Analgesia In Children Research Articles

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

Introduction: The purpose of analgesia in postoperative period is to minimize pain with the fewest probable side effects and to obtain the highest possible cost-effectiveness in our environment. In children, caudal anesthesia is often given in combination with general anesthesia for postoperative and intraoperative anesthesia. To extend the length of anesthesia; adjuvants can be further added to local anaesthetics. This research was performed to determine the caudal bupivacaine anesthesia duration given in combination with tramadol. Study Design: A prospective, comparative, randomized, double-blinded study Place and duration: In the department of Anesthesia, Khyber Teaching Hospital, Peshawar for one-year duration from 21st January 2021 to 20th January 2022. METHODS: 80 patients, 3-8 years of age, enduring elective urological, lower limb and lower abdominal surgery. Patients were randomised in to group A (n = 40) given 0.25% bupivacaine 1 ml / kg and group B (n = 40) receiving bupivacaine 0.25% in dose of 1 ml / kg plus 1 mg / kg tramadol. The hemodynamic responses, side effects and analgesia total duration were observed and analyzed. Results: The patients were comparable in groups A and B in terms of hemodynamic response and demographics and were not significant statistically (p greater than 0.05). It was detected that the analgesia mean time was longer significantly in B group (464.2 ± 167.1 minutes vs 238.1 ± 71.5 minutes, P <0.001). The postoperative vomiting was perceived in two cases, one in each group. Conclusions: One mg / kg Tramadol adjuvant to 0.25% bupivacaine for caudal anesthesia in children effectively lengthens the analgesia duration deprived of increasing side effects. Keywords: bupivacaine; tramadol and caudal analgesia.

Ultrasound-guided erector spinae plane block in patients undergoing pediatric abdominal surgery: a randomized study

BackgroundErector spinae plane block (ESPB) can provide effective analgesia in pediatric abdominal surgery. Additionally, when used as an analgesic method in abdominal surgery, ESPB may increase regional intra-abdominal tissue oxygen saturation (rSO2) throughout the operation. However, the number of related studies conducted on pediatric patients is insufficient.ResultsFifty-two patients undergoing lower abdominal surgery were allocated into two groups, the ESPB (E) and the control (C). Group E received general anesthesia plus unilateral ultrasound-guided ESPB, and group C received general anesthesia alone. Intraoperative fentanyl consumption, Face, Legs, Activity, Cry, Consolability (FLACC) score, time to first rescue analgesia and adverse events were recorded over the first 24 h postoperatively. The rSO2 level was evaluated in both groups throughout the operation. The FLACC score was significantly lower in group E than in group C (p<0.05). Four patients in group E required intraoperative fentanyl compared to 12 patients in group C (p<0.05). The first rescue analgesic administration time was significantly longer in group E than in group C (p<0.05). No significant difference in rSO2 values was detected between the groups (p>0.05). However, in group E, rSO2 values were significantly increased after the block compared to the postinduction values.ConclusionsESPB provides effective perioperative analgesia in children undergoing low abdominal surgery. Although there was no significant difference in rSO2 values between the groups, ESPB administration consistently increases rSO2 over time.Trial registrationThe trial was registered at ClinicalTrials.gov before patient enrolment (NCT03808129-13.12.2018).

Comparison between Caudal and TAP Blocks Post-Inguinal Surgery Analgesia in Children

Background: The optimal and lonely method to achieve typical analgesia post-inguinal surgeries in children is still not determined. This study compared the analgesic efficacy and adverse effects between caudal analgesia and TAP (Transversus Abdominis Plane) block. Methods: 40 children (male) between 3-9 years old, with parental consent and institutional board approval, undergoing elective inguinal hernia repair surgery, randomly divided in two groups were enrolled in this study. Both groups received induction on Sevoflurane, Fentanyl, Propofol and Atracurium (dose dependent), with laryngeal mask airway and mechanical ventilated, maintenance on Sevoflurane and smoothly recovered. The first group (C) received caudal analgesia of Bupivacaine 0.25% (1ml/kg). The second group (T) received TAP block of Bupivacaine 0.25% (0.5 ml/kg). Pain was assessed by CHEOPS (Children's Hospital of Eastern Ontario Pain Scale). Parents also assessed pain (after explain and orient them) with Wong-Baker scale 0 (no pain) and 10 (worst pain imaginable). Results: The first group (C) of patients had about 240 ± 30 minutes, while the second group (T) had about 360 ± 60 minutes, early ambulation and feeding and finally, most of them missed the pain till they were home discharged. Conclusion: TAP block enhances comfortable long-time post-op state for the patients, especially the young age group as they are hardly pain dealt off. Also TAP block has an easily performed procedure with less dose and complications compared to the caudal ones.

Comparison of Caudal Bupivacaine and Bupivacaine-tramadol Combination for Postoperative Analgesia in Children Undergoing Lower Abdominal Surgeries

Objective: The aim of current study is to determine the effectiveness of caudal bupivacaine and bupivacaine-tramadol combination for postoperative analgesia in children undergoing lower abdominal surgeries. Study Design: Randomized Control trial Place and Duration: Department of Anesthesiology Surgical ICU &amp; Pain Management Ghulam Muhammad Mahar Medical College, Sukkur and Lahore General Hospital, Lahore, during the period from March 2021 to August 2021. Methods: There were 110 children of both genders with ages 2-8 years undergoing lower abdominal surgery were included in this study. A detailed demographics of enrolled patients, including age, sex, and weight were computed after obtaining informed written consent from each individual. Patients were equally divided in two groups. Group I had 55 patients and received combination of tramadol (1 mg/kg) and bupivacaine (0.5 ml/kg of 0.25%) and group II received only bupivacaine 0.5 ml/kg of 0.25% after induction of anesthesia in caudal epidural space. Post-operatively pain score, requirement of rescue analgesia and sedation score was assessed and compared among both groups. SPSS 24.0 was used to analyze complete data. Results: There majority males 35 (63.6%) in group I and 32 (58.2%) in group II. In group I mean age of the patients was 5.9±4.61 years and in group II mean age were 4.8±9.44 years. Mean weight of the patients in group I was 17.6±4.52 kg and in group II mean weight was 19.5±7.34 kg. During the first 24 hours, we noticed a reduced pain score in the bupivacaine–tramadol group. When it comes to postoperative analgesia, the bupivacaine-tramadol group had much longer analgesia durations and a significantly lower need for rescue analgesia with p value &lt;0.003. Postoperative frequency of adverse effects in group II was greater found in 4 (7.3%) cases as compared to group I in 1 (1.8%) patients. Conclusion: In children having abdominal surgery, we found that caudal tramadol with bupivacaine provided more extended and better quality postoperative analgesia than plain bupivacaine. Keywords: Tramadol, Bupivacaine, Abdominal Surgery, Pain Score, Rescue Analgesia

“Comparative Evaluation of Caudal Tramadol and Adjuvant to Bupivacaine in Paediatric Age Group”

Background: Caudal anaesthesia is a type of regional anaesthesia in which local anesthetic is injected into epidural space. It is most popular regional anaesthesia with a predictable level of blockade used in paediatric surgeries. Adjuvants can be added to local anaesthetics for prolonging the duration of analgesia. Objective: To find out the duration of analgesia of caudal Bupivacaine in combination with Tramadol. Methods: This prospective, randomised, double-blind, comparative study was done in Department of Anesthesiology, Sher-e-bangla Medical College Hospital, Barishal, Bangladesh from June to December 2020. Total of 50 patients, aged between 2 to 9 years undergoing elective lower abdominal, urological and lower extremity surgeries. The patients were randomized to group A (n=25) receiving 1 ml/kg of 0.25% bupivacaine and group B (n=25) receiving 1 ml/kg of 0.25% bupivacaine plus 1mg/kg of tramadol caudally. Duration of analgesia, hemodynamic responses and adverse effects were noted and analysed. Results: Thirty patients in both groups were comparable with regard to demographic data and hemodynamic response and were statistically non-significant (P&gt;0.05). It was observed that the mean duration of analgesia was significantly longer in group B (468.5±164.5 min versus 241.5±69.4 min, P&lt;0.001). One patient in each group had postoperative vomiting. Conclusion: This study concludes that Tramadol 1 mg/kg can be added to 0.25% Bupivacaine for caudal analgesia with total volume of 1 ml/kg to prolong the duration of postoperative analgesia in children undergoing lower abdominal, urological, lower extremity surgery without an increase of adverse effects.

Addition of Clonidine or Dexmedetomidine With Bupivacaine to Prolong Caudal Analgesia in Children Undergoing Infraumbilical Surgery.

IntroductionClonidine, a selective α2 adrenergic receptor agonist, combined with caudally administered bupivacaine, is frequently used in children to prolong the duration of postoperative analgesia following infraumbilical surgery. On the other hand, dexmedetomidine is highly selective and has a greater affinity toward α2 adrenergic receptors, especially toward its α2a subtype, accountable for more analgesic and hypnotic effects than clonidine.Aims and objectivesWe designed a prospective, double-blinded, randomized controlled trial to compare the analgesic efficacy and adverse effects of clonidine and dexmedetomidine when combined with bupivacaine for caudal analgesia in children undergoing infraumbilical surgeries.Materials and methodsA total of 60 children aged one to eight years were randomly assigned into two different groups in a double-blinded manner. Following induction of general anesthesia, every patient received a single dose of caudal bupivacaine 0.25% (0.75 ml/kg) mixed with either clonidine (1 µ/kg) in normal saline or dexmedetomidine (1 µ/kg) in normal saline. We noted the hemodynamic variables and postoperative sedation scores. Duration and quality of postoperative analgesia and the number of rescue analgesic drug doses required were recorded during the first 24 hours postoperatively. We also observed the patients for any adverse effects to the study drugs.ResultAdding dexmedetomidine to caudally administered bupivacaine significantly increased the duration of analgesia (15 ± 0.78 hours) and decreased the need for rescue drug doses than the addition of clonidine to bupivacaine (9.63 ± 1.95 hours) in children undergoing infraumbilical surgeries. Incidences of hemodynamic changes or other side effects were comparable between patients of two groups.ConclusionThe addition of dexmedetomidine to caudally administered bupivacaine in children undergoing infraumbilical surgeries may provide a longer duration of analgesia than the addition of clonidine, with less requirement of rescue analgesic doses and without any significant differences in the hemodynamic parameters or other side effects.

Abstract No.: ABS2768: Comparison of pre-emptive ketamine nebulisation with intravenous ketamine for post-operative analgesia in children undergoing tonsillectomy: A randomised controlled trial

Background and Aims:Nebulised ketamine is a painless route of drug administration in children.This study aimed to compare the effectiveness of ketamine nebulisation as opposed to intravenous ketamine as premedication in childrenMethods:64 children aged 5-10 years, undergoing tonsillectomy were randomly allocated into 2 groups.Both groups received glycopyrrolate 5mcg/kg. First group received ketamine nebulisation (1mg/kg) 20minutes prior to the surgery and other group received intravenous ketamine (1mg/kg) just before shifting to operating room. Children were anaesthetised by standard technique using fentanyl 1 µg/kg, propofol 2mg/kg, atracurium 0.5mg/kg and sevoflurane. Postoperatively, pain score using verbal rating scale(VRS) was assessed immediately after shifting to post anaesthesia care unit (PACU)and after one hour and the time of first rescue analgesic requirement was noted. Children were also assessed for parental separation scores and levels of sedation using 5-point sedation scale preoperatively.Results:There was no difference in VRS pain score immediately after shifting to PACU but there was significant difference in the VRS pain score at one hour postoperatively (p<0.05).The mean time for rescue analgesia was significantly prolonged in ketamine nebulisation group (300±26.40min) in contrast to intravenous ketamine group (237.19±34.38min) (p<0.05). Nebulised and intravenous ketamine produced similar levels of sedation (score-2) and acceptable parental separation scores (score1,2) (table 1).Conclusion:Ketamine nebulisation (1mg/kg) administered before tonsillectomy significantly prolonged postoperative analgesia as opposed to intravenous ketamine with similar parental separation scores and sedation scores. Hence nebulisation can be used as an alternative route for administering ketamine.

Comparación de ibuprofeno y ketorolaco intravenosos para analgesia postoperatoria en niños tratados mediante cirugía de la zona inferior del abdomen: estudio aleatorizado, controlado y de no inferioridad

BackgroundNon-steroidal anti-inflammatory drugs are often used as part of multimodal analgesia to control postoperative pain. This randomized, controlled, double-blinded, non-inferiority study aimed to compare the postoperative analgesic effects of intravenous ibuprofen versus ketorolac in children undergoing open unilateral lower abdominal surgery. The authors hypothesized that postoperative analgesia produced by intravenous ibuprofen would be non-inferior to that of intravenous ketorolac. MethodsSixty-six children aged 2 to 8 years who were scheduled to undergo unilateral lower abdominal surgery, were recruited. Patients in the ibuprofen group received 10mg/kg/6h intravenous ibuprofen. Patients in the ketorolac group were given 0.5mg/kg/6h intravenous ketorolac. The primary outcome measure was 24-h postoperative morphine consumption. The secondary outcome measures were postoperative pain score, the incidence of early postoperative fever and the incidence of ibuprofen and ketorolac adverse effects including pain during drug infusion, vomiting, epigastric pain and allergic reaction. ResultsFifty-nine patients completed the study (30 ibuprofen, 29 ketorolac). There was no significant difference (P=.305) in the mean (SD) 24-h postoperative morphine consumption (μ/kg) between intravenous ibuprofen, 16.00 (5.31), and ketorolac, 14.65 (4.61). The reported pain scores were similar in both groups. The incidence of postoperative fever was significantly lower (p=0.039) in the ibuprofen group (3%) than the ketorolac group (20%). The incidence of adverse effects was similar in both ibuprofen and ketorolac groups. ConclusionsIntravenous ibuprofen can be used as an alternative to ketorolac for postoperative analgesia in children undergoing unilateral lower abdominal surgery because both drugs similarly provide safe and effective postoperative analgesia.

Retrospective review for procedural sedation and analgesia in paediatric patients in urgent care centre in a local private hospital in Hong Kong

Introduction: Procedural sedation and analgesia in children refer to the use of pharmacological measures to facilitate the management of painful procedures or emergency imaging, usually in emergency setting by non-anaesthetists. Emergency clinicians, nurses, patients and caregivers all have their roles to play in providing a safe sedation practice in the busy emergency department. Method: We did a retrospective review of all procedural sedation and analgesia done in patients below the age of 12 in our urgent care centre from October 2018 to August 2019. Results: There were 144 patients being identified in our review. Majority of them received intramuscular ketamine ranging from 2 to 4 mg/kg. There was no documented severe adverse effect in our review. Conclusion: Paediatric procedural sedation and analgesia is generally safe, efficient, adequate and facilitate early patient discharge.

Comparison of erector spinae plane and paravertebral nerve blocks for postoperative analgesia in children after the Nuss procedure: study protocol for a randomized controlled non-inferiority clinical trial

BackgroundThoracic paravertebral block (TPVB) is a widely advocated regional technique for alleviating postoperative pain in children undergoing elective pectus excavatum repair. However, this technique is associated with some undesirable adverse events. Recently, the erector spinae plane block (ESPB) has been introduced as a practical alternative to the TPVB in thoracic surgery. This interfascial regional anesthesia technique interrupts pain sensation by injecting local anesthetics between the muscular layers of the thoracic wall. Several case series described it as an effective pain management technique following pectus excavatum repair. Therefore, this trial is designed to test the hypothesis that ESPB is non-inferior to TPVB in postoperative pain control after pectus excavatum repair.MethodsThis is a prospective randomized double-blind non-inferiority trial. A total of 40 patients aged 4 to 18 years undergoing Nuss surgery will be randomly assigned to receive pain treatment with either ESPB or TPVB. All patients will receive additional systemic multimodal analgesia with an intravenous patient-controlled analgesia pump and acetaminophen. The primary outcome is the pain intensity at rest, 24 h postoperatively. Secondary outcomes include accumulated morphine-equivalent consumption, postoperative pain scores, emergence agitation incidence, time of the first mobilization, time to first rescue analgesia, complications related to pain treatment, and morphine-related adverse events.DiscussionThis will the first randomized controlled trial to compare ESPB with TPVB for analgesia after pectus excavatum repair. This trial aims to provide important clinical evidence to elaborate on the analgesic mechanism of ESPB in children.Trial registrationClinicalTrials.govNCT05034601. This trial was prospectively registered.

Pain and Analgesia in Children with Cancer after Hemipelvectomy: A Retrospective Analysis.

A paucity of data exists centering on the pain experience of children following hemipelvectomy performed for primary bone and soft tissue sarcomas. In this study, we aimed to describe the incidence, severity, and evolution of perioperative pain and function in pediatric oncology patients undergoing hemipelvectomy, and, additionally, we sought to detail the analgesic regimens used for these patients perioperatively. A retrospective chart review was conducted, studying cancer patients, aged 21 years and under, who underwent hemipelvectomy at MD Anderson Cancer Center (MDACC) from 2018 to 2021. Primary outcomes included the evolution of pain throughout the perioperative course, as well as the route, type, dose, and duration of analgesic regimens. Eight patients were included in the analysis. The mean age at operation was 13 ± 2.93 years. All patients received opioids and acetaminophen. The mean pain scores were highest on post-operative day (POD)0, POD5, and POD 30. The mean opioid use was highest on POD5. A total of 75% of patients were noted to be ambulating after hemipelvectomy. The mean time to ambulation was 5.33 ± 2.94 days. The combination of acetaminophen with opioids, as well as adjunctive regional analgesia, non-steroidal anti-inflammatory drugs, gabapentin, and/or ketamine in select patients, appeared to be an effective analgesic regimen, and functional outcomes were excellent in 75% of patients.

Fentanyl versus midazolam added to bupivacaine for spinal analgesia in children undergoing infraumbilical abdominal surgery: A randomized clinical trial

ABSTRACT Background The addition of fentanyl or midazolam to intrathecal bupivacaine was tested to reduce the occurrence and pain degree in children undergoing infraumbilical surgery under sevoflurane anesthesia with intrathecal analgesia. Methodology Children (6–8 years) were randomized into three groups of 30 patients each with consent from parents. Groups C, F, and M received 0.3 mg/kg of 0.5% bupivacaine + 0.9% NaCl (placebo),0.3 mg/kg of 0.5% bupivacaine + 0.2 µg/kg of fentanyl, and 0.3 mg/kg of 0.5% bupivacaine + 0.5 mg of midazolam, respectively. Assessments included time to first analgesic request, postoperative pain score, the total amount of rescue analgesics, motor and sensory blocks, sedation, family satisfaction, and adverse effects. Results The Children’s Hospital of Eastern Ontario score was higher in the control than in the midazolam and fentanyl groups. The mean time to the first request for rescue analgesia was longer in group M (297.1 ± 10.7 min) than in groups F (219.9 ± 25.4 min) and C (162.7 ± 37.5; P = 0.000). The total analgesic consumption was higher in both control and fentanyl groups (P = 0.044). Family satisfaction was significantly higher in group M (P = 0.013) with no adverse effects. Conclusion In the present study, intrathecal midazolam (0.5 mg) was superior to intrathecal fentanyl (0.2 μg/kg) in increasing the duration of postoperative pain relief with lower postoperative pain scores and less incidences of adverse effects. Consequently, intrathecal midazolam can be used as an adjuvant to local anesthetics if fentanyl is not accessible or contraindicated.

Ultrasound-guided transverse abdominis plane block, ilioinguinal/iliohypogastric nerve block, and quadratus lumborum block for elective open inguinal hernia repair in children: a randomized controlled trial

Background and objectivesUltrasound-guided ilioinguinal/iliohypogastric (II/IH) nerve blocks and transverse abdominis plane (TAP) blocks are widely used for postoperative analgesia in children undergoing inguinal hernia repair (IHR). Quadratus lumborum block (QLB)...

The effect of ultrasound-guided bilateral thoracic retrolaminar block on analgesia after pediatric open cardiac surgery: a randomized controlled double-blind study.

BackgroundThe thoracic retrolaminar block (TRLB) is a relatively new regional analgesia technique that can be used as an alternative to the thoracic paravertebral block. This study aimed to evaluate the postoperative analgesia effects of ultrasound-guided TRLB in children undergoing open cardiac surgery via median sternotomy incision.MethodsSixty-six patients aged 2–8 years were recruited. In the TRLB group, 0.25% bupivacaine 0.4 ml/kg was injected into the retrolaminar space on both sides at the level of the T4 lamina. Patients in the control group were injected with 0.9% saline. The primary outcome measure was fentanyl consumption in the first 24 h post-extubation. The secondary outcome measures were the total intraoperative fentanyl consumption, postoperative modified objective pain score (MOPS), and time to extubation.ResultsThe total intraoperative fentanyl requirements and fentanyl consumption in the first 24 h post-extubation were significantly lower (P < 0.001) in the TRLB group (9.3 ± 1.2; 6.9 ± 2.1 μg/kg, respectively) than in the control group (12.5 ± 1.4; 16.6 ± 2.8, respectively). The median (Q1, Q3) time to extubation was significantly shorter (P < 0.001) in the TRLB group (2 [1, 3] h) than in the control group (6 [4.5, 6] h). The MOPS was significantly lower (P < 0.05) in the TRLB group than in the control group at 0, 2, 4, 8, 12 and 16 h post-extubation. ConclusionsBilateral ultrasound-guided TRLB is effective in providing postoperative analgesia in children undergoing open cardiac surgery via median sternotomy incision.

Safety and Efficacy of Intrathecal Morphine in Children Undergoing Surgery for Abdominal Neuroblastoma. Dose Finding, Randomized, Clinical Study

Background: Pediatric patients have remained undertreated for postoperative pain because of the difficulty of pain assessment and apprehension. Intrathecal opioids—including morphine—have become a popular method for providing post-operative analgesia in children. Objectives: To compare different doses of morphine via intrathecal route (2 μg/kg, 5 μg/kg, and 10 μg/kg) for post-operative analgesia in pediatric patients following for abdominal neuroblastoma surgery. Methods: This randomized, double-blinded, study was approved by local ethics committee of South Egypt Cancer Institute, Assiut University, Assiut—Egypt, and registered at https://www.clinicaltrials.gov/ at no.: “NCT03158584”. Forty-five patients scheduled for surgical excision of abdominal neuroblastoma were divided into 3 groups (15 patients each); group (I): received intrathecal morphine 2 μg/kg added to normal saline (3 mL volume). Group (II): received intrathecal morphine 5 μg/kg. Group (III): received intrathecal morphine 10 μg/kg. Intra-, and post-operative hemodynamics, FLACC score, time to first request of rescue analgesia, total analgesic consumption, and side effects were recorded for 24 hours. Results: there was a significant reduction in FLACC score in groups II and III starting immediately till 24 hours postoperatively compared to group I (P 0.05). No significant difference was observed between groups in side effects. Conclusions: 5 μg/kg of IT morphine achieved a reasonable balance between postoperative analgesia, and the incidence of side effects in pediatric patients following major abdominal cancer surgeries.

Preemptive analgesia with ibuprofen increases anesthetic efficacy in children with severe molar: a triple-blind randomized clinical trial

Molar incisor hypomineralization (MIH) is often accompanied by dental hypersensitivity and difficulty in achieving effective analgesia.Objective:This study evaluated the effectiveness of preemptive analgesia in children with severe MIH, post-eruptive enamel breakdown, and hypersensitivity.Methodology:Ibuprofen (10 mg/kg child weight) or placebo was administered, followed by infiltrative anesthesia and restoration with resin composite. Hypersensitivity was evaluated in five moments. The data were analyzed using the chi-square test, Fisher’s exact test, and t-test.Results:Preemptive analgesia provided benefits for the treatment of severe cases of MIH, with an increase in the effectiveness of infiltrative anesthesia and improved patient comfort during the restorative procedure.Conclusion:Preemptive analgesia has shown efficacy in reducing hypersensitivity during restorative dental procedures, evidencing the significance of this study for patients with MIH and hypersensitivity.

Ropivacaine: A Review on the Pharmacological Features, Therapeutic Efficacy and Side-effects When used for Caudal Epidural Analgesia

Inadequate post operative pain treatment can lead to clinical and psychological changes, as well as increased morbidity, mortality, and financial burden, all of which can influence quality of life. A review of the pharmacological characteristics, therapeutic efficacy in delivering postoperative analgesia, and side-effects of Ropivacaine is presented in this article. Motor blockade is an unwanted effect during the post operative period. The fear of side-effects and hemodynamic instability caused by the most of the analgesic drugs are the challenges faced in providing effective post operative analgesia in children. Ropivacaine has lesser cardiotoxic effects, lesser motor blockade and minimal side-effects as compared to bupivacaine. These properties make it a promising drug for pediatric caudal analgesia and forms a cost-effective method by decreasing the requirement of systemic analgesics, morbidity and improving the life quality postoperatively.

Is Ultrasound-Guided Transversus Abdominis Plane Block Superior to a Caudal Epidural or Wound Infiltration for Intraoperative and Postoperative Analgesia in Children Undergoing Unilateral Infraumbilical Surgery? A Double-blind Randomized Trial.

ABSTRACTBackground and Aim:Caudal block (CB) is the standard of care in pediatric surgeries. Ultrasound (USG) transversus abdominis plane (TAP) block has also been used as an effective regional anesthesia technique. We compared the duration of postoperative and intraoperative analgesia between TAP block, CB, and local wound infiltration (LI) in children undergoing unilateral infraumbilical abdominal surgery.Materials and Methods:One hundred and twenty children, 3–10 years old and American Society of Anesthesiologists Grade I and II, undergoing elective unilateral infraumbilical abdominal surgery were allocated to three groups. Group TAP: USG-guided TAP block with 0.5 ml/kg of 0.25% bupivacaine; Group CB: CB with 0.75 ml/kg of 0.25% bupivacaine; and Group LI: Local wound infiltration along the incision with 0.5 ml/kg of 0.25% bupivacaine. The primary outcome was the efficacy of postoperative analgesia using modified objective pain score (MOPS), and the secondary outcome was to determine intraoperative analgesia with fentanyl requirement and minimum alveolar concentration (MAC) hour of isoflurane among the three groups.Results:The MOPS was statistically better in Group TAP compared to group CB and group LI at 8 and 24 h postoperatively. The mean ± standard deviation duration of postoperative analgesia in groups CB, LI, and TAP was 6.84 ± 0.47, 2.3 ± 1.26, and 9.78 ± 1.02 h, respectively. The intraoperative requirement of fentanyl and MAC hour was least in Group CB.Conclusion:We found that USG-guided TAP block is a good alternative, with longer and effective postoperative analgesia compared to CB. However, the quality of intraoperative analgesia was best in group CB. Local infiltration was a poor alternative.

Opioid Analgesic Prescription in French Children: A National Population-Based Study.

Codeine use was restricted in 2013 and is currently contraindicated for children below the age of 12 years. We examined how the prescription of opioid analgesics in children in France evolved between 2012 and 2018. Our population-based study from the SNIIRAM database (National System of Health Insurance Inter-Regime Information) was designed to determine trends in opioid prescription from 2012 to 2018 in all French children. The number of children who received at least one opioid prescription gradually declined from 452,665 in 2012 (347.5 children per 10,000) to 169,338 in 2018 (130.3 children per 10,000). This decrease was especially marked for codeine (36 children per 10,000 in 2018 vs. 308.5 children per 10,000 in 2012), whereas the number of tramadol prescriptions increased by 171% in 2018 (94.6 children per 10,000). Despite the increase, strong opioids still formed only a small proportion of prescriptions (2.6 children per 10,000 given opioids in 2018). Overall opioid prescriptions in French children dramatically decreased between 2012 and 2018, probably owing to restrictions on the use of codeine. Codeine has been partly replaced by tramadol. Morphine is still probably underused. This suggests that opioids are being used less often for pain management in children.

Comparative Randomised Study between Bupivacaine with Clonidine and Ropivacaine with Clonidine Used Caudally for Postopertaive Analgesia in Paediatric Hypospadias Surgery

Background: This study was conducted to compare and evaluate the caudal epidural clonidine when mixed with ropivacaine and bupivacaine in prolonging postoperative analgesia in children of Indian genotype undergoing hypospadias surgery, as well as compare the intraoperative haemodynamics using caudal bupivacaine with clonidine vs ropivacaine with clonidine. The study was also aimed at studying the side effects and the duration of post-operative pain relief of bupivacaine with clonidine v/s ropivacaine with clonidine.&#x0D; Methods: This is a prospective randomised comparative study that was carried out in the Department of Anaesthesiology, KEM Hospital, Pune, over 12 months (from October 2016 to September 2017), among 56 children having an ASA Grade of II, aged between 1 to 8 years admitted for hypospadias surgery. The data gathered was cleaned using Microsoft Excel, before statistical analysis was done.&#x0D; Results: It was observed that caudal epidural analgesic duration was more in the bupivacaine clonidine group than in the ropivacaine clonidine group. The sedation score was higher at the second hour in the bupivacaine clonidine group. The HR and mean arterial pressure values were found to be notably higher in the ropivacaine clonidine group than those in the bupivacaine clonidine group. Intraoperatively and postoperatively, there was a decrease in pulse rate and MAP but at no time did the value reach the criteria for intervention. Other side effects like postoperative vomiting, nausea, motor blockade, respiratory distress not observed in any group.&#x0D; Conclusion: Bupivacaine 0.25 % 0.5 ml per kg with clonidine 1 microgram / kg via caudal route increased the duration of postoperative analgesia with no adverse effects as compared to ropivacaine 0.25 % with clonidine 1 microgram/ kg. Hence clonidine is more efficient in increasing postoperative analgesia when added with Bupivacaine as compared to ropivacaine in Indian genotype in hypospadias surgery.