Caudal and intravenous dexamethasone as an adjuvant to pediatric caudal block: A systematic review and meta‐analysis

Zhu, Change; Zhang, Saiji; Gu, Zhiqing; Tong, Yiwei; Rong, Wei

doi:10.1111/pan.13338

Cited by 18 publications

(15 citation statements)

References 52 publications

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“…Moreover, dexamethasone has both local and systemic mechanisms to prolong the analgesic duration of LAs [ 39 ]. The local mechanism may stem from the fact that dexamethasone can delay the absorption of LAs by constricting the blood vessels and reducing capillary permeability [ 40 ]; the systemic mechanism is likely due to the fact that dexamethasone can inhibit the local cyclooxygenase activity in trauma and reduce the synthesis of pain-causing substances, such as prostaglandins, thus exerting analgesic effects [ 41 ]. Mao et al [ 42 ] compared the efficacy of perineural dexamethasone with ropivacaine for TPVB in patients undergoing elective thoracotomy.…”

Section: Ultrasound-guided Blockmentioning

confidence: 99%

The Role of Serratus Anterior Plane Block During in Video-Assisted Thoracoscopic Surgery

et al. 2021

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Although thoracoscopy has characteristics such as a small surgical incision and low stress response, post-surgical pain after a thoracoscopic operation is no less than that after a thoracotomy. Moreover, poor post-surgical pain management is likely to cause an increased incidence of postoperative pulmonary complications (PPCs) and chronic post-surgical pain. The serratus anterior plane block (SAPB) is a regional anesthesia method whereby local anesthetics (LAs) are injected into the serratus anterior space to block the lateral cutaneous branch of the intercostal nerve, long thoracic nerve, and dorsal thoracic nerve. The block range of the SAPB covers the incisions of videoassisted thoracoscopic surgery (VATS) and the site of the chest tube, which are often located in the antero-lateral chest wall. Therefore, the SAPB can achieve effective analgesia in VATS. For example, 0.125% to 0.25% levobupivacaine (20-25 ml) is widely used for thoracic surgery, which can achieve effective analgesia and avoid adverse reactions. Moreover, it has advantages compared with thoracic segmental epidural block (TEA) and thoracic paravertebral block (TPVB), such as simple operation, increased safety, fewer complications, and hemodynamic stability. In addition, adequate analgesia is helpful for pulmonary function recovery and reduces the incidence of PPCs. This article introduces the anatomical mechanism of the SAPB, diverse operation approaches, how to choose drugs and adjuvants, and the resulting impacted area range. It summarizes the advantages and disadvantages of the SAPB compared with other analgesic methods and posits that the SAPB is beneficial to the recovery of postoperative lung function, which provides more options for postoperative analgesia after VATS.

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Section: Ultrasound-guided Blockmentioning

confidence: 99%

The Role of Serratus Anterior Plane Block During in Video-Assisted Thoracoscopic Surgery

et al. 2021

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“…Several additives, such as dexamethasone and alpha-2-adrenergic receptor agonists, have been shown to prolong analgesia following peripheral nerve blocks with single doses and give the potential extent for pain beyond the provision of a single-shot nerve block (26). Therefore, in our study, we decided to use dexamethasone with the best-proven effectiveness (27,28).…”

Section: Discussionmentioning

confidence: 99%

Pericapsular Nerves Group (PENG) Block in Children under Five Years of Age for Analgesia in Surgery for Hip Dysplasia: Case Report

Domagalska¹,

Wieczorowska‐Tobis²,

Reysner³

et al. 2023

Preprint

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Introduction The Pericapsular Nerve Group (PENG) block is a novel technique that allows for analgesia of the anterior hip capsule via the articular branches of the accessory obturator nerve and femoral nerve, which have a significant role in the innervation of the hip capsule. PENG blockade is effective in both adult and pediatric patients. However, there are no studies in the available literature on patients under five years of age. Herein, we describe our experience with two pediatric patients with hip dysplasia. Purpose This study aimed to evaluate the analgesic effect of the pericapsular nerves group (PENG) in small children undergoing hip surgery. Patients and methods This study included two patients, aged 2 and 4 years old, who qualified for hip surgery. General or spinal anesthesia with the addition of a PENG block was performed. During the procedure, the basic hemodynamic parameters were monitored. After the surgery, the patients received 15mg/kg-1 iv paracetamol every 6 hours to prevent rebound pain. The pain was assessed using the FALCC score. The 15mg/kg-1 metamizole was administered if the FLACC score was 3. In the FLACC score 4, the application of 0,2mg/kg-1 Nalpain was ordered. Results The patient's hemodynamic parameters were stable and within normal range. FLACC scores from all patients ranged from 0 and 3 in the first 24 h period. One patient required metamizole 12 hours after surgery. No evidence of block complications was observed. Conclusions This case series showed that PENG block provided adequate postoperative analgesia and assured opioid-free pain management. However, we are convinced that future randomized, controlled trials are needed in this field.

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“…Systemic toxicity in children also continues to be a topic of concern. The consensus is that the traditional method of general anesthesia can be improved with reduced use of opioids or opioid-free therapy [6,12,13].…”

Section: Discussionmentioning

confidence: 99%

Pain management with ultrasound-guided lidocaine-ropivacaine caudal block in hypospadias repair: A single-surgeon comparative study

Dai

Chen

2019

Preprint

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Background: Postoperative pain management in hypospadias surgery can be challenging, especially with the occurrence of postoperative penile erection, which is usually accompanied with bleeding and often interferes with wound healing. Ultrasound-guided caudal epidural block is easy to administer and can attenuate postoperative physiological stress response. In this study, we compared the effect of pain control among patients receiving standard general anesthesia (Group G) and among those receiving caudal analgesics of lidocaine-ropivacaine (Group GC). Methods: A total of 100 patients needing hypospadias repair for the first time were consecutively enrolled; 50 patients received caudal analgesics depending on available anesthesiologists. All patients were operated on by the same experienced surgeon. Primary outcome included pain and sedation scores, and the incidence of painful erections within 24 hours following surgery. Heart rate (HR) and analgesic requirement were also compared. Results: Baseline characteristics and vital statistics did not differ between the two groups. Postoperative erections were significantly less frequent in the GC than in the G group (22% vs. 64%, P < 0.05). The HRs and pain scores of the GC group were lower than those of the G group (P < 0.05) in the first 12 hours. Postoperative sedative effect was better and analgesic requirement less for the GC than the G group (P < 0.05) in the first 24 hours. Conclusion : Caudal lidocaine + ropivacaine can provide effective pain management in the early postoperative period and reduce the occurrence of painful erections. Further volume dosing studies are needed to refine the strategy for optimal pain control.

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Caudal and intravenous dexamethasone as an adjuvant to pediatric caudal block: A systematic review and meta‐analysis

Cited by 18 publications

References 52 publications

The Role of Serratus Anterior Plane Block During in Video-Assisted Thoracoscopic Surgery

The Role of Serratus Anterior Plane Block During in Video-Assisted Thoracoscopic Surgery

Pericapsular Nerves Group (PENG) Block in Children under Five Years of Age for Analgesia in Surgery for Hip Dysplasia: Case Report

Pain management with ultrasound-guided lidocaine-ropivacaine caudal block in hypospadias repair: A single-surgeon comparative study

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