Regional anesthesia to ameliorate postoperative analgesia outcomes in pediatric surgical patients: an updated systematic review of randomized controlled trials

Abstract

Regional anesthesia is becoming increasingly popular among anesthesiologists in the management of postoperative analgesia following pediatric surgery. The main objective of this review was to systematically evaluate the last 5 years of randomized controlled trials on the role of regional anesthesia techniques in alleviating postoperative pain associated with various pediatric surgical procedures. Forty studies on 2,408 pediatric patients were evaluated. The majority of the articles published from 2013 to 2017 reported that the use of regional anesthesia minimized postoperative pain and reduced opioid consumption. Only a few surgical procedures (cholecystectomy, inguinal hernia repair, and non-laparoscopic major abdominal surgery) reported no significant difference in the postoperative pain relief compared with the standard anesthetic management. The growing number of randomized controlled trials in the pediatric literature is very promising; however, additional confirmation is needed to reinforce the use of specific regional anesthesia techniques to provide optimal postoperative pain relief for a few surgical procedures (reconstructive ear surgery, chest wall deformity, hypospadias, umbilical hernia, cleft palate repair) in pediatric patients. More randomized controlled trials are needed to establish regional anesthesia as an essential component of postoperative analgesia management in children.

Quadratus lumborum block in pediatric patients - a case series

“…Until few years ago, caudal block, TAP block, and ilioinguinal/iliohypogastric block were the most often used analgesic techniques for low abdominal surgery (inguinal hernia repair, and orchidopexy) in pediatric patients. Caudal block provides postoperative analgesia as good as TAP block, and both of them provide better analgesia than ilioinguinal/iliohypogastric block according to prospective randomized single-blinded study by Sahin et al [22] Kendall et al reached the same conclusion in their systematic review of 40 randomized controlled trials in 2018 [21]. Therefore, recently published data suggest that QLB provides significantly more effective, and longer lasting analgesia than caudal block in pediatric patients undergoing inguinal hernia repair, orchidopexy, and ureteral reimplantation [10,12,16].…”

“…Regional analgesia techniques reduce opioid consumption during general anesthesia perioperatively, and provide better postoperative pain control compared to pain control provided by either general anesthesia alone or general anesthesia plus local anesthetic wound infiltration [13,14,21]. Until few years ago, caudal block, TAP block, and ilioinguinal/iliohypogastric block were the most often used analgesic techniques for low abdominal surgery (inguinal hernia repair, and orchidopexy) in pediatric patients.…”

Ultrasound-guided suprazygomatic maxillary nerve block in cleft palate surgery: The efficacy of adding dexmedetomidine to bupivacaine

“…Pediatric regional anesthesia is being used increasingly as a part of the anesthetic approach combined with general anesthesia to decrease the intraoperative anesthetic requirement with rapid recovery; at the same time, provides postoperative analgesia [17].…”

Clinical Progress Note: Perioperative Pain Control in Hospitalized Pediatric Patients

“…A systematic review of randomized controlled trials demonstrated that regional anesthesia decreased opioid consumption and minimized postoperative pain with no significant complications attributed to its use. 13 Additional studies are needed to better delineate specific surgical procedures and subpopulations of pediatric patients in which regional anesthesia may provide the most benefit. Abbreviations: IV, intravenous; LA, local anesthetic; PCA, patient-controlled analgesia; PO, oral; PR, rectal.…”