Caudal bupivacaine supplemented with morphine or clonidine, or supplemented with morphine plus clonidine in children undergoing infra-umbilical urological and genital procedures: a prospective, randomized and double-blind study

Fernandes, Magda Lourenço; Pires, Kleber C. C.; Tibúrcio, Moacir A.; Gomez, Renato Santiago

doi:10.1007/s00540-011-1297-y

Cited by 22 publications

(37 citation statements)

References 33 publications

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“…compared the efficacy of caudal morphine 20 μg/kg with caudal clonidine 1 μg/kg in children undergoing infraumblical surgeries and concluded that morphine decreased the requirement of analgesics in the postoperative period, although it was associated with an increased incidence of nausea/vomiting. [ 5 ] Another alpha-2 agonist dexmedetomidine is increasingly being used for analgesia and sedation, but still there are many concerns about its use, especially in the pediatric age group. [ 14 15 16 ]…”

Section: Discussionmentioning

confidence: 99%

“…[ 1 2 3 4 ] These were proven to be practically free of the side-effects for which morphine had become notorious, but the quality and duration of analgesia provided by morphine remains unmatched. [ 5 6 ] Hence, our study was conducted to compare the efficacy and safety of three different doses of caudal epidural morphine (CEM). Since 50 μg/kg is the standard dose, and 100 μg/kg has been shown to cause respiratory depression, we decided to compare 30, 50, and 70 μg/kg of CEM.…”

Section: Introductionmentioning

confidence: 99%

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Postoperative analgesia in children: A comparison of three different doses of caudal epidural morphine

Baduni

Sanwal

Vajifdar

et al. 2016

J Anaesthesiol Clin Pharmacol

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Background and Aims:Caudal epidural block is the most commonly used neuraxial block in children. Morphine has been used as a caudal additive for more than three decades. The aim of our study was to evaluate the efficacy and duration of analgesia of three different doses of caudal epidural morphine (CEM), and to find out the incidence of side effects.Material and Methods:This study was conducted on 75 patients of American Society of Anesthesiologists grades I and II, aged 2-12 years, undergoing lower abdominal and urogenital surgeries. Patients were randomly allocated to one of the three groups according to the dose of morphine. Group I received 30 μg/kg, group II 50 μg/kg, and group III 70 μg/kg. Heart rate, blood pressure, oxygen saturation, electrocardiogram, pain score, sedation score, duration of analgesia, and side-effects were noted.Results:The mean duration of analgesia was 8.63 h in group I, 13.36 h in group II and 19.19 h in group III. Respiratory depression was noted in three patients in group III. One patient in group I had itching. One patient each in groups I, II, and III had nausea/vomiting.Conclusion:CEM significantly prolongs the duration of analgesia, though with a higher dose the risk of respiratory depression should always be kept in mind.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Postoperative analgesia in children: A comparison of three different doses of caudal epidural morphine

Baduni

Sanwal

Vajifdar

et al. 2016

J Anaesthesiol Clin Pharmacol

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“…Thus, there has been much interest in finding an adjuvant agent to prolong the duration and improve the quality of analgesia. Furthermore, most children in previous studies were observed for only 24 h or less after surgery; there is a need for studies with a sufficient duration of observation (3)(4)(5). Additionally, the recovery of functional activity in children having a caudal block with adjuvant agent after surgery has not been reported previously.…”

Section: Introductionmentioning

confidence: 99%

Magnesium as an adjuvant for caudal analgesia in children

Kim

Han

et al. 2014

Pediatric Anesthesia

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Summary Background There is a need for an adjuvant agent of caudal block that prolongs its duration and improves the analgesic efficacy to fasten functional recovery. Magnesium is an N‐methyl‐D‐aspartate receptor antagonist that functions as an analgesic. This study was aimed to evaluate whether magnesium as an adjuvant for caudal block in children can improve postoperative analgesia and functional recovery. Methods Eighty children, 2–6 years of age, undergoing inguinal herniorrhaphy, were included in this prospective, randomized, double‐blinded study. For caudal block, Group R received ropivacaine 1.5 mg·ml−1, 1 ml·kg−1 and Group RM received the same dose of ropivacaine mixed with 50 mg of magnesium. The Parents' Postoperative Pain Measure (PPPM) score, analgesic consumption, functional recovery, and adverse effects were evaluated at 6, 24, 48, and 72 h after surgery, as well as daily thereafter until the child showed full functional recovery. Results The PPPM score after hospital discharge was significantly lower for Group RM than for Group R at all times (P < 0.05). Children in Group RM required less fentanyl for rescue analgesia in the recovery area (16.2% vs 39.5%, P = 0.034) and less oral analgesics after discharge (20.5% vs 52.6%, P = 0.007). The time to return of normal functional activity was shorter in Group RM (P < 0.05). The incidence of adverse effects did not differ between groups. Conclusions As an adjuvant for caudal analgesia, 50 mg magnesium provided superior quality of analgesia and faster return of normal functional activity than local anesthetic alone in children.

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“…Owing to the high I 2 , a subgroup analysis was performed according to the use of epinephrine, demonstrating the RR of 0.001 between the clonidine group and other adjunct group when added without epinephrine ( p =0.003, I 2 =0). In the subgroup of adjuncts with epinephrine, there was still high heterogeneity in the two studies included, which may be the sake of LAs used, as Constant et al 8 used lidocaine plus bupivacaine, while Fernandes et al 9 used only bupivacaine.…”

Section: Resultsmentioning

confidence: 99%

Clonidine versus other adjuncts added to local anesthetics for pediatric neuraxial blocks: a systematic review and meta-analysis

Yang¹,

Yu²,

Zhang³

2018

JPR

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BackgroundClonidine is a common adjunct to local anesthetics for pediatric neuraxial block; however, the pros and cons between clonidine and other adjuncts remain unclear. Thus, we performed this meta-analysis of randomized controlled trials to assess the efficacy and adverse effects between clonidine and other adjuncts added to local anesthetics.Materials and methodsThe systematic search, data extraction, critical appraisal, and pooled analysis were performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Randomized controlled studies were searched in Cochrane (to present), Medline (1946 to present), Embase (1974 to present), and Biosis (1995 to present). Relative risks (RRs), standard mean difference (SMD), and associated CIs were calculated using RevMan statistical software to assess continuous and dichotomous data. Heterogeneity in studies was measured by forest plots and I2 values. Subgroup analysis was performed for continuous and dichotomous variables, while meta-regression was applied for continuous data with high I2 values.ResultsA total of 15 randomized controlled studies met the inclusion criteria. There was a longer duration of postoperative analgesia in the clonidine group than for other adjuncts (SMD=1.54, p=0.005, I2=96%). The number of patients requiring rescue analgesia was lower in the clonidine group without the addition of epinephrine (RR=0.55, p=0.0002, I2=0), while the RR for the comparison with epinephrine was significant (p=0.62, I2=95%). The duration of motor block was longer in the clonidine group (mean difference [MD]=1.06, p<0.00001, I2=0). The clonidine group also had a lower incidence of postoperative nausea and vomiting (PONV; RR=0.49, p<0.00001, I2=0). Postoperative bradycardia, hypotension, and urinary retention were not significantly different between clonidine and other adjuncts (p>0.05).ConclusionClonidine, compared with other adjuncts, added to local anesthetics for neuraxial block, provides a longer duration of postoperative analgesia with lower incidence of PONV. However, the duration of motor block may also be prolonged by clonidine.

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Caudal bupivacaine supplemented with morphine or clonidine, or supplemented with morphine plus clonidine in children undergoing infra-umbilical urological and genital procedures: a prospective, randomized and double-blind study

Cited by 22 publications

References 33 publications

Postoperative analgesia in children: A comparison of three different doses of caudal epidural morphine

Postoperative analgesia in children: A comparison of three different doses of caudal epidural morphine

Magnesium as an adjuvant for caudal analgesia in children

Clonidine versus other adjuncts added to local anesthetics for pediatric neuraxial blocks: a systematic review and meta-analysis

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