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Comparison of adjuvant pharmaceuticals for caudal block in pediatric lower abdominal and urological surgeries: A

Chang Xiong1, Chengpeng Han2, Huayan Lv1

  • 1Department of Anesthesiology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, Zhejiang Province, People's Republic of China.

Journal of Clinical Anesthesia
|June 21, 2022
PubMed

Insights

Dexmedetomidine and dexamethasone are effective caudal adjuvants for pediatric surgery, prolonging analgesia without complications. Neostigmine also prolongs pain relief but increases nausea and vomiting risk.

Area of Science:

  • Pediatric Anesthesiology
  • Pharmacology
  • Pain Management

Background:

  • Caudal blocks provide pain relief after pediatric surgery but have limited duration.
  • Adjuvant agents can extend the analgesic effect of local anesthetics (LAs) in caudal blocks.
  • Optimizing adjuvant use is crucial for prolonged postoperative analgesia in children.

Purpose of the Study:

  • To compare the efficacy and safety of various caudal adjuvants for pediatric lower abdominal and urological surgeries.
  • To identify the most effective adjuvants for prolonging postoperative analgesia.
  • To evaluate the side effect profiles of different caudal adjuvants.

Main Methods:

  • A network meta-analysis (NMA) was conducted.
  • Included 112 randomized controlled trials (RCTs) with 6800 pediatric patients.
  • Analyzed adjuvants including clonidine, dexamethasone, dexmedetomidine, fentanyl, ketamine, magnesium, midazolam, morphine, neostigmine, and tramadol.

Main Results:

  • Neostigmine, dexmedetomidine, and dexamethasone were the most effective adjuvants for prolonging analgesia.
  • These agents extended analgesia duration by 8.9h, 7.3h, and 5.9h, respectively.
  • Dexmedetomidine and dexamethasone had no significant postoperative complications, unlike neostigmine (increased nausea/vomiting).

Conclusions:

  • Dexmedetomidine and dexamethasone show promise as beneficial caudal adjuvants in pediatric anesthesia.
  • Further high-quality RCTs are needed to confirm efficacy and assess long-term safety, especially regarding off-label use.
  • These adjuvants may offer improved pain management strategies for pediatric surgical patients.
Abstract

Keywords:
Adjuvant pharmaceuticalsAnalgesiaCaudalChildrenNetwork meta-analysisPostoperative pain

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