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Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva

Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
Indexed/Abstracted in: Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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Minerva Anestesiologica 2018 Feb 22

DOI: 10.23736/S0375-9393.18.12523-5


lingua: Inglese

Dexmedetomidine as an adjunct for caudal anaesthesia and analgesia in children: a review

Mehdi TRIFA 1, 2 , Dmitry TUMIN 1, 4, Joseph D. TOBIAS 1, 3, 4

1 Department of Anaesthesiology & Pain Medicine, Nationwide Children’s Hospital, Columbus, Ohio; 2 Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia; 3 Department of Anaesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, Ohio; 4 Department of Paediatrics, The Ohio State University College of Medicine, Columbus, Ohio


BACKGROUND: The aim of this review was to evaluate the current evidence regarding the use of dexmedetomidine as an adjuvant to local anaesthetic agents (LAA) for caudal blockade anaesthesia and analgesia in children.
METHODS: A literature search was performed of the Medline, Embase, and CINAHL databases using the keywords “dexmedetomidine” and “caudal”. We included all studies that used caudal dexmedetomidine as an adjuvant to a LAA in children, excluding case reports, reviews, expert opinions, and animal studies.
RESULTS: Twenty-one publications met the inclusion criteria and included 1590 children. Fourteen compared the efficacy of adding dexmedetomidine to a LAA alone and 7 compared dexmedetomidine to other adjuvants in combination with a LAA. The duration of postoperative analgesia was significantly longer in patients receiving a caudal epidural block with a LAA plus dexmedetomidine when compared to a LAA alone. Only one study demonstrated improved analgesia with a dose of dexmedetomidine ≥ 1 μg/kg. Dexmedetomidine provided longer postoperative analgesia than fentanyl and morphine, while the quality of postoperative analgesia was similar to dexamethasone or clonidine. Although higher sedation scores were associated with caudal dexmedetomidine in the majority of the trials, postoperative behaviour scores were improved in these children. There were no reports of respiratory depression. Significant hemodynamic effects were uncommon, and occurred most commonly in patients receiving a higher dose of caudal dexmedetomidine (2 μg.kg-1).
CONCLUSIONS: There is sufficient evidence to recommend the addition of caudal dexmedetomidine to the LAA in patients undergoing lower extremity and infra-umbilical surgical procedures.

KEY WORDS: Caudal anaesthesia - Dexmedetomidine - Paediatrics - Postoperative regional analgesia

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Publication History

Article first published online: February 22, 2018
Manuscript accepted: February 21, 2018
Manuscript revised: January 22, 2018
Manuscript received: October 27, 2017

Per citare questo articolo

Trifa M, Tumin D, Tobias JD. Dexmedetomidine as an adjunct for caudal anaesthesia and analgesia in children: a review. Minerva Anestesiol 2018 Feb 22. DOI: 10.23736/S0375-9393.18.12523-5

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