Bilateral SMB is an easy regional anesthesia technique that reduces total morphine consumption at 48 h after cleft palate repair in children and the use of continuous infusion of morphine and may decrease postoperative respiratory complications.

D examethasone is recommended to reduce risk of postoperative nausea and vomiting in children undergoing tonsillectomy; nonsteroidal anti-inflammatory drugs (NSAIDs) are used for pain relief. Researchers sought to ascertain whether children who receive dexamethasone or dexamethasone with an NSAID are more likely to experience hemorrhage after a tonsillectomy. Randomized and nonrandomized investigations in which data of children undergoing tonsillectomy received dexamethasone or dexamethasone and an NSAID were sought within bibliographic databases and selected tertiary sources. The risk of bias in assessment and evaluation of hemorrhage rate data collection and reporting were evaluated using the Cochrane Risk of Bias Tool and McHarm Tool. Synthesis methods consisted of a pooled estimate of the effect of dexamethasone on the risk of hemorrhage rate using the Peto odds ratio method. The pooled estimate for hemorrhage rate in children who received dexamethasone was 6.2% (odds ratio, 1.41; 95% confidence interval, 0.89-2.25). There was a risk of bias and inconsistent data collection and reporting rates of hemorrhage in many of the studies included. Clinical heterogeneity was seen between studies. The pooled analysis failed to demonstrate a statistically significant increase in the risk of posttonsillectomy hemorrhage with dexamethasone with or without NSAID use in children. However, the majority of the studies included were not designed to investigate this end point; therefore, large studies that are specifically designed to collect data on the hemorrhage rate are needed. COMMENTIn 2008, Czarnetzki and colleagues 1 published a randomized trial suggesting that although dexamethasone decreased the incidence of postoperative nausea and vomiting after adenotonsillectomy, the drug may contribute to increased postoperative bleeding in this patient population (6.5-fold increased rate in Czarnetzki and colleagues' trial). Although the link between dexamethasone administration and posttonsillectomy hemorrhage is unclear, proposed mechanisms are impaired wound healing from glucocorticoids and even the possibility that therapeutic dosages of dexamethasone can increase the level of von Willebrand factor antigen leading to depressed levels of factor XIII. 2 Because posttonsillectomy hemorrhage can be life-threatening, Czarnetzki and colleagues' results should be taken seriously despite methodological limitations including lack of standardization of hemorrhage diagnosis, surgical techniques, and ibuprofen administration. 2 Here, J. R. Bellis et al publish an excellent meta-analysis regarding dexamethasone and hemorrhage after pediatric adenotonsillectomy that disputes these earlier findings by Czarnetzki et al. In their meta-analysis, Bellis and colleagues screened 3419 candidate articles, and ultimately 52 studies met stringent inclusion criteria (37 randomized controlled trials and 15 retrospective studies). The authors conclude that dexamethasone usage does not influence posttonsillectomy hemorrhage rates in children. Although t...

Ultrasound-guided TAP block is an appropriate technique for postoperative analgesia after AIC bone harvest in orthopedic surgery.

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