Efficacy of a low‐dose spinal morphine with bupivacaine for postoperative analgesia in children undergoing hypospadias repair

Apilioğulları, Seza; Duman, Ateş; Gök, Funda; Akillioglu, Isak; Çiftçi, İlhan

doi:10.1111/j.1460-9592.2009.03136.x

Cited by 9 publications

(13 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Epidural morphine (12–50mcg/kg) improves analgesia 90–92 , and although early systemic absorption was detected, analgesia was evident 1 and 3 hours later when plasma levels were lower than required for a systemic analgesic effect 88 . Lower doses (2–5μg/kg) are effective intrathecally 93–95 . The degree of dose sparing depends on the chemical properties of the drug, and for more lipophilic opioids such as fentanyl, the difference between equi-effective intrathecal, epidural and systemic doses may be less 96 .…”

Section: Clinical Choice Of a Spinal Analgesic: Efficacymentioning

confidence: 99%

Neuraxial Analgesia in Neonates and Infants

Walker

Yaksh

2012

Anesthesia &Amp; Analgesia

View full text Add to dashboard Cite

Neuraxial agents provide robust pain control, have the potential to improve outcomes, and are an important component of the perioperative care of children. Opioids or clonidine improve analgesia when added to perioperative epidural infusions; analgesia is significantly prolonged by addition of clonidine, ketamine, neostigmine or tramadol to single shot caudal injections of local anesthetic; and neonatal intrathecal anesthesia/analgesia is increasing in some centers. However, it is difficult to determine the relative risk-benefit of different techniques and drugs without detailed and sensitive data related to analgesia requirements, side-effects, and follow-up. Current data related to benefits and complications in neonates and infants are summarized, but variability in current neuraxial drug use reflects the relative lack of high quality evidence. Recent preclinical reports of adverse effects of general anesthetics on the developing brain have increased awareness of the potential benefit of neuraxial anesthesia/analgesia to avoid or reduce general anesthetic dose requirements. However, the developing spinal cord is also vulnerable to drug-related toxicity, and although there are well-established preclinical models and criteria for assessing spinal cord toxicity in adult animals, until recently there had been no systematic evaluation during early life. Therefore, the second half of this review presents preclinical data evaluating age-dependent changes in the pharmacodynamic response to different spinal analgesics, and recent studies evaluating spinal toxicity in specific developmental models. Finally, we advocate use of neuraxial agents with the widest demonstrable safety margin and suggest minimum standards for preclinical evaluation prior to adoption of new analgesics or preparations into routine clinical practice.

show abstract

Section: Clinical Choice Of a Spinal Analgesic: Efficacymentioning

confidence: 99%

Neuraxial Analgesia in Neonates and Infants

Walker

Yaksh

2012

Anesthesia &Amp; Analgesia

View full text Add to dashboard Cite

show abstract

“…[2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] Kliniğimizde son on yıldır pediatrik olgularda spinal anestezi yöntemi giderek artan bir sıklıkta uygulanmakla beraber özellikle nö-romusküler hastalığı olan uygun pediatrik hastalarda ilk tercih edilen anestezi yöntemi olarak uygulanmaktadır. [2][3][4] Spinal anestezi uygulamasının pediatrik hastalarda tecrübeli ellerde genel anesteziye alternatif olarak güvenle kullanılabileceği çok sayıda yayında gösterilmiştir.…”

Section: Discussionunclassified

“…[2][3][4] Spinal anestezi uygulamasının pediatrik hastalarda tecrübeli ellerde genel anesteziye alternatif olarak güvenle kullanılabileceği çok sayıda yayında gösterilmiştir. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] Pediatrik hasta grubunda erişkinlerden farklı olarak spinal anestezi uygulamalarının çoğu zaman sedasyon eşliğinde yapılması gerekmektedir. Sedasyon ile istemli ve istemsiz motor hareketler kontrol altına alınarak işlem esnasında uygulayıcı ve hasta konforu artırıldığı gibi aynı zamanda işlem güvenliği de artmaktadır.…”

Section: Discussionunclassified

See 1 more Smart Citation

Application of spinal anesthesia in a pediatric patient with Duchenne’s muscular dystrophy

Özmete

Şener

Caliskan

et al. 2016

Agri

View full text Add to dashboard Cite

SummaryDuchenne's muscular dystrophy (DMD) is a neuromuscular disease with a progressive course. It is the most common and most severe muscular dystrophic disorder for which the application of anesthesia is critical, due to muscle weakness, and cardiac and pulmonary involvement. Successful application of spinal anesthesia in a 2-year-old boy with DMD undergoing bilateral inguinal hernia repair is described in the present report. It is proposed that spinal anesthesia is an effective alternative to general anesthesia in certain pediatric patients, including those with DMD, for whom general anesthesia poses increased risk.

show abstract

“…Currently, bupivacaine as a local anaesthetic and morphine to relieve pain are widely used in combination to provide effective postoperative analgesia. [4][5][6][7][8][9][10] However, the efficacy and safety of this combination for patients undergoing knee arthroscopic surgery remains controversial. Some studies found that IA bupivacaine plus morphine provided effective pain relief for patients, [11][12][13][14][15][16][17][18][19] while others did not.…”

Section: Introductionmentioning

confidence: 99%

Single-dose intra-articular bupivacaine plus morphine after knee arthroscopic surgery: a meta-analysis of randomised placebo-controlled studies

et al. 2015

View full text Add to dashboard Cite

ObjectivesTo evaluate the efficacy and safety of single-dose intra-articular bupivacaine plus morphine after knee arthroscopic surgery.DesignMeta-analysis.Data sources and study eligibility criteriaA comprehensive literature search, using Medline (1966–2014), the Cochrane Central Register of Controlled Trials and Embase databases, was conducted to identify randomised placebo-controlled trials that used a combination of single-dose intra-articular bupivacaine and morphine for postoperative pain relief.Results12 articles were included in this meta-analysis. The mean visual analogue scale (VAS) scores of the bupivacaine plus morphine group were significantly lower than those of the placebo group (weighted mean difference (WMD) −1.75; 95% CI −2.16 to −1.33; p<0.001). The VAS scores at the last follow-up time point (last VAS scores) of the bupivacaine plus morphine group were also significantly lower than those of the placebo group (WMD −1.46; 95% CI −1.63 to −1.29; p<0.001). The number of patients requiring supplementary analgesia was also significantly reduced (RR 0.60; 95% CI 0.39 to 0.93; p=0.02), while there was no significant difference in the time to first analgesic request (WMD 3.46; 95% CI −1.81 to 8.72; p=0.20) or short-term side effects (RR 1.67; 95% CI 0.65 to 4.26; p=0.29).ConclusionsThe administration of single-dose intra-articular bupivacaine plus morphine after knee arthroscopic surgery is effective for pain relief, and its short-term side effects remain similar to saline placebo.

show abstract

Efficacy of a low‐dose spinal morphine with bupivacaine for postoperative analgesia in children undergoing hypospadias repair

Abstract: Spinal anesthesia provided by hyperbaric bupivacaine is adequate for distal hypospadias repair in children, but adding 2 microg x kg(-1) intrathecal morphine provides better postoperative pain control when compared to placebo in these children.

Cited by 9 publications

References 25 publications

Neuraxial Analgesia in Neonates and Infants

Neuraxial Analgesia in Neonates and Infants

Application of spinal anesthesia in a pediatric patient with Duchenne’s muscular dystrophy

Single-dose intra-articular bupivacaine plus morphine after knee arthroscopic surgery: a meta-analysis of randomised placebo-controlled studies

Contact Info

Product

Resources

About