Effect of caudal ketamine on minimum local anesthetic concentration of ropivacaine in children: a prospective randomized trial

Wang, Huaizhen; Ly, Wang; Liang, Huihong; Fan, Yan-Ting; Song, Xingrong; She, Ying-Jun

doi:10.1186/s12871-020-01058-y

Cited by 7 publications

(4 citation statements)

References 25 publications

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“…However, its effect on the quality of block is conflicting, ranging from incomplete motor block [66] to enhanced segmental spread [67]. The addition of ketamine to paediatric caudal epidurals prolongs postoperative analgesia with lidocaine [68], bupivacaine [69] and ropivacaine [70,71]. Ketamine facilitates intrathecal local anaesthetic sparing but its application may be limited by adverse central effects such as sedation, dizziness, nystagmus, dysphoria and nausea [72].…”

Section: Anaesthetic Adjunctsmentioning

confidence: 99%

Pharmacological and clinical implications of local anaesthetic mixtures: a narrative review

Nestor

Sepúlveda

et al. 2021

Anaesthesia

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Summary Various techniques have been explored to prolong the duration and improve the efficacy of local anaesthetic nerve blocks. Some of these involve mixing local anaesthetics or adding adjuncts. We did a literature review of studies published between 01 May 2011 and 01 May 2021 that studied specific combinations of local anaesthetics and adjuncts. The rationale behind mixing long‐ and short‐acting local anaesthetics to hasten onset and extend duration is flawed on pharmacokinetic principles. Most local anaesthetic adjuncts are not licensed for use in this manner and the consequences of untested admixtures and adjuncts range from making the solution ineffective to potential harm. Pharmaceutical compatibility needs to be established before administration. The compatibility of drugs from the same class cannot be inferred and each admixture requires individual review. Precipitation on mixing (steroids, non‐steroidal anti‐inflammatory drugs) and subsequent embolisation can lead to serious adverse events, although these are rare. The additive itself or its preservative can have neurotoxic (adrenaline, midazolam) and/or chondrotoxic properties (non‐steroidal anti‐inflammatory drugs). The prolongation of block may occur at the expense of motor block quality (ketamine) or block onset (magnesium). Adverse effects for some adjuncts appear to be dose‐dependent and recommendations concerning optimal dosing are lacking. An important confounding factor is whether studies used systemic administration of the adjunct as a control to accurately identify an additional benefit of perineural administration. The challenge of how best to prolong block duration while minimising adverse events remains a topic of interest with further research required.

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Section: Anaesthetic Adjunctsmentioning

confidence: 99%

Pharmacological and clinical implications of local anaesthetic mixtures: a narrative review

Nestor

Sepúlveda

et al. 2021

Anaesthesia

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“…It has been shown that the use of ketamine in the caudal block resulted in prolonged analgesia and reduced postoperative analgesic demand, but that the minimum local anesthetic concentration (MLAC) of ropivacaine is necessary for intraoperative pain control does not change [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Review of clinical evidence of caudal block for postoperative analgesia in children with ketamine added local anesthetics

Endeshaw

Aligaz

Molla

et al. 2022

Annals of Medicine &Amp; Surgery

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“…Later, the direct action of ketamine on sodium channels at peripheral nerve terminals was theorised [248]. Although ketamine does not play a significant role in pain management, the idea of using ketamine to induce local anaesthesia is intriguing and deserves further investigation [249][250][251][252].…”

Section: − Ketamine As a Local Anaestheticmentioning

confidence: 99%

Narrative Review: Low-Dose Ketamine for Pain Management

Riccardi¹,

Guarino

Serra

et al. 2023

JCM

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Pain is the leading cause of medical consultations and occurs in 50–70% of emergency department visits. To date, several drugs have been used to manage pain. The clinical use of ketamine began in the 1960s and it immediately emerged as a manageable and safe drug for sedation and anesthesia. The analgesic properties of this drug were first reported shortly after its use; however, its psychomimetic effects have limited its use in emergency departments. Owing to the misuse and abuse of opioids in some countries worldwide, ketamine has become a versatile tool for sedation and analgesia. In this narrative review, ketamine’s role as an analgesic is discussed, with both known and new applications in various contexts (acute, chronic, and neuropathic pain), along with its strengths and weaknesses, especially in terms of psychomimetic, cardiovascular, and hepatic effects. Moreover, new scientific evidence has been reviewed on the use of additional drugs with ketamine, such as magnesium infusion for improving analgesia and clonidine for treating psychomimetic symptoms. Finally, this narrative review was refined by the experience of the Pain Group of the Italian Society of Emergency Medicine (SIMEU) in treating acute and chronic pain with acute manifestations in Italian Emergency Departments.

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Effect of caudal ketamine on minimum local anesthetic concentration of ropivacaine in children: a prospective randomized trial

Cited by 7 publications

References 25 publications

Pharmacological and clinical implications of local anaesthetic mixtures: a narrative review

Pharmacological and clinical implications of local anaesthetic mixtures: a narrative review

Review of clinical evidence of caudal block for postoperative analgesia in children with ketamine added local anesthetics

Narrative Review: Low-Dose Ketamine for Pain Management

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