Evaluation of prolonged epidural chloroprocaine for postoperative analgesia in infants

Ross, Emma L.; Reiter, Pamela D.; Murphy, Michael E.; Bielsky, Alan R.

doi:10.1016/j.jclinane.2015.05.022

Cited by 14 publications

(14 citation statements)

References 21 publications

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“…However, measures outside the immediate perioperative period were more heterogeneous. Among the 10 studies 44,45,47,48,50,52‐56 reporting the application of a direct scoring and/or ranking system for pain, each used a different method with the exception of the FLACC (Face, Legs, Activity, Cry, Consolability) scale that was applied in 3 studies, one prospective, 56 one retrospective, 55 and one case study 48…”

Section: Resultsmentioning

confidence: 99%

“…Our review yielded a cumulatively larger sample size reporting timing and dosing, but results were discrepant between studies. Opioid requirements ranged from as little as three to five percent, 47 up to requiring a morphine infusion 55 . The use of non‐opioid analgesics such as acetaminophen was reported in a maximum of 94 percent of patients 54 .…”

Section: Resultsmentioning

confidence: 99%

“…The total number of cases includes all patients who underwent a neuraxial procedure, either as a single‐dose or continuous infusion. Assessments/complications (number of patients) that yielded no positive finding include the following: spinal cord injury 40 (307), persistent neurological problem 40 (307), epidural hematoma 40 (307), deep infection 40 (307), urinary retention 56 (30), unspecified respiratory complications 57 (22), allergy 55 (18), edema 55 (18), and superficial infection 50 (13). GRADE rating (+, very low; ++, low; +++, moderate; ++++, high) is represented on a per study basis or as a rounded, weighted average among relevant studies.…”

Section: Resultsmentioning

confidence: 99%

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Regional anesthesia in neonates and infants outside the immediate perioperative period: A systematic review of studies with efficacy and safety considerations

Relland

Neel

Gehred

et al. 2020

Pediatric Anesthesia

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This review examines the quality and quantity of literature regarding methods that measure efficacy in the context of reported safety of regional anesthesia techniques in preterm and term infants <1 year of age. Because the role of anesthesiologists continues to expand outside the operating room, we focused on all relevant settings with assessments that extend beyond 24 hours from the intraoperative period. All study designs were included from a search of MEDLINE, EMBASE, CINAHL, Scopus, and Cochrane databases from 1946 to the end of 2019. A total of 31 studies were included (n = 1038 participants), consisting of five randomized controlled trials and 26 observational studies. Twenty‐three studies examined neuraxial procedures, seven studies examined peripheral procedures, and one study examined both. Efficacy measures included pain assessment tools, analgesic use, and factors pertaining to the recovery of patients. Safety was assessed in multiple systems (neurological, cardiovascular, respiratory, pathological) and with vital signs and/or measures of systemic toxicity. Evidence in this review establishes that neuraxial and peripheral anesthesia treatments may be applied to neonates and infants with a high degree of safety. However, large gaps in the consistency of methods used to assess pain in these studies underline the need for rigorous prospective efficacy studies of these techniques in this population. This systematic review was registered on PROSPERO (CRD42018114466).

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Regional anesthesia in neonates and infants outside the immediate perioperative period: A systematic review of studies with efficacy and safety considerations

Relland

Neel

Gehred

et al. 2020

Pediatric Anesthesia

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show abstract

“…These studies have demonstrated effective analgesia with acceptable pain scores and limitation of postoperative opioid needs with the use of a postoperative epidural infusion with 2-chloroprocaine. 9 – 11 The reader is referred to the manuscript of Veneziano and Tobias for a full review of the use of chloroprocaine for epidural infusions in neonates, infants, and children. 9 …”

Section: Discussionmentioning

confidence: 99%

“…4 – 8 Given these concerns, there has been expanding use of 2-chloroprocaine especially for continuous postoperative epidural infusions in neonates and infants. 4 , 9 – 11 Chloroprocaine is an ester that undergoes rapid metabolism by plasma cholinesterases with a serum half-life of approximately 60 seconds. 12 …”

Section: Introductionmentioning

confidence: 99%

<p>Postoperative Analgesia in Neonates and Infants Using Epidural Chloroprocaine and Clonidine</p>

Gibbs

Kim

Heydinger

et al. 2020

JPR

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Introduction In neonates and infants, epidural analgesia has gained popularity as a means of providing postoperative analgesia, limiting opioid-related adverse effects and improving the postoperative course. In addition to a local anesthetic agent, adjunctive agents may be added to further augment analgesia. Clonidine is an α 2 -adrenergic agonist that is frequently added to single-shot caudal analgesia, but there are limited data regarding its use in a continuous epidural infusion, especially in patients ≤12 months of age. Methods We retrospectively reviewed the hospital records of neonates and infants who received postoperative epidural infusions with 2-chloroprocaine, and clonidine was identified over a 4-year period. Results The study cohort included 52 neonates and infants ranging in age from 0 to 12 months and in weight from 2.1 to 10.1 kilograms. The catheters were dosed with either 1.5% 2-chloroprocaine (n=47) or 3% 2-chloroprocaine (n=5) with clonidine (median concentration 0.2 µg/mL) infused at a median rate of 0.72 mL/kg/hour. Pain scores were uniformly ≤3 at all evaluation points during the first 72 postoperative hours with a limited need for supplemental systemic opioids. No serious adverse effects were noted. Conclusion With the recognized limitations of a retrospective study, these preliminary data demonstrate the safety of adding clonidine to an epidural infusion of 2-chloroprocaine in neonates and infants less than 12 months of age. Future studies are needed to determine its analgesic efficacy compared to 2-chloroprocaine alone and the optimal clonidine concentration for postoperative epidural infusions.

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Efficacy and Safety of Epidural Chloroprocaine for Breakthrough Pain During Labor Analgesia: A Prospective, Double-Blind, Randomized Trial

Ji,

Jiang,

Liu

et al. 2024

Pain Ther

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Introduction A significant number of women who undergo neuraxial labor analgesia experience breakthrough pain. Prompt mitigation of breakthrough pain is essential to improve maternal and fetal outcomes. We evaluated epidural chloroprocaine compared with ropivacaine in alleviating labor breakthrough pain. Methods We performed a double-blind randomized controlled clinical trial between May and July 2023. Eligible parturients received epidural analgesia with ropivacaine and sufentanil. Those with breakthrough pain were randomized to receive either 0.125% epidural ropivacaine (group R) or chloroprocaine at concentrations of 0.5% (group C1), 1.0% (group C2), or 1.5% (group C3), all in a volume of 6 mL. The primary outcome was the treatment success rate, indicated by a decrease of at least 4 points on the numerical rating scale pain score 9 min after analgesic injection. Secondary outcomes and adverse effects were also recorded. Results Out of 323 patients receiving epidural analgesia, 192 experienced breakthrough pain. After exclusion of three patients because of protocol deviation, there were 47, 48, 47, and 47 patients in group R, C1, C2, and C3, respectively. Group C3 demonstrated a higher treatment success rate (39/47, 83.0%) in managing breakthrough pain than group R (26/47, 55.3%), group C1 (12/48, 25.0%), and group C2 (30/47, 63.8%) ( p < 0.001). Group C3 had lower numerical rating scale scores at 6 and 9 min after injection and required fewer patient-controlled epidural boluses than other groups. In addition, group C3 reported greater satisfaction than the other groups ( p < 0.001). No significant differences were observed in obstetric or neonatal outcomes across these groups. Conclusion Parturients experiencing breakthrough pain could receive 1.5% epidural chloroprocaine, rather than lower chloroprocaine concentrations and ropivacaine, to achieve more rapid and better pain relief with higher patient satisfaction. Trial Registration Chinese Clinical Trial Registry, ChiCTR2300071069, http://www.chictr.org.cn/index.aspx .

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Evaluation of prolonged epidural chloroprocaine for postoperative analgesia in infants

Cited by 14 publications

References 21 publications

Regional anesthesia in neonates and infants outside the immediate perioperative period: A systematic review of studies with efficacy and safety considerations

Regional anesthesia in neonates and infants outside the immediate perioperative period: A systematic review of studies with efficacy and safety considerations

<p>Postoperative Analgesia in Neonates and Infants Using Epidural Chloroprocaine and Clonidine</p>

Efficacy and Safety of Epidural Chloroprocaine for Breakthrough Pain During Labor Analgesia: A Prospective, Double-Blind, Randomized Trial

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