Perioperative Analgesia In Children Research Articles

Supraklavikularni blok sa perineuralnim kateterom kod deteta sa dvostrukim prelomom lakta i podlaktice - prikaz slučaja

Introduction: Ultrasound-guided supraclavicular block with perineural catheter placement has enabled a significant reduction in block-related complications, as well as far better perioperative pain management. Case report: A 9-year-old boy was admitted for a combined forearm/elbow fracture, with a history of laryngitis. As a result, we opted to perform an ultrasound-guided supraclavicular brachial plexus block under procedural sedation, with the placement of a perineural catheter. We used 25 mL of 0,5% Levobupivacaine. Orthopedic repositioning and internal fixation were performed under procedural sedation and the supraclavicular block with monitoring of basic vital parameters. Throughout the procedure, the patient maintained hemodynamic and respiratory stability, and the pain was postoperatively managed with a continuous Levobupivacaine infusion at 0,2-0,5 mg/kg/h. The patient was discharged on the fifth postoperative day. Discussion: Although information is limited regarding peripheral nerve block in the pediatric population their use in adults is well established, as is a higher degree of skill necessary for their administration in children due to clear anatomic nuance. The utilization of peripheral nerve blocks reduces the incidence of postoperative nausea and vomiting, as well as the use of opioid or nonopioid rescue analgesia. Their benefit is additionally underlined by the fact that adequate postoperative analgesia can reduce exaggerated responses to pain later in life. Conclusion: Ultrasound-guided supraclavicular brachial plexus block with placement of a perineural catheter provides safe and effective perioperative analgesia in children with fractures at or below the level of the humerus.

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).

Effect of transcutaneous electrical acupoint stimulation on postoperative pain in pediatric orthopedic surgery with the enhanced recovery after surgery protocol: a prospective, randomized controlled trial

Study objectiveTo evaluate the safety and effectiveness of transcutaneous electrical acupoint stimulation (TEAS) in postoperative analgesia following pediatric orthopedic surgery with the enhanced recovery after surgery (ERAS) protocol. DesignProspective randomized controlled trial. SettingThe Seventh Medical Center of the Chinese People’s Liberation Army General Hospital. ParticipantsEligible participants were children aged 3–15 years who were scheduled to undergo orthopedic surgery of the lower extremities under general anesthesia. InterventionsA total of 58 children were randomly allocated into two groups: TEAS (n = 29) and sham-TEAS (n = 29). The ERAS protocol was used in both groups. In the TEAS group, the bilateral Hegu (LI4) and Neiguan (PC6) acupoints were stimulated starting from 10 min before anesthetic induction until the completion of surgery. In the sham-TEAS group, the electric stimulator was also connected to the participants; however, electrical stimulation was not applied. MeasuresThe primary outcome was the severity of pain before leaving the post-anesthesia care unit (PACU) and at postoperative 2 h, 24 h, and 48 h. Pain intensity was measured with the Faces Pain Scale-Revised (FPS-R). ResultsNone of the participants had any TEAS-related adverse reactions. In comparison with the sham-TEAS group, FPS-R scores in the TEAS group were significantly decreased before leaving the PACU and at postoperative 2 h and 24 h (p < 0.05). The incidence of emergence agitation, intraoperative consumption of remifentanil, and time to extubation were significantly reduced in the TEAS group. Furthermore, the time to first press of the patient-controlled intravenous analgesia (PCIA) pump was significantly longer, the pressing times of the PCIA pump in 48 h after surgery was significantly decreased, and parental satisfaction was significantly improved (all p < 0.05). ConclusionTEAS may safely and effectively relieve postoperative pain and reduce the consumption of perioperative analgesia in children following orthopedic surgery with the ERAS protocol. Trial registrationChinese Clinical Trial Registry (ChiCTR2200059577), registered on May 4, 2022.

Efficacy of perioperative analgesia in children with anorectal malformations

Efficacy of perioperative analgesia in children with anorectal malformations

Acetaminophen pharmacokinetics in infants and children with congenital heart disease.

Acetaminophen is routinely used for perioperative analgesia in children undergoing major surgical procedures. There are few estimates of acetaminophen pharmacokinetic parameters in children with congenital heart disease, especially those with cyanotic heart disease. The current study prospectively investigated differences in acetaminophen pharmacokinetics following surgery using cardiopulmonary bypass in children with cyanotic and acyanotic congenital heart disease. Children (2-6 years, 9-23 kg) presenting for median sternotomy for Fontan palliation (cyanotic patients) or two ventricle surgical repair (acyanotic patients) were eligible for inclusion. A single intravenous dose of acetaminophen (15 mg/kg) was administered at the start of sternal closure after separation from cardiopulmonary bypass. The time-course of acetaminophen concentrations were described using non-linear mixed effects models. One and two-compartment disposition models with first-order elimination were tested. Pharmacokinetic parameter estimates were scaled using allometry and standardized to a 70 kg person. There were 208 acetaminophen concentrations assayed from 30 children, 15 with cyanotic, and 15 with acyanotic heart disease. A 2-compartment model best described acetaminophen PK. Parameter estimates (population parameter variability, PPV%; 95% confidence interval, CI) were clearance CL 15.3L.h-1.70 kg-1 (22.2%; 13.8-16.7), intercompartment clearance Q 45.4L.h-1.70 kg-1 (22.4%; 25.2-61.9), central volume of distribution V1 33.5L.70 kg-1 (23.2%; 25.9-38.8), peripheral volume of distribution V2 32.1L.70 kg-1 (21.7%; 25.9-38.8). Neither clearance nor volume parameters differed between cyanotic and acyanotic patients. Acetaminophen pharmacokinetics were characterized using a 2-compartment model with first-order elimination following cardiac bypass surgery in children. Population pharmacokinetic parameter estimates were similar to other studies in children. No differences were detected between patients with cyanotic and acyanotic heart disease.

Dexmedetomidine and perioperative analgesia in children.

Dexmedetomidine (DEX) is an anaesthetic agent that mimics natural deep sleep and produces minimal cardiorespiratory depression. As such, it is a very valuable option in the management of such a challenging population as paediatric patients. The main objective of this mini review was to evaluate the role of DEX as a perioperative analgesic in children receiving anaesthesia. We searched Google, Pubmed, Embase and the Cochrane Library for articles published between 2010 and 2021, and reviewed various of aspects of DEX, such as pharmacology, effectiveness, safety, and the most recent evidence on its clinical use as an analgesic in paediatric anaesthesia. We also include a cost estimate of perioperative analgesia with DEX.

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).

Postoperative analgesic effects of the quadratus lumborum block III and transversalis fascia plane block in paediatric patients with developmental dysplasia of the hip undergoing open reduction surgeries: a double-blinded randomised controlled trial

ObjectiveTo evaluate the analgesic effectiveness of two novel regional nerve blocks in paediatric patients with developmental dysplasia of the hip (DDH) after open reduction surgeries.DesignProspective, double-blinded, randomised controlled trial.Setting2 tertiary...

A comparison of bupivacaine with or without tramadol in caudal epidural block for postoperative caudal analgesia in children undergoing lower abdominal surgery under general anesthesia

Background and Objective: Millions of children receive sedative, anesthetic and analgesic drugs for surgery worldwide. Caudal epidural block with bupivacaine is widely used for perioperative analgesia in children undergoing surgeries under general anesthesia. Current study aims to determine postoperative pain relief and side effects due to caudally administered 0.25% bupivacaine (0.5-1 ml/kg) alone and a combination of 0.25% bupivacaine (0.5-1 ml/kg) with tramadol (1 mg/kg).Methodology: A randomized clinical trial was conducted at department of Anesthesiology, Shaikh Zayed Hospital, Lahore. Study duration was 1 year and 6 months (February 2015-August 2016). A sample size of 108 patients was calculated using WHO calculator. Non probability consecutive sampling was used. Patients were randomly divided into two groups; Group B was given inj. bupivacaine 0.25% while Group BT received a combination of 0.25% bupivacaine (0.5-1 ml/kg) with tramadol (1 mg/kg). Patients were observed for sedation score, FLACC pain score and adverse effects in both interventional groups. Data were analyzed using SPSS version 22. Student’s T-test was applied on data. P-value ≤ 0.05 was considered significant.Results: Total 108 patients were included in the study (1:1 randomization). Mean age of patients was 6.41 ± 1.77 y. There were 92 (85.2%) male and 16 (14.8%) female children. Mean sedative scores (p = 0.00) and mean FLACC pain scores (p = 0.000) were significantly lower in bupivacaine tramadol group as compared to bupivacaine group. However, bupivacaine group had more adverse effects as compared to combination of bupivacaine and tramadol group. Conclusion: Caudal epidural with a combination of 0.25% bupivacaine (0.5-1 ml/kg) with tramadol (1 mg/kg) has high postoperative analgesic efficacy and limited adverse effects as compared to 0.25% bupivacaine alone in children undergone general anesthesia for lower abdominal surgery.

Bilateral greater palatine nerve block for perioperative analgesia in children undergoing palatoplasty

Background The aim of this study is to evaluate the efficacy of greater palatine nerve block for perioperative analgesia in children undergoing palatoplasty.Patients and methods This prospective randomized double-blinded study was carried out on 40 patients in Alexandria Main University Hospital scheduled for cleft palate repair. General anaesthesia was induced to all children. Patients were randomly categorized into two equal groups. Group A patients received no block (control group), whereas group B patients received bilateral greater palatine nerve block with 2 ml of 0.25% bupivacaine, 1 ml on each side, before surgical stimulation. Vital signs, time to postanaesthesia awakening, time to first cry and time to feed were recorded. Children and Infants Postoperative Pain Scale (CHIPPS) was used for scoring, and first dose and total dose of analgesic were recorded.Results There were significantly lower postoperative heart rate, mean arterial blood pressure and CHIPPS values in group B than in group A. First dose of diclofenac sodium was given at 1 h postsurgery in group A and at 8 h postsurgery in group B. Total dose of postoperative analgesic requirements was significantly lower in group B (22.73±6.20 mg) than in group A (32.40±3.84 mg) (P≤0.001). The time to postanaesthesia awakening, time to first feed and time to first cry were significantly shorter in group B than in group A (P≤0.001).Conclusion Bilateral greater palatine nerve block provided adequate perioperative analgesia up to 8 h postsurgery, less postoperative analgesic requirements and it shortened the time to postanaesthesia awakening, time to first cry and time to feed.

Analgesic efficacy of dexamethasone as an adjuvant to caudal bupivacaine for infraumbilical surgeries in children: A prospective, randomized study.

Background and Aims:Provision of adequate perioperative analgesia in children is important to attenuate the stress response to surgery. Caudal analgesia using local anesthetics is a traditionally used technique but provides a limited duration of analgesia. Several adjuvants can be added to local anesthetics to increase the duration of action. This study was undertaken to evaluate the efficacy of dexamethasone added to bupivacaine for caudal block in children.Material and Methods:This was a prospective, double-blinded trial on 130 children aged between 6 months and 6 years of age allocated randomly into one of two groups for elective subumbilical surgeries. Children in Group C received caudal bupivacaine and those in Group D received caudal bupivacaine with 0.1 mg/kg of dexamethasone.Results:The mean duration of analgesia when dexamethasone was added to caudal bupivacaine was 1044.92 (±48.66) min, while it was 435.85 (±17.95) min with plain bupivacaine. The number of doses of rescue analgesics required and the mean pain score was also lesser in this group.Conclusion:The addition of 0.1 mg/kg of dexamethasone to caudal bupivacaine increases the duration of analgesia of caudal bupivacaine without any side effects in children undergoing subumbilical surgeries.

Evaluation of caudal block with dexmedetomidine mixed with lidocaine for management of perioperative analgesia in children

Objective To evaluate the efficacy of caudal block with dexmedetomidine mixed with lidocaine for management of perioperative analgesia in children. Methods Thirty pediatric patients, aged 2-6 yr, weighing 8-23 kg, scheduled for elective unilateral high ligation of hernial sac, were equally and randomly assigned into either lidocaine group (group L) or dexmedetomidine mixed with lidocaine group (group DL) using a random number table.Each patient received a single caudal dose of 1% lidocaine 1 ml/kg in group L. Each patient received a single caudal dose of 1% lidocaine 1 ml/kg mixed with dexmedetomidine 1 μg/kg in group DL.Postoperative analgesia was assessed using FLACC scale.When FLACC score ≥4, ibuprofen suspension 10 mg/kg was given orally.The consumption of ibuprofen was recorded within 8 h after operation.The onset time of caudal block and duration of analgesia were recorded, and adverse effects were observed. Results Compared with group L, the onset time of caudal block was significantly shortened, the duration of analgesia was prolonged, and the requirement for ibuprofen was decreased in group L. There was no significant difference in adverse effects between the two groups. Conclusion Addition of dexmedetomidine 1 μg/kg to caudal lidocaine can significantly optimize the efficacy of caudal block with lidocaine alone for the management of perioperative analgesia in children. Key words: Dexmedetomidine; Lidocaine; Anesthesia, caudal; Child; Analgesia

Evaluation of caudal block with dexmedetomidine mixed with ropivacaine for management of perioperative analgesia in children

Objective To evaluate the efficacy of caudal block with dexmedetomidine mixed with ropivacaine for the management of perioperative analgesia in children. Methods Sixty pediatric patients, aged 1-5 yr, of ASA physical status Ⅰ or Ⅱ, scheduled for elective hypospadias repair, were equally and randomly assigned into 2 groups using a random number table: ropivacaine group (group R) and dexmedetomidine mixed with ropivacaine group (group DR). Each patient received a single caudal dose of 0.25% ropivacaine 1 ml/kg in group R. Each patient received a single caudal dose of 0.25% ropivacaine 1 ml/kg mixed with dexmedetomidine 2 μg/kg in group DR. Postoperative analgesia was assessed using FLACC scale, and the degree of motor block was assessed using modified Bromage scale within 24 h after the end of operation. The duration of analgesia (the time from onset of caudal block to first requirement for the rescue analgesic) and development of side effects were recorded. Results Compared with group R, the duration of analgesia was significantly prolonged, and the incidence of bradycardia and oversedation was increased in group DR. Hypoxemia, hypotension and postoperative motor block were not found in either group. Conclusion Addition of dexmedetomidine 2 μg/kg to caudal ropivacaine can significantly optimize the efficacy of caudal block with ropivacaine alone for the management of perioperative analgesia in children. Key words: Anesthesia, caudal; Dexmedetomidine; Amides; Child; Analgesia

Ultrasound-guided trunk and core blocks in infants and children

Regional anesthetic techniques for perioperative analgesia in children are being increasingly utilized with the reported advantages of providing superior analgesia, decreasing opioid consumption, and reducing opioid-related adverse effects. The following article reviews the available literature regarding core and trunk blocks in infants and children; specifically, transversus abdominis plane, ilioinguinal/iliohypogastric nerve, rectus sheath, lumbar plexus, and paravertebral and intercostal nerve blockade. The common indications and potential complications and adverse effects for each block are presented. Additionally, the anatomy and techniques needed for their performance are reviewed. Finally, a summary of the relevant literature in relation to each peripheral nerve block technique is included.

Intrathecal Clonidine in the Neonatal Rat

Neuraxial clonidine is used for perioperative analgesia in children of all ages. Preclinical studies in the postnatal rat allow comparison of the relative toxicity and safety of spinal analgesics throughout postnatal development. Rat pups aged 3, 7, or 21 postnatal (P) days were briefly anesthetized for intrathecal injections of saline or clonidine. At each age, the maximum tolerated, antinociceptive (increased hindlimb mechanical withdrawal threshold) and antihyperalgesic (hindpaw carrageenan inflammation) doses were determined. Lumbar spinal cord sections were assessed for apoptosis and cell death (histology, activated caspase-3 immunohistochemistry, Fluoro-Jade C staining), histopathology (hematoxylin and eosin staining), and increased glial reactivity (microglial and astrocytic markers). P3 intrathecal ketamine sections served as positive controls. In additional groups, thermal latency and mechanical withdrawal threshold were measured at P35. Intrathecal clonidine produces age- and dose-dependent analgesia in rat pups. Maximal doses of clonidine did not alter the degree or distribution of apoptosis or increase glial reactivity in the neonatal spinal cord. No spinal histopathology was seen 1 or 7 days after injection at any age. Intrathecal clonidine did not produce persistent changes in reflex sensitivity to mechanical or thermal stimuli at P35. Intrathecal clonidine in the postnatal rat did not produce signs of spinal cord toxicity, even at doses much larger than required for analgesia. The therapeutic ratio (maximum tolerated dose/antihyperalgesic dose) was >300 at P3, >30 at P7, and >10 at P21. These data provide additional information to inform the clinical choice of spinal analgesic drug in early life.

Absence of perioperative analgesia in children with cerebral palsy: how justified is it?

Pediatric AnesthesiaVolume 22, Issue 2 p. 178-178 CORRESPONDENCE Absence of perioperative analgesia in children with cerebral palsy: how justified is it? Jeetinder K. Makkar, Jeetinder K. Makkar Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, IndiaSearch for more papers by this authorNarinder P. Singh, Narinder P. Singh Department of Anaesthesia and Pain Management, Alchemist Hospital, Chandigarh, India Email: jeet1516@gmail.comSearch for more papers by this author Jeetinder K. Makkar, Jeetinder K. Makkar Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, IndiaSearch for more papers by this authorNarinder P. Singh, Narinder P. Singh Department of Anaesthesia and Pain Management, Alchemist Hospital, Chandigarh, India Email: jeet1516@gmail.comSearch for more papers by this author First published: 02 January 2012 https://doi.org/10.1111/j.1460-9592.2011.03699.xCitations: 1Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume22, Issue2February 2012Pages 178-178 RelatedInformation

In reply: absence of perioperative analgesia in children with cerebral palsy: how justified is it?

In reply: absence of perioperative analgesia in children with cerebral palsy: how justified is it?

Sublethal Spinal Ketamine Produces Neuronal Apoptosis in Rat Pups

Sublethal Spinal Ketamine Produces Neuronal Apoptosis in Rat Pups

Pharmacogenetics and personalizing perioperative analgesia in children

Pharmacogenetics and personalizing perioperative analgesia in children

Comparison of sub-Tenon’s block with i.v. fentanyl for paediatric vitreoretinal surgery

Vitreoretinal (VR) surgery is associated with moderate to severe pain and significant postoperative nausea and vomiting (PONV). The study aimed to assess the effectiveness of sub-Tenon's block for providing perioperative analgesia in children undergoing VR surgery. In a randomized, observer-blinded trial, after obtaining institutional ethical committee approval and parental consent, 200 ASA grade I-II children aged 5-16 yr were allocated to receive either a sub-Tenon's block (Group SB) or 2 microg kg(-1) i.v. fentanyl (Group F) after induction of anaesthesia and topical anaesthesia of the conjunctiva with proparacaine 0.5% drops. Patients in Group F received fentanyl 0.5 microg kg(-1) and those in Group SB were given a corresponding volume of normal saline i.v. every hour from preloaded syringes. Increases in heart rate or mean arterial pressure by more than 20% of baseline were treated with additional 0.5 microg kg(-1) i.v. fentanyl boluses in both groups. The incidence of oculocardiac reflex (OCR), need for additional analgesics, postoperative pain, and PONV were recorded for the first 24 h after surgery. More patients in Group F (47.96%) had moderate to severe pain in the first 24 h when compared with Group SB (31.36%) (P=0.023). The need for postoperative ibuprofen was higher in Group F (66.3%) compared with Group SB (47.95%) (P=0.012). The incidence of OCR was significantly higher in Group F (31.6%) compared with Group SB (5.1%) (P<0.001). The incidence of PONV was similar in both groups. Sub-Tenon's block provides more effective analgesia than i.v. fentanyl for paediatric VR surgery.