Pediatric Analgesia Research Articles

Enhancing Caudal Analgesia in Pediatrics: A Comparison of Ropivacaine With and Without Clonidine for Infra-Umbilical Surgeries.

Introduction Regional anesthesia, particularly caudal blocks, is increasingly used in pediatric surgeries for effective post-operative pain management. However, the duration of analgesia with agents such as ropivacaine alone can be limited. This study investigates the effects of adding clonidine to ropivacaine in caudal blocks for pediatric patients undergoing infra-umbilical surgeries, with the purpose of enhancing the duration and quality of analgesia. Methods We conducted a randomized, double-blind study including 50 children aged one to eight years, divided equally into two groups: group R received 0.2% ropivacaine and group RC received 0.2% ropivacaine with 2 mcg/kg clonidine. Intraoperative and post-operative monitoring included heart rate, blood pressure, and respiratory parameters. Analgesia duration, sedation scores, and the need for rescue analgesia were assessed. Results Group RC exhibited significantly longer analgesia duration (18.4 ± 2.31 hours) compared to group R (10.56 ± 2.27 hours, P < 0.0001). Fewer patients in group RC required a second dose of rescue analgesia (4% vs. 32%, P = 0.023), with no significant differences in sedation scores or adverse effects between the groups. Conclusion Adding clonidine to ropivacaine in caudal blocks significantly prolongs analgesia and reduces the need for additional post-operative pain management in pediatric surgeries without increasing the risk of side effects. This study supports the use of clonidine as an effective adjuvant in pediatric pain management.

Procedural sedation and analgesia in Swiss Pediatric Emergency Departments: a national subgroup analysis of a European cross-sectional survey

This study aims to provide a national overview of procedural sedation and analgesia practices within Pediatric Emergency Departments in Switzerland, focusing on the availability of pharmacologic agents, the presence of safety protocols, the utilization of non-pharmacological interventions, and to identify specific local limitations. We conducted a detailed subgroup analysis of Swiss data from a European cross-sectional survey on emergency department pediatric Procedural Sedation and Analgesia (PSA) practice, isolating data from Swiss sites. The survey, conducted between November 2019 and March 2020, covered various aspects of procedural sedation and analgesia practices. The survey included nine Swiss sites, treating a total of 252,786 patients in 2019. Topical analgesia, inhaled equimolar nitrous oxide-oxygen mixture, and ketamine were largely available. All sites had nurse-directed triage protocols in place; however, opioid administration was included in the protocols in only 66% of sites. Only 33% of hospitals reported common use of intravenous sedation. Barriers to procedural sedation and analgesia implementation included staffing shortages (89% of sites) and lack of dedicated spaces (78%).Conclusions: Despite a broad array of pharmacological and options available in Swiss Pediatric Emergency Departments, challenges remain in standardizing practices across the country. Limited space and staffing and enhancing training on non-pharmacological interventions were identified as potential areas for improving pain and anxiety management in pediatric emergency care. This study underscores the need for national guidelines to harmonize emergency department PSA practices across Switzerland, ensuring all children have access to effective and evidence-based procedural comfort.What is Known:• Recent research, conducted in European emergency departments, suggests that in pediatric Procedural Sedation and Analgesia (PSA) resources are limited, and practice is heterogeneousWhat is New:• Swiss pediatric hospitals offer a wide range of pharmacological options for pain and anxiety management. However, significant barriers to PSA were identified. These include external control of intravenous sedation and insufficient integration of non-pharmacological interventions, such as child life specialists and procedural hypnosis. National guidelines are needed to harmonize PSA practices

Methods of prolonging the effect of caudal block in children.

Caudal epidural blockade is one of the most frequently administered regional anesthesia techniques in children. It is a supplement during general anesthesia and for providing postoperative analgesia in pediatrics for sub-umbilical surgeries, especially for genitourinary surgeries. However, the duration of the analgesic effect is occasionally unsatisfactory. In this review, we discuss the main advantages and disadvantages of different techniques to prolong postoperative analgesia for single-injection caudal blockade in children. A literature search of the keywords "caudal", "analgesia", "pediatric", and "children" was performed using PubMed and Web of Science databases. We highlight that analgesic quality correlates substantially with the local anesthetic's type, dose, the timing relationship between caudal block and surgery, caudal catheterization, and administration of epidural opioids or other adjuvant drugs.

Cryoanalgesia as Essential Component of PerioperativeMultimodal Analgesia in Pediatrics – Literature Review

The article introduces the application of cryoanalgesia as an innovative method utilizing low temperatures toalleviate pain, particularly in perioperative care for pediatric patients. Emphasis is placed on the necessity of paincontrol in accordance with Enhanced Recovery After Surgery (ERAS) principles. Temporary or permanent nervestructure damage due to cooling attenuate pain conduction, finding application across various medical fields. Inthe context of pediatric chest surgery, cryoanalgesia proves exceptionally effective in managing acute pain andpreventing chronic pain. Research demonstrates shortened hospitalization times, potential opioid dose reduction,and improved mobility rehabilitation. The article describes the first intraoperative application of intercostal nervecryoablation during the Nuss procedure in Polish children, showcasing its efficacy in treating acute pain. Twocryoanalgesia techniques are discussed in the article: intraoperative – intrathoracic during the thoracoscopy andpercutaneous – before the surgical procedure. Studies underscore the crucial role of precise probe placement foroptimal results. In conclusion, cryoanalgesia serves as an effective complement to pain control methods, presentingfavorable outcomes in various medical specialties, especially pediatric surgery. The article underscores the need forfurther research and a multidisciplinary approach to achieve optimal results.

Ultrasound-guided procedures for postoperative pain management in pediatric patients undergoing abdominal surgeries: A systematic review.

Many ultrasound-guided procedures are available for administering analgesia via peripheral nerve blockade. This systematic review aims to compare different ultrasound-guided procedures to determine which procedure is better suited for pediatric abdominal surgeries. The objective is to understand the efficacy of ultrasound-guided procedures for postoperative pain management in children undergoing abdominal surgeries and to identify which procedure takes less time and is better suited for a particular surgery. A systematic literature search was performed in PubMed, SCOPUS, Central Cochrane Registry of Controlled Trials (The Cochrane Library), and ScienceDirect databases for pediatric abdominal surgeries conducted with ultrasound-guided procedures for administering analgesia. We included studies involving randomized controlled trials (RCTs). Quasi-randomized controlled studies, prospective, retrospective observational studies, case series, case reports, letters, editorials, comments, animal studies, and studies from non-English literature were excluded. We reviewed 13 articles with 910 patients included. Age groups varied from 6 months to 21 years. The most common block used was the transversus abdominis block (47.76%), and the most common surgery performed was hernia and hydrocele (52.10%). Quadratus lumborum block was used in 26.92%, erector spinae block in 8.97%, modified transversus abdominus block and rectus sheath block in 9.62%, and ilioinguinal block in 6.73% of the patients. No complications were reported in any of the studies. Transversus abdominus block is less effective in two of the studies. Each procedure for pediatric postoperative analgesia has specific advantages and limitations, highlighting the complexity of tailoring interventions. Our review focuses on the advancements in ultrasound-guided analgesia for lower abdominal surgeries in pediatric patients while also emphasizing the need for future randomized controlled trials (RCTs) to compare efficacy, standardize practices, and improve patient outcomes.

Lumbar Epidural versus Caudal Epidural for Postoperative Analgesia After Lower Extremity Osteotomy Surgery in Pediatric Patients with Osteogenesis Imperfecta: A Propensity-Matched Cohort Analysis in a Single-Center Over 9 Years.

Although pediatric epidural analgesia is a well-established technique used perioperatively. It is unclear whether a lumbar or caudal epidural is suitable for osteogenesis imperfecta (OI) patients, which may be associated with brittle bones and spine deformity. We conducted a retrospective study to investigate and compare the efficacy of the two continuous epidural techniques in pediatric patients undergoing lower extremity osteotomy surgery using a propensity score-matched analysis (PSMA). A total of 274 patients were included. Patients' age, weight, and height were adjusted using PSMA. 90 patients were matched for further analysis, with 45 patients in the lumbar epidural group (Group L) and 45 patients in the caudal epidural group (Group C). Pain scores were categorized into three grades: mild (0-3), moderate (4-6), and severe (7-10), and compared between the two groups. Additionally, operation time, operation site, blood loss, scoliosis, oral analgesic medications, and catheter or nerve-related complications were compared. There were no significant differences in operation time, operation site, scoliosis, and blood loss between the two groups. The percentage of moderate to severe pain during movement was significantly higher in Group L than in Group C, with 37.5% versus 17.5% on the second-day post-operation (P=0.039). However, no statistically significant difference was observed on other days. Additionally, there was no significant difference in oral medication consumption and complications between the two groups. Both lumbar and caudal epidural analgesia can be effectively used postoperatively, and a caudal epidural should be considered where performing a lumbar epidural is challenging in OI pediatric patients.

Role of adding dexmedetomidine, ketamine, and magnesium sulphate to caudal block as preemptive analgesia in hypospadias repair in pediatrics: A randomized double-blinded prospective trial

ABSTRACT Background The caudal block (CB) is a quick, and safe approach for pediatric analgesia. Numerous adjuvants were added to extend the analgesia duration. Our trial aims to evaluate the significance of CB by adding dexmedetomidine, ketamine, and MgSO₄ to bupivacaine to provide postoperative analgesia in children undergoing hypospadias repair. Methods This randomized double-blinded study was performed on 75 male children undergoing hypospadias repair under CB. Patients were randomized into three equal groups. All received 0.5 ml/kg bupivacaine 0.25% caudally plus 1 ml volume containing either dexmedetomidine 1 μg/kg in Group D, 0.5 mg/kg ketamine in Group K or 50 mg of MgSO₄ in Group M. Results Time of first rescue analgesia was significantly delayed in group D (8.2 ± 3.45 h) than in group K (5.8 ± 2.85 h) and group M (3.7 ± 1.51 h) (P value = 0.007 vs. <0.001) and in group K than in group M (P value = 0.027). Heart rate and mean arterial blood pressure measurements after block and 60 min intraoperative reduced significantly in group D than in K and Group M. At 6 h and 12 h, FLACC scores were considerably lower with Group D compared to Group K, and Group M, and ketamine group compared to Group M at 4 h. The total amount of pethidine consumed 24 hours postoperatively was significantly lower in Group D than in Group K and Group M. Conclusions Dexmedetomidine as an additive to the CB significantly prolonged time to first analgesia required and decreased total rescue opioid consumption compared to ketamine and MgSO₄.

Nalbuphin as an Adjuvant to Levobupivacaine in Caudal Analgesia in Children

Abstract Background Caudal anethesia is the single most important pediatric regional anethetic technique and is increasingly performed in pediatric regional anesthesia practices. It is preferred in order to relieve intraoperative and postoperative pain in children of all age groups undergoing pelvi-abdominal or lower limbs surgeries using levobupivacaine 0.25%.Various adjuvant have been added to levobupivacaine to prolong postoperative caudal analgesia. Nalbuphine as many opioids can be added in caudal analgesia. This prospective randomised double blind study was done to compare the effects of plain levobupivacaine 0.25% versus Levobupivacaine 0.25% plus nalbuphine 0.1 mg/kg single-shot for postoperative pain relief in children undergoing hypospadius repair surgery. Materis and Methods At total of 64 pediatric patient 1 to 3 years old with American society of Anethesiologist (ASA) status | to |‖, undergoing hypospadius repair surgery were prospectively randomized into two groups, Group 1 received levobupivacaine 0.25% only 1 ml/kg plus 1 ml normal saline and group 2 received levobupivacaine 0.25% 1 ml/kg plus 0.1 mg/kg in 1 ml normal saline. The primary outcome of the study were time to first analgesia request, total consumption of rescue analgesia and the FLACC scale (face, legs, activity, cry and consonlability). The secondary outcome were heart rate (HR), mean arterial blood pressure (MAP), Oxygen saturation, occurrence of complications (respiratory depression, pruritis, xerostomia and postoperative nausea and vomiting). Results During surgery adequate intraoperative analgesia was defined by hemodynamic stability. An increase in the HR or MAP within 15 minutes greater than 15% compared to the baseline values obtained before skin incision recieved a rescue opioid in the form of fentanyl 5 mcg /kg and was excluded from the study. The difference between the two groups regarding time to first analgesia request was highly significant, group 1 (7.28±1.07), group 2 (11.59±2.54) (p &amp;lt; 0.01).The comparison between the two groups regarding the total consumption of rescue analgesia was also significant, group 1 (23.47±8.17), group 2 (19.23±7.31) (p &amp;lt; 0.05). There was statistically significant increase in FLACC in group 1 than group 2 at 30 min and up to 8 hours. There was no significant decrease in HR or MAP in group 2 more than group 1 except between 20 min and 8 hours. There was no statistically significant difference found between two studied groups regarding oxygen saturation regarding intraoperative and postoperative follow up. No patients in both groups had respiratory depression, xerostomia or pruritis.Few patients (3 _4) had postoperative nausea and vomiting with no statistically significant difference between the two groups. Conclusion The combination between nalbuphine and Levobupivacaine was valuable as regarding efficacy and safety profiles in pediatric analgesia. The intensity and duration of analgesia were remarkable compared to levobupivacaine alone. Fortunately, there were no side effects of systemic hazards recorded from systemic absorption of nalbuphine. To recommend considering nalbuphine as one of the valuable adjuvants to levobupivacaine in epidural analgesia according to its efficacy and safety profile.

Safety and Analgesic Efficacy of General Versus Caudal Block in Pediatric Infra Umbilical Surgery

Background: Caudal analgesia has become popular in the management of intraoperative and postoperative pain management, further with the use of adjuvants to prolong its duration each with varying results. Caudal block is the most preferred postoperative analgesia in pediatrics, despite its limited duration of action. Many additives are used to improve the effectiveness of caudal blocks, such as opioids or a2 agonists. Recently, the use of caudal dexamethasone as an analgesic after surgery has increased. Objectives: The aim of this study is to evaluate the safety and analgesic efficacy of general versus caudal block in pediatric infra umbilical surgery. Methods: This is an observational study. This study was carried out on 50 patients the find out about the population including children in the Department of Anaesthesia, Uttara Adhunik Medical College Hospital, Dhaka, Bangladesh. The duration of the period from January 2022 to December 2022. Statistical evaluation of the results used to be got via the use of a window-based computer software program devised with Statistical Packages for Social Sciences (SPSS-24). Results: The mean duration of postoperative analgesia was 3 times longer in Bupivacaine with preservative free Clonidine Group. Bupivacaine solution Group received significantly more doses of rescue analgesic than Bupivacaine with preservative free Clonidine Group (p-value of 0.004). There was no significant bradycardia, hypotension, sedation or urinary retention in either of the groups. There was no residual motor blockade at 6 hours. Incidence of vomiting was similar in both the groups. Conclusion: Dexamethasone in combination with bupivacaine reduces postoperative pain intensity and total analgesic consumption and prolongs analgesia.

The Topics and Publication Trends in Emergence Deliri-Um: A Bibliometric Analysis from 2002 to 2022.

Emergence delirium is an early postoperative behavior change in pediatric patients, posing risks to patient safety and leading to prolonged hospital stays and increased medical costs. As a result, the research on emergence delirium has grown substantially. This study aims to identify the most influential literature, trends, and topics in emergence delirium research, as well as to quantify the fundamental data of academic publications on this topic. We searched for articles on emergence delirium in the Science Citation Index Expanded databases, covering the period from 2002 to 2022. Bibliographic information, including countries, institutions, journals, authorships, references, and keywords, was collected for further analysis. A total of 739 articles on emergence delirium published between 2002 and 2022 were collected. China emerged as the most prolific publisher in this field, accounting for over 30% of all articles (226 publications), followed by the United States (n = 143) and South Korea (n = 92). The top three productive journals were Pediatric anesthesia (n=78, IF=2.129), Anesthesia and Analgesia (n=28, IF=6.627), and BMC Anesthesiology (n=28, IF=2.583). Yonsei University was the most active institution, with 22 publications related to emergence delirium. Among authors, Kin, Hee-Soo (n = 9) published the most articles in this field, followed by Yao, Yusheng (n = 7), Lee, Ji-Hyun (n = 7). The prominent topics in emergence delirium research during the past two decades were "children", "emergence delirium" and "propofol". Through bibliometric analysis, this study provides a comprehensive overview of the trends and developments in the field of emergence delirium over the past two decades. The results demonstrate a significant growth in emergence delirium research worldwide, with China leading in the number of publications. Despite the wealth of literature on strategies for preventing and managing emergence delirium in clinical settings, further basic research is needed to elucidate the underlying mechanisms of emergence delirium.

Efficacy and safety of parecoxib and flurbiprofen axetil for perioperative analgesia in children: a network meta-analysis.

The aim of this study was to systematically review the efficacy and safety of parecoxib and flurbiprofen axetil for perioperative analgesia in children through Bayesian network meta-analysis. We systematically searched PubMed, Embase, Cochrane Library, Web of Science, Sinomed, CNKI, VIP, and Wanfang Data databases on 18 July 2022 to obtain randomized controlled trials comparing perioperative parecoxib or flurbiprofen with placebo or standard treatment for pediatric analgesia. The outcomes were the postoperative pain score and the incidence of adverse events. The Gemtc package of R-4.0.3 and Stata 17.0 were used for Bayesian network meta-analysis. We retrieved 942 articles and 49 randomized controlled trials involving 3,657 patients who met the inclusion criteria. Compared with children who received placebo treatment, those who received flurbiprofen axetil had lower pain sores at each time point within 24 h postoperatively, and those who received parecoxib had lower pain sores at each time point within 12 h postoperatively. Compared with children who received tramadol treatment, both the children who received flurbiprofen axetil or parecoxib had lower pain scores at 8 h postoperatively. The ranking results demonstrated that flurbiprofen axetil had significant superiority in reducing pain scores at 2, 4, and 12 h postoperatively, and parecoxib had significant superiority in reducing pain scores at 0, 0.5, 1, 6, 8, and 24 h postoperatively. In terms of safety, compared with children who received placebo, those who received flurbiprofen axetil or parecoxib had a lower incidence of total adverse events and postoperative agitation. Compared with tramadol, flurbiprofen axetil and parecoxib both significantly reduced the incidence of total adverse events and postoperative nausea and vomiting. Compared with flurbiprofen axetil or fentanyl, parecoxib significantly reduced the incidence of postoperative nausea and vomiting. The ranking results showed that parecoxib was advantageous in decreasing the incidence of total adverse events and postoperative nausea and vomiting. Flurbiprofen axetil was most effective at reducing pain scores at 2, 4, and 12 h postoperatively. Parecoxib had an advantage in terms of reducing pain scores at 0, 0.5, 1, 6, 8, and 24 h postoperatively, as well as the incidence of total adverse events and postoperative nausea and vomiting. https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=348886, PROSPERO (CRD42022348886).

Paediatric procedural sedation and analgesia in a South African emergency centre: a single-centre, descriptive study

BackgroundProcedural sedation and analgesia are considered a core competency in emergency medicine as patients present to the emergency centre on an unscheduled basis, often with complex complaints that necessitate emergent management. Previous evidence has consistently shown that procedural sedation and analgesia in the emergency centre in the paediatric population, even the very young, are safe if appropriate monitoring is performed and appropriate medications are used. The aim of the study was to describe the indications for procedural sedation and analgesia, the fasting status of paediatric patients undergoing procedural sedation and analgesia and the complications observed during procedural sedation and analgesia in the paediatric population at a single emergency centre in Cape Town, South Africa.MethodsA retrospective, descriptive study was conducted at Mitchells Plain Hospital, a district-level hospital situated in Mitchells Plain, Cape Town. All paediatric patients younger than 13 years of age who presented to the emergency centre and received procedural sedation and analgesia during the study period (December 2020–April 2021) were included in the study. Data was extracted from a standardised form, and simple descriptive statistics were used.ResultsA total of 113 patients (69% male) were included: 13 infants (< 1 year of age), 47 young children (1–5 years of age) and 53 older children (5–13 years of age). There was only 1 (0.9%) complication documented, which was vomiting and did not require admission. The majority of patients received ketamine (96.5%). The standardised procedural sedation and analgesia form was completed in 49.1% of cases. Indications included burns debridement (11.5%), suturing (17.7%), fracture reduction (23.9%), lumbar punctures (31.9%) and others (15.0%). The indications for procedural sedation and analgesia varied between the different age groups. The majority of patients in this study did not have their fasting status documented (68.1%), and 18.6% were not appropriately fasted as per American Society of Anaesthesiology guidelines. Despite this, there was an extremely low rate of documented complications of 0.9%.ConclusionThe study findings are in accordance with previous international literature reporting low complication rates. Although fasting status was unknown in the majority of patients, there was an extremely low rate of documented complications and no interventions required. Safe, timely procedural sedation and analgesia with minimal pain and unnecessary suffering can become the norm in emergency medicine practice in South Africa.

Safety of pediatric sedation and analgesia during burn dressing changes by pediatric residents.

Acute pain and anxiety management during pediatric burn dressing change is very challenging. There are limited data regarding feasibility and safety of sedation administration by nonanesthesiologists. We sought to describe the implementation of a sedation protocol for pediatric residents during burn dressing changes in the pediatric ward. An analgesia and sedation protocol was designed and implemented in the pediatric wards in 2015. Retrospective data were collected on all children who were sedated by pediatric residents for burns in the pediatric wards over a 4-year period in our hospital. Demographics, burn characteristics, and data regarding adverse events were collected from patients' electronic medical records. The main outcomes were successful procedure completion and safety. During the study period, 1130 sedations were performed in 272 patients by pediatric residents. The median age was 2.5 years (IQR 1.3-9.1). Sixty-two percent (695/1130) of the patients were male. The majority of the burns (84%, 955/1130) were <20%, and the majority of the patients (91%, 1030/1130) had an ASA (American Society of Anesthesiologists) score of 1. The incidence rate of adverse events was 4.3% (49/1130) and 1.3% (15/1130) for serious adverse events . There were no statistically significant differences in gender, age, ASA, or burn degree between patients with or without adverse events. We designed and implemented an analgesia and sedation protocol for pediatric residents to be applied in patients during burn dressing change. The implemented protocol in the pediatric wards was found to be feasible and with a low incidence of adverse events.

Bibliometric analysis on pediatric caudal anesthesia

Abstract&#x0D; Background: Bibliometric analysis studies are studies that examine the literature on a subject numerically and holistically, and have recently attracted a lot of attention in the field of medicine. The number of articles about pediatric caudal anesthesia has increased gradually over the past few decades. However, there is no bibliometric analysis study on pediatric caudal anesthesia in the literature. This study aimed to present a bibliometric analysis of articles published in the Web of Science (WoS) Core database related to pediatric caudal anesthesia.&#x0D; Method: We used the search engine of WoS and included all types of contributions (original articles, reviews, letters, etc.) in the bibliometric analysis. The keywords used to access articles are ‘’pediatric, caudal, anesthesia, analgesia, and block’’ words. For the analyses, VOSViewer 1.6.13. version was used.&#x0D; Results: The most cited publications on pediatric caudal anesthesia were in the following journals: Pediatric Anesthesia (84 articles, 1892 citations), Anesthesia and Analgesia (26 articles, 884 citations) and Anesthesiology (7 articles, 537 citations). The countries that publish and receive the most citations about pediatric caudal anesthesia starting from the highest are the USA, France, Sweden, Turkey, Canada.&#x0D; Conclusion: The following parameters were the foci of a thorough analysis of articles on pediatric caudal anesthesia: publication date, number of citations, journal name, theme, and country. It is noteworthy that pediatric caudal anesthesia currently plays a crucial role in pediatric anesthesia research. However, there is still a need for new studies from different countries on different cases in the literature on pediatric caudal anesthesia.

Paracetamol and ibuprofen combination for the management of acute mild-to-moderate pain in children: expert consensus using the Nominal Group Technique (NGT)

BackgroundAcute pain is a common symptom in children of all ages, and is associated with a variety of conditions. Despite the availability of guidelines, pain often remains underestimated and undertreated. Paracetamol and ibuprofen are the most commonly used drugs for analgesia in Pediatrics. Multimodal pain management by using a combination of paracetamol and ibuprofen results in greater analgesia.MethodsAn investigation using the Nominal Group Technique was carried out between May and August 2022. Two open (non-anonymous) questionnaires were consecutively sent to a Board of ten clinicians to understand their opinions on the use of the oral paracetamol and ibuprofen association. Answers were examined in a final meeting where conclusions were drawn.ResultsThe board achieved a final consensus on a better analgesic power of paracetamol and ibuprofen in fixed-dose combination as compared to monotherapy, without compromising safety. Strong consensus was reached on the opinion that the fixed-dose combination of paracetamol and ibuprofen may be a useful option in case of inefficacy of one or other drug as monotherapy, especially in case of headaches, odontalgia, earache, and musculoskeletal pain. The use of the fixed combination may be also considered suitable for postoperative pain management.ConclusionsThe use of the fixed-dose combination may represent advantage in terms of efficacy and safety, allowing a better control of the dose of both paracetamol and ibuprofen as monotherapy, thus minimizing the risk of incorrect dosage. However, the limited evidence available highlights the need for future well designed studies to better define the advantages of this formulation in the various therapeutic areas.

Age-Stratified Propofol Dosage for Pediatric Procedural Sedation and Analgesia.

Procedural sedation and analgesia (PSA) for diagnostic and minimally invasive therapeutic procedures has become common practice in children of all ages. Based on our clinical experience, we suspected an inverse relation between age and dosage. However, a schedule for age-stratified propofol induction and maintenance dosage for PSA was not available and could be helpful to many anesthesiologists as a reference. We performed a retrospective cohort study of children who received procedural sedation at the Wilhelmina Children's Hospital (WKZ), a tertiary pediatric hospital part of the University Medical Center Utrecht (UMCU), between June 2007 and December 2020. We studied whether the induction (mg·kg -1 ) and maintenance (mg·kg -1 ·h -1 ) dosage is age-dependent using linear regression models. A total of 6438 pediatric procedures were retrieved from Anesthesia Information Management Systems (AIMS). A total of 5567 records were available for induction dose analysis and 5420 records for analysis of the maintenance dose. After adjustment for sex, American Society of Anesthesiologists (ASA) physical status classification, opioid administration, and diagnostic or interventional, we obtained a coefficient of -0.11 (95% confidence interval [CI], -0.12 to -0.11) for age (years) from a multivariable linear regression model for propofol induction dosage (mg·kg -1 ) and a coefficient of -0.36 (95% CI, -0.39 to -0.34) for age (years) for propofol maintenance dosage. We found a noteworthy inverse age-effect on propofol dosage for both induction and maintenance of pediatric procedural sedation. Furthermore, our study revealed that remarkably higher propofol sedation doses were needed for infants and toddlers than previously expected and reported.

A cross-sectional observation study to evaluate the efficacy and complications of epidural analgesia in paediatric population.

With advances in pediatric surgery, pediatric epidurals are increasingly being used for analgesia. As there is scarcity of data in India about the pediatric epidurals, we sought to determine the efficacy and complications of epidural analgesia. The aim of this study was to determine the efficacy of pediatric epidural analgesia and the incidence of complications aimed at improving the quality of care. It was a prospective observational study in tertiary care hospital in the Southern part of India. Newborns to children aged 18 years in whom continuous epidural analgesia was planned were recruited. They were followed up postoperatively at specified intervals wherein pain scores were used to determine analgesic efficacy. Complications were noted in a specified format and the level of satisfaction of patient and surgeon was noted objectively. All the statistical analyses were performed using SPSS 25.0. 100 children were recruited of which 63 received thoracic epidurals and 37 lumbar epidurals. Overall efficacy of epidural in pain management was 90.96% with the highest efficacy for lower abdominal epidurals (94.9%). Kinking of a catheter was the most common complication encountered (11%), followed by migration of catheter, occlusion of pump, and motor block. Continuous epidural analgesia has proven to be a safe and effective method to provide analgesia to the children in a protected environment and experienced hands.

Efficacy, safety and complication of epidural analgesia in pediatrics

For managing different types of pain, epidural analgesia is widely used in adults. Its application in children is less common and subject to discussion. This article seeks to investigate the evidence concerning the efficacy, safety, and potential complications of analgesia in patients. We analyzed randomized controlled trials, observational studies, and systematic reviews that compared analgesia to pain management methods or placebo for children undergoing surgery or experiencing acute or chronic pain. The findings indicated that epidural analgesia effectively reduced pain intensity and opioid consumption in children undergoing types of surgeries—especially thoracic, abdominal, and orthopedic procedures. Epidural analgesia has also been proven to create satisfaction and improve the quality of life for children experiencing cancer pain or sickle cell crisis. The use of analgesia may result in some side effects, like itchiness, feelings of nausea, vomiting, difficulty urinating, and low blood pressure. Serious complications such as hematoma, infection, nerve damage, or respiratory depression were occurrences. Affected less than 1% of patients. In summary, we conclude that epidural analgesia is an option for pain management as it offers relief with minimal risk of significant complications. Nonetheless, further high-quality studies are required to compare techniques, medications, and dosages of analgesia, specifically in children, while also evaluating its long-term outcomes.

Comparative Study between Dexmedetomidine and Magnesium Sulphate as Adjuvants to Bupivacaine for Caudal Analgesia in Pediatrics

Comparative Study between Dexmedetomidine and Magnesium Sulphate as Adjuvants to Bupivacaine for Caudal Analgesia in Pediatrics

Virtual Reality Animal Rescue World: Pediatric virtual reality analgesia during just noticeable pressure pain in children aged 2-10 years old (crossover design).

Excessive pain during medical procedures is a worldwide medical problem. Most scald burns occur in children under 6, who are often undermedicated. Adjunctive Virtual Reality (VR) distraction has been shown to reduce pain in children aged 6-17, but little is known about VR analgesia in young children. This study tests whether desktop VR (VR Animal Rescue World) can reduce the just noticeable pressure pain of children aged 2-10. A within-subject repeated measures design was used. With treatment order randomized, each healthy volunteer pediatric participant underwent brief cutaneous pressure stimuli under three conditions: (1) no distraction, (2) a verbal color naming task (no VR), and (3) a large TV-based desktop VR distraction. A hand-held Wagner pressure pain stimulation device was used to generate just noticeable pain sensations. Participants indicated when a steadily increasing non-painful pressure stimulus first turned into a painful pressure sensation (just noticeable pain). A total of 40 healthy children participated (43% aged 2-5 years; and 57% aged 6-10 years). Compared to the no distraction condition, the 40 children showed significant VR analgesia (i.e., a significant reduction in pain sensitivity during the VR Animal Rescue World condition), t(39) = 9.83, p < 0.001, SD = 6.24. VR was also significantly more effective at reducing pain sensitivity vs. an auditory color naming task, t(39) = 5.42, p < 0.001, SD = 5.94. The subset of children aged 2-5 showed significant reductions in pain during VR. Children under 6 showed greater sensitivity to pain during no distraction than children aged 6-10. During no distraction, children under 6 years old were significantly more sensitive to pain than children aged 6-10. Virtual reality (VR) significantly reduced the "just noticeable" pressure pain sensitivity of children in both age groups.