Effect of an Intravenous Dexamethasone Added to Caudal Local Anesthetics to Improve Postoperative Pain: A Systematic Review and Meta-analysis With Trial Sequential Analysis

Kawakami, Hiromasa; Mihara, Takahiro; Nakamura, Naoyuki; Ka, Koui; Goto, Takahisa

doi:10.1213/ane.0000000000002453

Cited by 10 publications

(12 citation statements)

References 33 publications

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“…Many published reports in different surgical fields have described the analgesic effect of steroids. [23][24][25][26][27] In the present study, patients receiving dexamethasone also reported less pain and needed less oxycodone for 5 postoperative days. A study by Clayburgh et al 28 showed that extended perioperative corticosteroid use after transoral robotic surgery for initial treatment of oropharyngeal squamous cell carcinoma decreased the length of hospital stay, although postoperative pain was minimally affected.…”

Section: Discussionsupporting

confidence: 55%

More Harm Than Benefit of Perioperative Dexamethasone on Recovery Following Reconstructive Head and Neck Cancer Surgery: A Prospective Double-Blind Randomized Trial

Kainulainen

Lassus

Suominen

et al. 2018

Journal of Oral and Maxillofacial Surgery

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Section: Discussionsupporting

confidence: 55%

More Harm Than Benefit of Perioperative Dexamethasone on Recovery Following Reconstructive Head and Neck Cancer Surgery: A Prospective Double-Blind Randomized Trial

Kainulainen

Lassus

Suominen

et al. 2018

Journal of Oral and Maxillofacial Surgery

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“…Steroids may have many perioperative effects on complications. Recent investigations including a systematic review and meta‐analysis confirmed that intravenous dexamethasone prolongs analgesia from a caudal . We assessed dexamethasone's effect, if any, on perioperative complications in part as a search for a possible cause of increased complications, ie, could the improved analgesia or altered edema be a cause for the increased complications.…”

Section: Discussionmentioning

confidence: 99%

Effect of anesthesia for hypospadias repair on perioperative complications

Splinter

Kim

et al. 2019

Pediatric Anesthesia

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Hypospadias is a common anomaly among males 1 with several variations, each with a slightly different surgical approach toward correction of the defects in the urethral fold and ventral foreskin. 1 Previous studies have demonstrated that duration of surgery and type of hypospadias repair impact surgical results. Additional complicating factors were the specific surgical technique, patient age, penile engorgement, postoperative inflammatory response, and tissue edema. [1][2][3][4][5][6][7][8] Recent publications from centers in the United States, India, and Korea report that children undergoing hypospadias repair with caudal regional anesthesia/analgesia could have increased postoperative surgical complications. [2][3][4][5] This was unexpected to many of us, AbstractBackground: Recent publications from the United States, India, and Korea report that children undergoing hypospadias repair with caudal regional anesthesia/analgesia could have increased postoperative surgical complications. Aims:The purpose of this retrospective cohort study was to assess the impact between caudal regional anesthesia, other regional anesthesia, and no regional anesthesia on complications after hypospadias repair at a tertiary care children's hospital in Ottawa, Canada, with an expectation to changing practices if a link was found. Method:We reviewed the health records of 827 children with hypospadias undergoing penile surgery from January 1991-June 2017. The final sample size for the analysis consisted of 764 patients and 825 procedures. Results:The overall complications were almost identical when considering anesthesia effects, and this similarity persisted when we assessed specifically for only surgical complications. We had 716, 94, and 15 subjects who had a caudal block, penile block, and general anesthesia only, respectively, and their complication rates were 28, 31, and 27%, respectively, and their fistula formation rates were 10, 6, and 0%, respectively, and their stricture formation rates were 8, 7, and 20%,, respectively.Hypospadias type and surgical repair technique were marked predictors of complications in the postoperative period.Conclusion: Anesthesia technique appears to have minor impact on complications after hypospadias repair, while surgical technique and type of hypospadias impact complications after hypospadias surgery in children. Based upon these results, we will not change our current practice of using a variety of regional anesthesia techniques for children undergoing hypospadias repair. K E Y W O R D Sanesthesia, caudal, complications, hypospadias repair, regional anesthesia | 761as a caudal has been routine practice of pediatric anesthesiologists for 40+ years and is strongly supported by most surgical colleagues and families.We wanted to review our results and determine if the issues and concerns noted in other centers were also occurring at Children's Hospital of Eastern Ontario, Ottawa, Canada. If so, we would need to change our routine practice to an improved, evidence-based medicine practice, ie, stop ...

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“…Several meta-analyses have compared the relative efficacy and adverse effects of various adjuvants such as alpha-2 agonists (clonidine [9] and dexmedetomidine [8]), N-methyl-D-aspartate (NMDA) agonists (ketamine [10] and magnesium [11]), opioids (fentanyl, morphine, and tramadol [12]), corticosteroids (dexamethasone [13][14]), and acetylcholine esterase inhibitors (neostigmine) [12]. However, such individual pairwise meta-analyses cannot provide all adjuvants' comparative effectiveness and relative rankings.…”

Section: Summary Of Evidencementioning

confidence: 99%

“…Various adjuvants have been shown to enhance caudal blocks with varying degrees of success. A multitude of clinical trials and meta-analyses have analyzed the efficacy of different adjuvants such as alpha-2 agonists (clonidine [9] and dexmedetomidine [8]), N-methyl-D-aspartate (NMDA) agonists (ketamine [10] and magnesium [11]), opioids (fentanyl, morphine, and tramadol [12]), corticosteroids (dexamethasone [13][14]), and acetylcholine esterase inhibitors (neostigmine) [12]. The European Society of Regional Anesthesia and Pain Therapy (ESRA) and the American Society of Regional Anesthesia and Pain Medicine (ASRA) joint committee practice advisory on pediatric regional anesthesia [3] provides specific recommendations on many adjuvants but given a plethora of recent studies; this advisory is likely already outdated.…”

Section: Introduction and Background Introductionmentioning

confidence: 99%

Analgesic Efficacy of Adjuvant Medications in the Pediatric Caudal Block for Infraumbilical Surgery: A Network Meta-Analysis of Randomized Controlled Trials

Shah¹,

Karuppiah²,

Karapetyan³

et al. 2022

Cureus

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Various adjuvants are added to local anesthetics in caudal block to improve analgesia. The comparative analgesic effectiveness and relative rankings of these adjuvants are unknown. This network meta-analysis (NMA) sought to evaluate the comparative analgesic efficacy and relative ranking of caudal adjuvants added to local anesthetics (versus local anesthetics alone) in pediatric infraumbilical surgery. We searched the United States National Library of Medicine database (MEDLINE), PubMed, and Excerpta Medica database (Embase) for randomized controlled trials (RCTs) comparing caudal adjuvants (clonidine, dexmedetomidine, ketamine, magnesium, morphine, fentanyl, tramadol, dexamethasone, and neostigmine) among themselves, or to no adjuvant (control). We performed a frequentist NMA and employed Cochrane's 'Risk of Bias' tool to evaluate study quality. We chose the duration of analgesia (defined as 'the time from caudal injection to the time of rescue analgesia') as our primary outcome. We also assessed the number of analgesic dose administrations and total dose of acetaminophen within 24 h.The duration of analgesia [87 randomized control trials (RCTs), 5285 patients] was most prolonged by neostigmine [mean difference: 513 min, (95% confidence interval, CI: 402, 625)]. Dexmedetomidine reduced the frequency of analgesic dose administrations within 24 h [29 RCTs, 1765 patients; -1.2 dose (95% CI: -1.6, -0.9)] and the total dose of acetaminophen within 24 h [18 RCTs, 1156 patients; -350 mg (95% CI: -467, -232)] the most.Among caudal adjuvants, neostigmine (moderate certainty), tramadol (low certainty), and dexmedetomidine (low certainty) prolonged the duration of analgesia the most. Dexmedetomidine also reduced the analgesic frequency and consumption more than other caudal adjuvants (moderate certainty).

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Effect of an Intravenous Dexamethasone Added to Caudal Local Anesthetics to Improve Postoperative Pain: A Systematic Review and Meta-analysis With Trial Sequential Analysis

Abstract: Intravenous dexamethasone prolongs the analgesic duration of caudal anesthesia. Trials to investigate the effectiveness of a lower dose of the dexamethasone in prolonging analgesic effects would be of interest. Further trials with a low risk of bias are necessary.

Cited by 10 publications

References 33 publications

More Harm Than Benefit of Perioperative Dexamethasone on Recovery Following Reconstructive Head and Neck Cancer Surgery: A Prospective Double-Blind Randomized Trial

More Harm Than Benefit of Perioperative Dexamethasone on Recovery Following Reconstructive Head and Neck Cancer Surgery: A Prospective Double-Blind Randomized Trial

Effect of anesthesia for hypospadias repair on perioperative complications

Analgesic Efficacy of Adjuvant Medications in the Pediatric Caudal Block for Infraumbilical Surgery: A Network Meta-Analysis of Randomized Controlled Trials

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