Comparison of epidural versus systemic analgesia for major surgeries in neonates and infants

Solanki, NM; Vecham, P

doi:10.4103/jcn.jcn_66_16

Cited by 7 publications

(8 citation statements)

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“…The five RCTs included in this review encompassed both neuraxial and peripheral single‐dose techniques, as well as neuraxial continuous infusions 36,38,45,56,59 . These RCTs collectively contributed 29.2% of the participants with prospective data independent of the PRAN data, which alone supplied 29.6% of patients in this review.…”

Section: Resultsmentioning

confidence: 99%

“…However, measures outside the immediate perioperative period were more heterogeneous. Among the 10 studies 44,45,47,48,50,52‐56 reporting the application of a direct scoring and/or ranking system for pain, each used a different method with the exception of the FLACC (Face, Legs, Activity, Cry, Consolability) scale that was applied in 3 studies, one prospective, 56 one retrospective, 55 and one case study 48…”

Section: Resultsmentioning

confidence: 99%

“…The total number of cases includes all patients who underwent a neuraxial procedure, either as a single‐dose or continuous infusion. Assessments/complications (number of patients) that yielded no positive finding include the following: spinal cord injury 40 (307), persistent neurological problem 40 (307), epidural hematoma 40 (307), deep infection 40 (307), urinary retention 56 (30), unspecified respiratory complications 57 (22), allergy 55 (18), edema 55 (18), and superficial infection 50 (13). GRADE rating (+, very low; ++, low; +++, moderate; ++++, high) is represented on a per study basis or as a rounded, weighted average among relevant studies.…”

Section: Resultsmentioning

confidence: 99%

“…Many of these scales have conflicting evidence with regard to their accuracy and have incomplete psychometric testing 9 . Among all the studies in this review, six different pain scales were used (CRIES, 53,60,65 OPS, 44 PAT, 45 FLACC, 48,55,56 PIPP, 55 and EDIN 59 ), with only two of them (CRIES and FLACC) used in more than one study. Altogether, there were no possible objective recommendations with regard to pain mitigation based on observable pain behaviors.…”

Section: Discussionmentioning

confidence: 99%

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Regional anesthesia in neonates and infants outside the immediate perioperative period: A systematic review of studies with efficacy and safety considerations

Relland

Neel

Gehred

et al. 2020

Pediatric Anesthesia

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This review examines the quality and quantity of literature regarding methods that measure efficacy in the context of reported safety of regional anesthesia techniques in preterm and term infants <1 year of age. Because the role of anesthesiologists continues to expand outside the operating room, we focused on all relevant settings with assessments that extend beyond 24 hours from the intraoperative period. All study designs were included from a search of MEDLINE, EMBASE, CINAHL, Scopus, and Cochrane databases from 1946 to the end of 2019. A total of 31 studies were included (n = 1038 participants), consisting of five randomized controlled trials and 26 observational studies. Twenty‐three studies examined neuraxial procedures, seven studies examined peripheral procedures, and one study examined both. Efficacy measures included pain assessment tools, analgesic use, and factors pertaining to the recovery of patients. Safety was assessed in multiple systems (neurological, cardiovascular, respiratory, pathological) and with vital signs and/or measures of systemic toxicity. Evidence in this review establishes that neuraxial and peripheral anesthesia treatments may be applied to neonates and infants with a high degree of safety. However, large gaps in the consistency of methods used to assess pain in these studies underline the need for rigorous prospective efficacy studies of these techniques in this population. This systematic review was registered on PROSPERO (CRD42018114466).

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Regional anesthesia in neonates and infants outside the immediate perioperative period: A systematic review of studies with efficacy and safety considerations

Relland

Neel

Gehred

et al. 2020

Pediatric Anesthesia

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show abstract

“…The sample size was approved to be sufficient by the department of Statistics, Medical Research Institute, Alexandria University, Egypt [11].…”

Section: Methodsmentioning

confidence: 99%

Ultrasound guided continuous caudal epidural analgesia in neonates undergoing thoracotomy

Rabie

Ghoneim²

2021

Egyptian Journal of Anaesthesia

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Background and Aims: Adequate postoperative analgesia guarantees adequate ventilation and minimizes respiratory complications after thoracotomy. This study compares postoperative outcomes of continuous caudal epidural blockade to systemic intravenous analgesia in neonates undergoing thoracotomy for trachea-esophageal fistula (TOF) repair. Methods: A randomized, single-center, prospective, controlled study was conducted at El-Shatby University Hospital, from August 2016 to September 2020 where 40 neonates, weighing 2.5-4 kg belonging to the ASA physical Grade II to IV, posted for a TOF repair via thoracotomy. After general anesthesia, in group A, the epidural catheter was inserted through standard caudal epidural technique. Initial bolus of 0.25% bupivacaine (0.2 ml/kg) and postoperatively continuous infusion of 0.125% bupivacaine (0.1 ml/kg/h) was given. In group B, they received fentanyl (2 μg/kg) and paracetamol (10 mg/kg) IV Intraoperatively and postoperatively paracetamol (10 mg/kg/6 h) intravenously. Results: In group A, good quality of analgesia for 48 h postoperative with a lesser doses of rescue opioids (1 µg/kg fentanyl) required to maintain adequate analgesia, which shortened the length of hospital stay compared to group B. Conclusion: Very efficient postoperative analgesia can be achieved via continuous caudally inserted epidural blockade compared to intravenous fentanyl in neonatal post-thoracotomy pain.

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Guidelines for Opioid Prescribing in Children and Adolescents After Surgery

et al. 2021

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IMPORTANCEOpioids are frequently prescribed to children and adolescents after surgery. Prescription opioid misuse is associated with high-risk behavior in youth. Evidence-based guidelines for opioid prescribing practices in children are lacking.OBJECTIVE To assemble a multidisciplinary team of health care experts and leaders in opioid stewardship, review current literature regarding opioid use and risks unique to pediatric populations, and develop a broad framework for evidence-based opioid prescribing guidelines for children who require surgery.EVIDENCE REVIEW Reviews of relevant literature were performed including all English-language articles published from January 1, 1988, to February 28, 2019, found via searches of the PubMed (MEDLINE), CINAHL, Embase, and Cochrane databases. Pediatric was defined as children younger than 18 years. Animal and experimental studies, case reports, review articles, and editorials were excluded. Selected articles were graded using tools from the Oxford Centre for Evidence-based Medicine 2011 levels of evidence. The Appraisal of Guidelines for Research & Evaluation (AGREE) II instrument was applied throughout guideline creation. Consensus was determined using a modified Delphi technique.FINDINGS Overall, 14 574 articles were screened for inclusion, with 217 unique articles included for qualitative synthesis. Twenty guideline statements were generated from a 2-day in-person meeting and subsequently reviewed, edited, and endorsed externally by pediatric surgical specialists, the American Pediatric Surgery Association Board of Governors, the American Academy of Pediatrics Section on Surgery Executive Committee, and the American College of Surgeons Board of Regents. Review of the literature and guideline statements underscored 3 primary themes: (1) health care professionals caring for children who require surgery must recognize the risks of opioid misuse associated with prescription opioids, (2) nonopioid analgesic use should be optimized in the perioperative period, and (3) patient and family education regarding perioperative pain management and safe opioid use practices must occur both before and after surgery.CONCLUSIONS AND RELEVANCE These are the first opioid-prescribing guidelines to address the unique needs of children who require surgery. Health care professionals caring for children and adolescents in the perioperative period should optimize pain management and minimize risks associated with opioid use by engaging patients and families in opioid stewardship efforts.

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Comparison of epidural versus systemic analgesia for major surgeries in neonates and infants

Cited by 7 publications

References 0 publications

Regional anesthesia in neonates and infants outside the immediate perioperative period: A systematic review of studies with efficacy and safety considerations

Regional anesthesia in neonates and infants outside the immediate perioperative period: A systematic review of studies with efficacy and safety considerations

Ultrasound guided continuous caudal epidural analgesia in neonates undergoing thoracotomy

Guidelines for Opioid Prescribing in Children and Adolescents After Surgery

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