New insights into paediatric regional anaesthesia: new drugs (original) (raw)
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journal of Medical Science And clinical Research, 2019
Caudal epidural block is one of the most common regional anesthetic techniques in children being used to supplement general anesthesia for a wide variety of surgeries. The local anesthetics currently in use are safe and their pharmacological effects have been well evaluated. The aim of this study is to clinically evaluate the efficacy of caudal epidural clonidine in prolonging the post-operative analgesia when mixed with ropivacaine in children and to compare the post-operative pain-free duration and the side effects of ropivacaine with or without Clonidine. The addition of α-2 agonist, Clonidine to local anesthetic solution 0.2% ropivacaine has been shown to enhance the duration and quality of central and peripheral nerve blocks. The main advantage of Clonidine (versus opioids) is the negligible risk of respiratory depression.
Kathmandu University Medical Journal, 2013
Background Caudal epidural analgesia with bupivacaine is very popular in paediatric anaesthesia for providing intra- and postoperative analgesia. Several adjuvants have been used to prolong the action of bupivacaine. Objectives To compare the efficacy of ketamine, fentanyl and clonidine in terms of quality and duration of analgesia they produce when added with caudal bupivacaine by single shot technique in children. Methods Eighty children, age one to ten years, undergoing sub-umbilical surgery, were prospectively randomized to one of four groups: caudal analgesia with 0.75 ml/kg of 0.25% bupivacaine in normal saline (Group B) or caudal analgesia with 0.75 ml/kg of 0.25% bupivacaine with 1 μg/kg of clonidine in normal saline (Group BC) or caudal analgesia with 0.75ml/kg of 0.25% bupivacaine with ketamine 0.5mg/kg (Group BK) or caudal analgesia with 0.75ml/kg of 0.25% bupivacaine with fentanyl 1mcg/kg (Group BF). Post-operative pain was assessed for 24 hours using the FLACC scale. Re...
Postoperative analgesia in children when using clonidine or fentanyl with ropivacaine given caudally
Journal of Anaesthesiology Clinical Pharmacology, 2011
Background: Background: The aim of the study was to compare the efficacy of clonidine and fentanyl as an additive to ropivacaine given via single shot caudal epidural in pediatric patients for postoperative pain relief. Materials and Methods: Materials and Methods: In the present double blind study, 90 children of ASA-I-II aged 3-8 years scheduled for infraumblical surgical procedures were randomly allocated to two groups to receive either ropivacaine 0.25% 1 ml/kg + clonidine 2 mg/kg (group I) or ropivacaine 0.25% 1 ml/kg + fentanyl 1 mg/kg (group II). Caudal block was performed after the induction of general anesthesia. Postoperatively patients were observed for analgesia, sedation, hemodynamics, and side effects/complications. Results: Results: Both the groups were similar with respect to patient and various block characteristics. The analgesic properties and hemodynamics were also comparable in both groups (P > 0.05). Side effects such as respiratory depression, vomiting bradycardia were significantly less in group I than group II (P < 0.05) ensuing more patient comfort. Conclusions: Conclusions: The analgesic properties of clonidine and fentanyl as additives to ropivacaine in single shot caudal epidural in children are comparable but clonidine offers a more favorable side effect profile. The use of clonidine as additive to ropivacaine in caudal epidural is superior choice to fentanyl because of lack of unwanted side effects and increased patient comfort.
Background & Objectives: Spinal anaesthesia reduces the incidence of morbidity that follows general anaesthesia in children with good efficacy and safety record. Racemic bupivacaine is the widely used local anaesthetic for paediatric spinal anaesthesia. Local anaesthetic levobupivacaine has an equivalent potency to that of racemic bupivacaine but with a greater safety margin. Limited duration of surgical anaesthesia is however, one of the major deterrents for widespread use of spinal anesthesia in children. Clonidine lengthens spinal anaesthesia in adults and in children. We conducted a prospective, randomized clinical trial to study the effect of the addition of clonidine to 0.5% isobaric levobupivacaine induced spinal anaesthesia in children undergoing infra-umbilical procedures. Methods: Sixty patients between 5 to 10 years, posted for infra-umbilical surgeries were given spinal anaesthesia with either 0.5% plain isobaric levobupivacaine (5-15 kg – 0.4 mg/kg, 15-40 kg – 0.3 mg/kg) or levobupivacaine (5-15 kg – 0.4 mg/kg, 15-40 kg – 0.3 mg/kg) with clonidine (1μg/kg). Blockade characteristics and duration of analgesia were recorded along with mean arterial pressure, heart rate, respiratory rate and SpO2. Results: Satisfactory surgical anaesthesia was achieved in all 60 patients with comparable mean arterial pressure, heart rate, respiratory rate and SpO2. Block extension was 2 segments higher in patients given intrathecal clonidine. Duration of spinal anaesthesia (2 segment regression) increased from (90.3 ± 7.2 min) in the control group to (143.5 ± 8.7 min) in the group receiving clonidine 1μg/kg (p<0.001) and postoperative analgesia from 228 ± 14 min to 360 ± 31min (p<0.001). Sedation was the most common side effect observed in children receiving intrathecal clonidine. Conclusion: We conclude that clonidine 1μg/kg provides a significant improvement in spinal anesthesia and analgesic duration without undesirable side-effects.
Journal of Anaesthesiology Clinical Pharmacology, 2012
The use of clonidine as an adjuvant to ropivacaine in different concentrations through the caudal space has been shown to improve the analgesic efficacy of local anesthetics. Aims: Aims: The purpose of our study was to compare the efficacy of ropivacaine 0.1% with clonidine 1 mcg/kg to that of plain 0.1% and 0.2% ropivacaine for caudal analgesia in children. Settings and Design: Settings and Design: Prospective, double blind, randomized controlled trial. Materials and Methods: Materials and Methods: Sixty children in the age group of 1-6 years undergoing subumbilical surgeries were included in the study. Group A received 1 ml/kg of 0.1% ropivacaine, group B received 1 ml/kg of 0.1% ropivacaine with clonidine 1 mcg/ kg, and group C received 1 ml/kg of 0.2% ropivacaine. Results: Results: The mean duration of analgesia was 243.7 ± 99.29 min in group A, 590.25 ± 83.93 min in group B, and 388.25 ± 82.35 min in group C. The duration of analgesia was significantly prolonged in group B compared to groups A and C with the P value of 0.001. At 8 h, all the 20 children in group A had received the first rescue analgesic compared to 18 children in group C and 3 children in group B. The duration of motor blockade after extubation was 30.6 ± 7.8 min and was noted only in group C. Only 1 child in group B received two rescue medications compared to 15 (75%) children in group A and 8 (40%) children in group C. None of the groups were treated for bradycardia or hypotension and no significant sedation was noted. Conclusions: Conclusions: Clonidine 1 mcg/kg with ropivacaine 0.1% prolongs the duration and quality of analgesia compared to plain ropivacaine 0.1% and 0.2% without any significant sedation.
Comparison of ropivacaine and bupivacaine with fentanyl for caudal epidural in pediatric surgery
Anesthesia: Essays and Researches, 2013
Context: Ropivacaine, s-enantiomer of amide local anaesthetic produces differential neural blockade with less motor blockade, cardiovascular and neurological toxicity makes it suitable for day case surgery in children. Aims: To compare the effectiveness of Inj. Ropivacaine (0.2 or 0.25%) or Inj. Bupivacaine (0.25%) with fentanyl in caudal block for intra and postoperative analgesia. Settings and Design: Double blind retrospective randomized study. Materials and Methods: All the patients (n=112) varying from age group 3.02 ± 3.29 years belonging to ASA I-IV were randomly allocated to receive caudal analgesia Group BF inj. Bupivacaine (0.25%, 2 mg/kg) + Inj. Fentany1 µg/kg (n=70) and group RF: Inj. Ropivacaine (0.25% or 0.2%, 2 mg/kg) + inj. Fentanyl 1 µg/kg (n=42).We monitored vitals and requirement of inhalational gases inraoperatively and also observed pain by pain score (Visual Analogue Score in verbal group and Objective Pain Scale in nonverbal group) and vitals postoperatively. We used rescue analgesics (inj. Paracetamol 5 mg/kg iv) when VAS score ≥4. Statistical Analysis: Student's t-test. Results: Duration of analgesia was prolonged in both group RF and BF. Time for first rescue analgesic for group RF (6.1 ± 1.1 hr) compared to group BF (5.6 ± 0.9 hr). Haemodynamic stability and less requirement of inhalation agent intraoperatively with group RF than others. Conclusions: Ropivacaine with Fentanyl found to be better combination for pediatric surgeries for below umbilical surgeries as an adjuvant to general anaesthesia or sole technique with chances of less complication with high success rate.
Medical Research Archives
Pediatric anesthesia is a specialized subset of general anesthesia that differs in several important ways from adult anesthesia. This field focuses on the routine care of neonates, infants, children and adolescents and includes a thorough preoperative evaluation, patient and parent preparation, induction of anesthesia, maintenance of anesthesia and emergence from anesthesia There are important differences pharmacodynamics and pharmacokinetics that must be considered and a thorough understanding of the differences between anesthesia in children and adults. In this review these important differences between pediatric anesthesia and adult anesthesia are discussed. The present investigation also describes relevant pharmacology and the techniques required for the preparation, intubation, induction of anesthesia, and maintenance of anesthesia in pediatric patients. Finally, newer drug considerations in the pediatric population, such as magnesium sulfate as an adjuvant drug and albuterol for children undergoing tonsillectomy, are reviewed.
Journal of Nepal Paediatric Society, 2013
Introduction: The purpose of the study was to compare the analgesic quality and duration of Ropivacaine 0.2% with the addition of Fentanyl (1 mcg/kg) with that of Ropivacaine 0.2% and the addition of Ketamine (0.5 mg/kg) and also compare the post complications. Materials and Methods: Ninety children, age one to ten years, undergoing sub-umbilical surgery, were prospectively randomized to one of three groups: caudal analgesia with 0.75 ml/kg of 0.2% Ropivacaine in normal saline (Group R) or caudal analgesia with 0.75 ml/kg of 0.2% Ropivacaine with Ketamine 0.5 mg/kg (Group RK) or caudal analgesia with 0.75 ml/kg of 0.2% Ropivacaine with Fentanyl 1 mcg/kg (Group RF). Post-operative pain was assessed for 24 hours using the FLACC scale. Results: The mean duration of analgesia was significantly longer in Group RK (629.06 ± 286.32 min) than other two groups P < 0.05. The pain score assessed using FLACC scale was compared between the three groups, and children in Group RK had lower pain...
Objective: Caudal block has gained much popularity in the past few decades to provide analgesia in pediatric population. Although local anesthetic agents remain the mainstay for caudal blocks, addition of additives to the solution improves quality and duration of analgesia and reduces the toxicity by allowing lower concentrations of the local anesthetic agents. In this regard opioids have been studied extensively, but there is not much comparative research about caudal clonidine. The aim of our current study was to compare the caudal block characteristics of ropivacaine 0.25% with clonidine 1 µg/ kg versus ropivacaine 0.25% with fentanyl 1µg/kg in pediatric patients. Methodology: A total of 60 ASA 1 children of either gender, age from 2 to 10 years, weighing 10 to 30 kg, scheduled for lower abdominal or limb surgery, were enrolled for this study. Children were randomly allocated into 2 equal groups. Group RF received 1 ml/kg of ropivacaine 0.25% plus fentanyl 1μg/kg via caudal route. Group RC received 1 ml/ kg of ropivacaine 0.25% plus clonidine 1 µg/kg via same route. All children were administered general anesthesia followed by caudal block for postoperative analgesia. Duration of analgesia, sedation score and any side effects were noted. Calculation of sample size was done by using power analysis. The non-parametric data comparison was done by Student's t-test. Results: Duration of analgesia was significantly prolonged in RC group. Dose requirement for rescue analgesia was significantly lesser in group RC. There was no significant difference between both groups for hemodynamic response after caudal block. The incidence of side effects were not significant. Conclusion: In conclusion clonidine and fentanyl, both improve the quality of analgesia when used with ropivacaine in caudal block in pediatric patients, but the quality of analgesia and duration with clonidine plus ropivacaine is superior to fentanyl plus ropivacaine. Citation: Khatavkar SS, Lonkar SS, Panchal PB, Thatte WS, Nagendra S, Tewari D. The efficacy of ropivacaine-fentanyl versus ropivacaine-clonidine for pre-emptive caudal anesthesia in children. Anaesth Pain & Intensive Care 2016;20(1):54-58
Pediatric Regional Anesthesia: A Review and Update
Current Anesthesiology Reports, 2017
Purpose of Review This review summarizes the main regional anesthesia techniques currently in use for pediatric patients and identifies the recent evidence for their safety and efficacy. Recent Findings The Pediatric Regional Anesthesia Network (PRAN) database with over 115,000 documented nerve blocks has addressed the question of safety for a variety of techniques. PRAN has demonstrated that caudal epidural blocks, interscalene brachial plexus blocks, transversus abdominus plane (TAP) blocks, and neonatal caudal catheters have been routinely performed under general anesthesia in the pediatric population without significant report of adverse events. Randomized controlled trials have shown that paravertebral catheters perform favorably compared to thoracic epidurals for thoracic procedures without the side effects of hypotension and urinary retention. Summary Pediatric nerve blocks continue to grow as the new standard for pediatric pain control. Concerns about performance of blocks under general anesthesia have largely been eliminated now that ultrasound guided blocks are routine. New horizons include truncal blocks including TAP, quadratus lumborum, paravertebral blocks, and catheters as well as increasing performance of extremity blocks, even in the setting of trauma.