Effect of dexmedetomidine as an adjuvant to ropivacaine in ilioinguinal-iliohypogastric nerve blocks for inguinal hernia repair in pediatric patients: A randomized, double-blind, control trial

Karan, Daisy; Swaro, Swastika; Mahapatra, Pratik Ranjan; Banerjee, Anwesha

doi:10.4103/aer.aer_169_18

Cited by 16 publications

(4 citation statements)

References 30 publications

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“…A study of 60 children undergoing OIHR randomized to receive II block ± adjunctive dexmedetomidine found prolonged duration of analgesia, lower pain scores, and less rescue analgesic requirements during the first 24 hours postoperatively in the group receiving dexmedetomidine. 19 While this study supports the use of II block + dexmedetomidine for OIHR versus II block alone, it does not include an assessment of II block + fentanyl, as was done in our QI study.…”

Section: Discussionmentioning

confidence: 70%

“…18 RCTs on dexmedetomidine use, specifically in pediatric OIHR, are limited to its use as an adjuvant for regional techniques. 19 Based upon the BCSC T&A QI project findings, the BCSC facility expanded the use of dexmedetomidine in its protocols, minimizing intraoperative opioids for multiple pediatric ambulatory surgeries in a phased manner to track effectiveness. 18,20 In January 2019, the team replaced fentanyl with dexmedetomidine in the OIHR protocol.…”

Section: Introductionmentioning

confidence: 99%

“…18 RCTs on dexmedetomidine use, specifically in pediatric OIHR, are limited to its use as an adjuvant for regional techniques. 19…”

Section: Introductionmentioning

confidence: 99%

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An Opioid Sparing Anesthesia Protocol for Pediatric Open Inguinal Hernia Repair: A Quality Improvement Project

Chiem

Franz

Bishop

et al. 2022

Pediatric Quality &Amp; Safety

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Introduction: Using plan-do-study-act (PDSA) cycles, this quality improvement (QI) project aimed to standardize an anesthetic protocol to optimize multimodal pain management for pediatric open inguinal hernia repair (OIHR). Methods: PDSA cycle 1: in December 2017, we standardized the intraoperative OIHR anesthesia protocol by replacing transversus abdominis plane (TAP) or ilioinguinal-iliohypogastric (II) blocks and fentanyl with exclusively II blocks and fentanyl. PDSA cycle 2: in January 2019, we used an opioid sparing strategy, replacing II blocks and fentanyl with II blocks and dexmedetomidine. We used statistical process control (SPC) charts to analyze data from the medical record. Outcome measures included the percent of patients requiring rescue morphine in the postanesthesia care unit (PACU), maximum PACU pain score, PACU length of stay (LOS), and anesthesia preparation duration. Results: The team performed a total of 641 pediatric OIHRs between July 2015 and June 2021. The three groups included 203 patients in our baseline group, 127 patients in the PDSA cycle 1 group, and 311 patients in the PDSA cycle 2 group. Special cause variation (SCV) occurred for the percent of patients requiring rescue morphine, anesthesia preparation duration, and PACU LOS. The percent of patients requiring rescue morphine showed improvement. Anesthesia preparation duration improved compared to baseline. There was no SCV detected in the SPC chart for maximum PACU pain score. Conclusion: We implemented an opioid sparing anesthetic protocol for pediatric OIHR utilizing II blocks and dexmedetomidine without adversely affecting postoperative pain score or morphine rescue rate over 6 years.

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Section: Discussionmentioning

confidence: 70%

Section: Introductionmentioning

confidence: 99%

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An Opioid Sparing Anesthesia Protocol for Pediatric Open Inguinal Hernia Repair: A Quality Improvement Project

Chiem

Franz

Bishop

et al. 2022

Pediatric Quality &Amp; Safety

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“…All adjuvants have typical systemic side effects like hypotension and bradycardia and are off-label-drugs for perineural use 132 . Findings for clonidine are heterogenous while dexmedetomidine and dexamethasone prolong blocks significantly in clinical practice and dexmedetomidine didn`t show any neurotoxicity in animal models 133,134,135,136 . Neither the action nor the side effects of adjuvants can be altered using ultrasound.…”

Section: Are Adjuvants Necessary Useful and Safe In Usgra?mentioning

confidence: 99%

Ultrasound guided regional anesthesia: What we know, what we think we know, what we don't know yet: Running title USGRA: Overview about facts and questions: An educational narrative review of literature

Huppertz-Thyssen,

Nikolić

2023

Serb J Anest Inten Therapy

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The introduction of ultrasound guidance over the last two decades brought progress, new blocks and new challenges to Regional Anesthesia. This narrative review addresses and discusses facts, frequent questions, beliefs, controversies, unsolved issues, open safety questions and existing knowledge gaps related to efficacy and safety of ultrasound guided regional anesthesia (USGRA), based on the available literature. We discuss evidence-based advantages and limitations of ultrasound guidance, as well as unresolved questions, with respect to successful anesthesia, undesired side effects and patient safety, like nerve injury and local anesthetic systemic toxicity (LAST). In an educational approach we also emphasize some practical aspects of our everyday experience as well as necessary structural requirements.

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Dexmedetomidine in Enhanced Recovery After Surgery (ERAS) Protocols for Postoperative Pain

Kaye

Chernobylsky

Thakur

et al. 2020

Curr Pain Headache Rep

168

111

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Purpose of Review Effective acute pain management has evolved considerably in recent years and is a primary area of focus in attempts to defend against the opioid epidemic. Persistent postsurgical pain (PPP) has an incidence of up to 30-50% and has negative outcome of quality of life and negative burden on individuals, family, and society. The 2016 American Society of Anesthesiologists (ASA) guidelines states that enhanced recovery after surgery (ERAS) forms an integral part of Perioperative Surgical Home (PSH) and is now recommended to use a multimodal opioid-sparing approach for management of postoperative pain. As such, dexmedetomidine is now being used as part of ERAS protocols along with regional nerve blocks and other medications, to create a satisfactory postoperative outcome with reduced opioid consumption in the Post anesthesia care unit (PACU). Recent Findings Dexmedetomidine, a selective alpha 2 agonist, possesses analgesic effects and has a different mechanism of action when compared with opioids. When dexmedetomidine is initiated at the end of a procedure, it has a better hemodynamic stability and pain response than ropivacaine. Dexmedetomidine can be used as an adjuvant in epidurals with local anesthetic sparing effects. Its use during nerve blocks results in reduced postoperative pain. Also, local infiltration of IV dexmedetomidine is associated with earlier discharge from PACU. Summary Perioperative use of dexmedetomidine has significantly improved postoperative outcomes when used as part of ERAS protocols. An in-depth review of the use of dexmedetomidine in ERAS protocols is presented for clinical anesthesiologists.

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Effect of dexmedetomidine as an adjuvant to ropivacaine in ilioinguinal-iliohypogastric nerve blocks for inguinal hernia repair in pediatric patients: A randomized, double-blind, control trial

Cited by 16 publications

References 30 publications

An Opioid Sparing Anesthesia Protocol for Pediatric Open Inguinal Hernia Repair: A Quality Improvement Project

An Opioid Sparing Anesthesia Protocol for Pediatric Open Inguinal Hernia Repair: A Quality Improvement Project

Ultrasound guided regional anesthesia: What we know, what we think we know, what we don't know yet: Running title USGRA: Overview about facts and questions: An educational narrative review of literature

Dexmedetomidine in Enhanced Recovery After Surgery (ERAS) Protocols for Postoperative Pain

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