Comparison of fentanyl–bupivacaine or midazolam–bupivacaine mixtures with plain bupivacaine for caudal anaesthesia in children

Barış, Sibel; Karakaya, Deniz; Kelsaka, Ebru; Güldoğuş, Fuat; Arıtürk, Ender; Tür, Ayla

doi:10.1046/j.1460-9592.2003.00979.x

Cited by 30 publications

(23 citation statements)

References 21 publications

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“…Wu et al have also reported that using dexmedetomidine as an adjuvant for inducing neuroaxial anesthesia can cause bradycardia without profound hypotension (34). However, in agreement with our present findings, a number of other studies (21, 24) have also reported that postoperative vomiting and nausea were not observed.…”

Section: Discussionsupporting

confidence: 94%

“…In agreement with our findings, a number of other studies have shown that administering dexmedetomidine with bupivacaine has better analgesic and sedative effects than administering bupivacaine alone (21-23), and one study has also shown that administering fentanyl with bupivacaine has better analgesic and sedative effects than bupivacaine alone (24). …”

Section: Discussionsupporting

confidence: 93%

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Treatment of Postoperative Pain in Pediatric Operations: Comparing the Efficiency of Bupivacaine, Bupivacaine-Dexmedetomidine and Bupivacaine-Fentanyl for Caudal Block

2016

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BackgroundCaudal analgesia is a common method for postoperative pain management in pediatric patients. Additive agents such as opioids and α2 agonists have been used to enhance the analgesic effects of local anesthetics for caudal block.ObjectivesThe aim of this study was to compare the additive effects of dexmedetomidine and fentanyl on bupivacaine-induced caudal analgesia in pediatric patients who had undergone elective inguinal hernia repair.MethodsThis randomized, double-blind clinical trial included children aged 1 - 5 years who were divided into three groups: the bupivacaine group (Group B) received 0.25% bupivacaine (1 ml/kg), the bupivacaine-dexmedetomidine group (Group BD) received 0.25% bupivacaine (1 mL/kg) plus 2 µg/kg dexmedetomidine, and the bupivacaine-fentanyl group (Group BF) received 0.25% bupivacaine (1 mL/kg) plus 2 µg/kg fentanyl. The hemodynamic variables (heart rate, systolic blood pressure, respiratory rate, and peripheral arterial oxygen saturation) were measured perioperatively. Pain, sedation and motor block scores and adverse events (nausea and vomiting, pruritis, hypotension, bradycardia, urinary retention and respiratory depression) were documented at 30 and 60 minutes, and the 1st, 2nd, 4th, 6th, 12th and 24th hours after the operation. The other recordings include the duration of surgery and analgesic requirement.ResultsA total of 61 patients were analyzed. The lowest pain scores were found in the BD group at all time points (P < 0.001). The sedation scores were higher in the BD group than in the other two groups at all time points (P < 0.001). No motor block was observed after the operation. Only three patients required analgesic administration 2 to 6 hours after the operation in group B. No side effects were observed in any of the groups, and there was no significant difference in the duration of surgery among the three groups.ConclusionsThe results show that the analgesic and sedative effects were better when dexmedetomidine was added to bupivacaine than when fentanyl was added or bupivacaine alone was administered in the pediatric population studied here that underwent elective inguinal hernia repair.

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Section: Discussionsupporting

confidence: 94%

Section: Discussionsupporting

confidence: 93%

Treatment of Postoperative Pain in Pediatric Operations: Comparing the Efficiency of Bupivacaine, Bupivacaine-Dexmedetomidine and Bupivacaine-Fentanyl for Caudal Block

2016

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“…They attributed this neurotoxicity to low pH. Caudal epidural midazolam with pH 6.0-7.4 is safe in children [9,31]. The concentration of midazolam used in our study was 0.001% and the pH of the solution was 6.0 in Group B and 5.9 in Group BM.…”

Section: Discussionmentioning

confidence: 58%

Addition of midazolam to continuous postoperative epidural bupivacaine infusion reduces requirement for rescue analgesia in children undergoing upper abdominal and flank surgery

Ghai¹,

Makkar²,

Chari³

et al. 2009

Journal of Clinical Anesthesia

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“…When added to local anesthetic solutions, midazolam can also prolong the duration of analgesia. Unfortunately, this effect has not been consistently demonstrated [44]. Similar to ketamine, the safety of midazolam for neuraxial use has not been established and a preservativefree formulation is not universally available [18].…”

Section: Additives and Non-local Anesthetic Drugsmentioning

confidence: 99%

Caudal analgesia and anesthesia techniques in children

Tsui

Berde

2005

Current Opinion in Anaesthesiology

143

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The addition of ketamine or clonidine to a caudal local anesthetic prolong the duration of the block. However, a preservative-free preparation of ketamine that is suitable for neuraxial use is not widely available. Ultrasound imaging and electrical stimulation are promising options to accurately position a caudal needle. However, because ultrasound imaging is more difficult in older children, nerve stimulation is a more-suitable technique to accurately guide caudal catheters in this patient population. Although complications associated with caudal block are rare, the risks and benefits must be carefully considered on an individual basis.

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Comparison of fentanyl–bupivacaine or midazolam–bupivacaine mixtures with plain bupivacaine for caudal anaesthesia in children

Abstract: Caudal block with 0.75 ml.kg(-1) 0.25% bupivacaine and 50 microg.kg(-1) midazolam or 1 microg.kg(-1) fentanyl provides no further analgesic advantages to bupivacaine alone when administered immediately after induction of anaesthesia in children undergoing unilateral inguinal herniorrhaphy.

Cited by 30 publications

References 21 publications

Treatment of Postoperative Pain in Pediatric Operations: Comparing the Efficiency of Bupivacaine, Bupivacaine-Dexmedetomidine and Bupivacaine-Fentanyl for Caudal Block

Treatment of Postoperative Pain in Pediatric Operations: Comparing the Efficiency of Bupivacaine, Bupivacaine-Dexmedetomidine and Bupivacaine-Fentanyl for Caudal Block

Addition of midazolam to continuous postoperative epidural bupivacaine infusion reduces requirement for rescue analgesia in children undergoing upper abdominal and flank surgery

Caudal analgesia and anesthesia techniques in children

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