Comparison of Dexmedetomidine and Fentanyl as an Adjuvant to Ropivacaine for Postoperative Epidural Analgesia in Pediatric Orthopedic Surgery

Park, Sang Jun; Shin, Seokyung; Kim, Shin Hyung; Kim, Hyun Woo; Kim, Seung Hyun; Yoon, Hae Sang; Choi, Yong Seon

doi:10.3349/ymj.2017.58.3.650

Cited by 26 publications

(23 citation statements)

References 29 publications

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“…The midazolam group was required to pump a larger dosage of hydromorphone. It indicates that dexmedetomidine may have a certain degree of analgesic effect that reduces the side effects of opioid analgesics, such as respiratory depression and other complications [17]. The incidence of respiratory depression was significantly higher in the midazolam group than in the dexmedetomidine group in our study.…”

Section: Discussionsupporting

confidence: 47%

Comparison between Dexmedetomidine and Midazolam for Sedation in Patients with Intubation after Oral and Maxillofacial Surgery

Wang

Zhang

Huang

et al. 2020

BioMed Research International

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The aim of the investigation is to clarify the beneficial sedative effects for patients with postoperative intubation in the intensive care unit (ICU) after oral and maxillofacial surgery. Forty patients with postoperative intubation were divided into two groups in method of random number table: midazolam group and dexmedetomidine group. The Ramsay score, the behavioral pain scale (BPS) score, SpO 2 , HR, MAP, and RR were recorded before sedation (T0), 30 minutes (T1), 1 hour (T2), 2 hours (T3), 6 hours (T4), and 12 hours (T5) after dexmedetomidine or midazolam initiation in intensive care unit, and 10 minutes after extubation (T6). The rate of incidences of side effects was calculated. Sedation with midazolam was as good as standard sedation with dexmedetomidine in maintaining target sedation level. The BPS score in the midazolam group was higher than that in the dexmedetomidine group. The time of tracheal catheter extraction in the dexmedetomidine group was shorter than that in the midazolam group (p ≤ 0:001). The incidence of bradycardia in the dexmedetomidine group was higher than that in the midazolam group (p = 0:028). There was no statistically significant difference in the incidence of hypotension between the two groups (p = 0:732). The incidence of respiratory depression of group midazolam was higher than that of group dexmedetomidine (p = 0:018). The incidence of delirium in the dexmedetomidine group was significantly lower than that in the midazolam group, and the difference was statistically significant (p = 0:003). Dexmedetomidine and midazolam can meet the needs for sedation in ICU patients. And dexmedetomidine can improve patients' ability to communicate pain compared with midazolam.

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Section: Discussionsupporting

confidence: 47%

Comparison between Dexmedetomidine and Midazolam for Sedation in Patients with Intubation after Oral and Maxillofacial Surgery

Wang

Zhang

Huang

et al. 2020

BioMed Research International

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“…Management of postoperative pain was assessed after ( n =number of studies): lower limb orthopaedic surgery ( n =12) and selective dorsal rhizotomy surgery ( n =6) …”

Section: Resultsmentioning

confidence: 99%

Management of pain in children and adolescents with cerebral palsy: a systematic review

Ostojic

Paget

Morrow

2018

Develop Med Child Neuro

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ABBREVIATIONS BoNT-A Intramuscular botulinum toxin-A VAS Visual analogue scale ITB Intrathecal baclofen AIM To determine the efficacy of interventions for the management of pain in children and adolescents with cerebral palsy (CP). METHOD Electronic databases were searched from the earliest date possible to April 2018 using a mixture of subject headings and free text. Inclusion criteria comprised of studies with (1) diagnosis of CP, (2) under the age of 18 years, (3) intervention for the management of pain, (4) outcome measure of pain, and (5) studies published in English-language peerreviewed journals. RESULTS Fifty-seven studies met the eligibility criteria. Pain related to (n=number of studies): hypertonia (n=17), spastic hip disease (n=13), procedures for the management of CP (n=7), postoperative (n=18), and other (n=2). Most of the studies were of level III to level V evidence.

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“… 72 DEX as an epidural adjuvant had a greater analgesic and local anesthetic-sparing effect, compared with fentanyl, in the early postoperative period in children undergoing major orthopedic lower extremity surgery. 73 The use of DEX as an adjunct to an ilioinguinal/iliohypogastric nerve block resulted in reduced pain following pediatric inguinal hernia repair in the PACU and a prolongation of the period to first supplemental analgesia demand. 74 DEX local wound infiltration 5 minutes prior to skin incision significantly reduced perioperative (including PACU) fentanyl consumption, and subsequently ensured earlier discharge from PACU and less side effects.…”

Section: Pharmacological Managementmentioning

confidence: 99%

Postoperative pain management in the postanesthesia care unit: an update

Luo

Min

2017

JPR

103

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Acute postoperative pain remains a major problem, resulting in multiple undesirable outcomes if inadequately controlled. Most surgical patients spend their immediate postoperative period in the postanesthesia care unit (PACU), where pain management, being unsatisfactory and requiring improvements, affects further recovery. Recent studies on postoperative pain management in the PACU were reviewed for the advances in assessments and treatments. More objective assessments of pain being independent of patients’ participation may be potentially appropriate in the PACU, including photoplethysmography-derived parameters, analgesia nociception index, skin conductance, and pupillometry, although further studies are needed to confirm their utilities. Multimodal analgesia with different analgesics and techniques has been widely used. With theoretical basis of preventing central sensitization, preventive analgesia is increasingly common. New opioids are being developed with minimization of adverse effects of traditional opioids. More intravenous nonopioid analgesics and adjuncts (such as dexmedetomidine and dexamethasone) are introduced for their opioid-sparing effects. Current evidence suggests that regional analgesic techniques are effective in the reduction of pain and stay in the PACU. Being available alternatives to epidural analgesia, perineural techniques and infiltrative techniques including wound infiltration, transversus abdominis plane block, local infiltration analgesia, and intraperitoneal administration have played a more important role for their effectiveness and safety.

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Comparison of Dexmedetomidine and Fentanyl as an Adjuvant to Ropivacaine for Postoperative Epidural Analgesia in Pediatric Orthopedic Surgery

Cited by 26 publications

References 29 publications

Comparison between Dexmedetomidine and Midazolam for Sedation in Patients with Intubation after Oral and Maxillofacial Surgery

Comparison between Dexmedetomidine and Midazolam for Sedation in Patients with Intubation after Oral and Maxillofacial Surgery

Management of pain in children and adolescents with cerebral palsy: a systematic review

Postoperative pain management in the postanesthesia care unit: an update

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