Efficacy of caudal vs intravenous administration of α₂ adrenoceptor agonists to prolong analgesia in pediatric caudal block: A systematic review and meta‐analysis

Abstract

Background: α 2 adrenoceptor agonists have been proposed as adjuncts to prolong analgesia in pediatric caudal block. The aim of this meta-analysis was to compare the analgesic efficacy of caudal vs intravenous α 2 adrenoceptor agonists during pediatric caudal block. Methods: A systematic search, data extraction, bias risk assessment, and pooled data analysis were performed following the PRISMA guidelines. All randomized controlled trials comparing caudal with intravenous α 2 adrenoceptor agonists in pediatric caudal block were included. Relative risk and weighted mean differences (the corresponding 95% confidence intervals) were calculated for dichotomous and continuous data, respectively. Trial sequential analyses were performed to evaluate the credibility of the meta-analysis. Results: A total of 244 patients in five trials were identified. Compared with the intravenous group (9.56 ± 4.23 hours), the time to the first rescue analgesia was prolonged in the caudal α 2 adrenoceptor agonists group (12.72 ± 5.99 hours) by a weighted mean difference of 2.98 hours [95% confidence interval: 0.59-5.36 hours; P = .01]. The number of children requiring rescue analgesia in the caudal group (64, 66.67%) was lower than that in the intravenous group (80, 81.63%) [relative risk = 0.82; 95% confidence interval: 0.69-0.97; P = .02]. These findings were also verified by trial sequential analysis. There were no significant differences in the side effects. Conclusion: Caudal α 2 adrenoceptor agonists as adjuncts to local anesthetic during pediatric caudal block are more effective than intravenous injection. However, the results were affected by small sample size and significant heterogeneity. K E Y W O R D S analgesia, caudal block, meta-analysis, postoperative pain, α 2 adrenoceptor agonists 1 | INTRODUC TI ON Caudal anesthesia is a popular perioperative analgesia method in pediatric surgery. 1,2 However, its duration action time is short (only 4-8 hours), 3 increasing the concentration 4 or dosage 5 of the local anesthetic can prolong the duration of caudal block and also increase the incidence of side effects given the narrow therapeutic window in children. 6 Many adjuvants, such as opioids, 7,8 ketamine, 8,9 and dexamethasone, 10,11 have been applied to prolong the effective duration of local anesthetics. α 2 adrenergic agonists also have

The Outcomes of Caudal or Intravenous Addition of Morphine and Clonidine into The Caudal Block Performed with Levobupivacaine In Children; A Retrospective Study

“…Caudal epidural block application is a reliable technique widely used in pediatric surgery, especially in sub umbilical and genitourinary operations, and is routinely applied in many clinical centers (6,7,9,10,11,13,14). In studies performed using caudal morphine and clonidine in different doses in children, the results show variability (13,15,16).…”

“…Almost 4-6 hours of postoperative analgesia is provided with local anesthetics (LA) through caudal block. Furthermore, additional drugs such as clonidine, ketamine, morphine, and dexmedetomidine are added to intraspinal LAs to reduce the adverse effects of LAs such as toxicity and motor block and extend the postoperative analgesia period (8)(9)(10)(11)(12). However, although various additives with LAs increase analgesia, there are also risks of itching, nausea, vomiting, and respiratory depression (13).…”

A Randomized Controlled Trial on the Effectiveness of Tramadol as an Adjunct to Bupivacaine for Caudal Analgesia in Children

“…The subjects with insufficient analgesia cannot take deep breaths, they have an ineffective cough, which results in numerous pulmonary complications postoperatively 15 . In this way, by reducing nociceptive stimuli to the CNS and preserving analgesia perioperatively, the surgical stress responsecan be prevented, facilitating early recovery and reducing complications [16][17] . Regional anesthesia methods have been cast-off successfully for acute pain treatment following various operations.…”