significant hemodynamic changes noted [ 100 ]. A meta-analysis of 10 RCTs evaluating DEX combined with bupivacaine for caudal anesthesia in the pediatric population reported similar results with longer post-operative analgesia and few rescue analgesics [ 101 ].…”

Section: Updates Of Synergistic Effectsmentioning

confidence: 99%

Dexmedetomidine: What’s New for Pediatrics? A Narrative Review

Mahmoud

Barbi

Mason

2020

JCM

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Over the past few years, despite the lack of approved pediatric labelling, dexmedetomidine’s (DEX) use has become more prevalent in pediatric clinical practice as well as in research trials. Its respiratory-sparing effects and bioavailability by various routes are only some of the valued features of DEX. In recent years the potential organ-protective effects of DEX, with the possibility for preserving neurocognitive function, has put it in the forefront of clinical and bench research. This comprehensive review focused on the pediatric literature but presents relevant, supporting adult and animal studies in order to detail the recent growing body of literature around the pharmacology, end-organ effects, organ-protective effects, alternative routes of administration, synergetic effects, and clinical applications, with considerations for the future.

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Evaluation of the Efficacy of Dexmedetomidine as a Local Anesthetic Adjuvant in Children: A Meta‐Analysis of Randomized Controlled Trials

Sun

et al. 2022

The Journal of Clinical Pharma

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Dexmedetomidine has been identified as a useful adjunct to improve the effect of nerve blocks in adults; however, its effect for children has not yet been fully investigated. This meta‐analysis aimed to evaluate the reliability and efficacy of dexmedetomidine as a local anesthetic adjunct for pediatric surgeries. Eligible studies were searched in Cochrane, Embase, PubMed, and CBM. RevMan 5.4 was used to assess the risk of bias of each study and perform statistical analysis. Stata 15.0 was used to evaluate the publication bias of primary outcomes. Thirteen randomized controlled trial (RCTs) involving 722 patients aged 6 months to 12 years were harvested. Statistical analysis showed that dexmedetomidine resulted in: a significantly longer duration of analgesia (standardized mean difference [SMD], 7.16; 95% confidence interval [95%CI], 4.88 to 9.43; P < .001; I2 = 98%); a reduction in the 1‐hour pain score (mean difference [MD], –0.27; 95%CI, –0.47 to –0.06; P = .01; I2 = 28%); cumulative doses of rescue analgesic required of 2 doses (risk ratio [RR], 0.26; 95%CI, 0.14 to 0.49; P < .001; I2 = 0) or 3 doses (RR, 0.04; 95%CI, 0.01 to 0.16; P < .001; I2 = 4%); the frequency of emergence agitation (RR, 0.44; 95%CI, 0.22 to 0.91; P = .03; I2 = 0); and a reduction in the onset time of blocks (mean difference –3.56; 95%CI, –6.39 to –0.74; P = .01; I2 = 90%). However, the incidence of some side effects, including hypotension, bradycardia, nausea and vomiting, pruritis, urinary retention, and respiratory depression, did not significantly differ between the dexmedetomidine group and the placebo group. Therefore, dexmedetomidine is a reliable and efficient adjunct to local anesthetics in children.

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The Efficacy and Safety of Dexmedetomidine Combined with Bupivacaine on Caudal Epidural Block in Children: A Meta-Analysis

Cited by 13 publications

References 30 publications

Study of Dexmedetomidine in Caudal Block for Children Undergoing Inguino-scrotal Surgery

Study of Dexmedetomidine in Caudal Block for Children Undergoing Inguino-scrotal Surgery

Dexmedetomidine: What’s New for Pediatrics? A Narrative Review

Evaluation of the Efficacy of Dexmedetomidine as a Local Anesthetic Adjuvant in Children: A Meta‐Analysis of Randomized Controlled Trials

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