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The Outcomes of Caudal or Intravenous Addition of Morphine and Clonidine into The Caudal Block Performed with Levobupivacaine In Children; A Retrospective Study

Yıl 2023, Cilt: 10 Sayı: 1, 34 - 41, 10.04.2023
https://doi.org/10.47572/muskutd.1088900

Öz

Ineffective post-operative pain management in children may be associated with chronic pain. 98 pediatric patients aged 6 months to 12 years who underwent caudal levobupivacaine for hypospadias surgery were evaluated retrospectively. The patients who received additional intravenous clonidine were added in group 1; the patients who received additional intravenous morphine were added in group 2, patients who received additional caudal clonidine was added in group 3, and patients who received additional caudal morphine was added in group 4. CHEOPS score was assessed 1, 6, 12 and 24 hours after the operation and patients with score 6 or higher were determined. At the 1st hour, there were 8 cases in the intravenous morphine group (40%), 5cases in the intravenous clonidine group (25%), and 3 cases in the caudal morphine group (15%). At the 12th hour, there were 5 cases in the intravenous morphine group (25%), 10 cases in the intravenous clonidine group (50%), and 4 cases in the caudal morphine group (20%). At the 24th hour, there were 10 cases in the intravenous morphine group (50%), 10 cases in the intravenous clonidine group (50%), 9 cases in the caudal morphine group (45%) and 2 cases in the caudal clonidine group (10%) (p<0.05). There was no difference between the groups in terms of sedation scores at all hours (p>0.05). The lowest pain scores at the 1st, 12th, and 24th hours were recorded in the caudal clonidine group. It had the lowest pain scores at 6 hours. By these methods, in favor of the clonidine group, we agreed that the analgesia lasts for approximately 12 hours postoperatively, so the postoperative stress that the children and their families have can be minimized.

Kaynakça

  • 1. Collins VJ. Principles of anesthesiology. Philadelphia. Lea Febiger, 1993;1317-49.
  • 2. Kayhan Z. Klinik Anestezi 3. Baskı. Logos yayıncılık 2004; 655-704.
  • 3. Friedrichsdorf SJ, Goubert L. Pediatric pain treatment and prevention for hospitalized children. Pain reports. 2020;5(1): e804.
  • 4. Cramton RE, Gruchala NE. Managing procedural pain in pediatric patients. Curr. Opin. Pediatr. 2012;24:530-8.
  • 5. Lee JY, Jo YY. Attention to postoperative pain control in children. Korean J Anesthesiol. 2014;66:183-8.
  • 6. Ecoffey C, Lacroix F, Giaufré E, et al. Epidemiology and morbidity of regional anesthesia in children: a follow‐up one‐year prospective survey of the French‐Language Society of Paediatric Anaesthesiologists (ADARPEF). Paediatr Anaesth. 2010;20(12):1061-9.
  • 7. Polaner DM, Taenzer AH, Walker BJ, et al. Pediatric Regional Anesthesia Network (PRAN): a multi-institutional study of the use and incidence of complications of pediatric regional anesthesia. Anesth Analg. 2012;115(6):1353-64.
  • 8. Dalens BJ. Regional anesthesia in children. İn: Miller RD. Ed., Anesthesia 5th Ed, Volume II, Philadelphia: Churchill Livingstone Inc. 2000:1549-85.
  • 9. Hansen TG, Henneberg SW, Walther‐Larsen S, et al. Caudal bupivacaine supplemented with caudal or intravenous clonidine in children undergoing hypospadias repair: a double‐blind study. Br J Anaesth. 2004;92:223-7.
  • 10. Xing M, Liang X, Li L, et al. Efficacy of caudal vs intravenous administration of α2 adrenoceptor agonists to prolong analgesia in pediatric caudal block: A systematic review and meta‐analysis. Paediatr Anaesth. 2020;30:1322-30.
  • 11. Wiegele M, Marhofer P, Lönnqvist PA. Caudal epidural blocks in paediatric patients: a review and practical considerations. Br J Anaesth. 2019;122:509-17.
  • 12. Karl HW, Tyler DC, Krane EJ. Respiratory depression after low-dose caudal morphine. Can J Anaesth. 1996;43:1065–7.
  • 13. Cucchiaro G, Adzick SN, Rose JB, et al. A comparison of epidural bupivacaine-fentanyl and bupivacaine-clonidine in children undergoing the Nuss procedure. Anesth Analg. 2006;103(2):322-7.
  • 14. Vetter TR, Carvallo D, Johnson JL, et al. A comparison of single-dose caudal clonidine, morphine, or hydromorphone combined with ropivacaine in pediatric patients undergoing ureteral reimplantation. Anesth Analg. 2007;104(6):1356-63.
  • 15. Bonisson ACM, Fernandes ML, Araújo GF, et al. Combination of clonidine-bupivacaine in caudal epidural anesthesia for hypospadias surgery in children: prospective, randomized, blind study☆. Rev Bras Anestesiol. 2019;69:27-34.
  • 16. Motsch J, Böttiger BW, Bach A, et al. Caudal clonidine and bupivacaine for combined epidural and general anaesthesia in children. Acta Anaesthesiol Scand. 1997;41(7): 877-83.
  • 17. Rauck RL, Eisenach JC, Jackson K, et al. Epidural clonidine treatment for refractory reflex sympathetic dystrophy. Anesthesiology. 1993;79(6):1163-9.
  • 18. Kaabachi O, Zerelli Z, Methamem M, et al. Clonidine administered as adjuvant for bupivacaine in ilioinguinal–iliohypogastric nerve block does not prolong postoperative analgesia. Paediatr Anaesth. 2005;15(7):586-90.
  • 19. Jamali S, Monin S, Begon C, et al. Clonidine in pediatric caudal anesthesia. Anesth Analg. 1994;78(4):663-6.
  • 20. Singh R, Kumar N, Singh P. Randomized controlled trial comparing morphine or clonidine with bupivacaine for caudal analgesia in children undergoing upper abdominal surgery. Br J Anaesth. 2011;106:96-100.
  • 21. Potti LR, Bevinaguddaiah Y, Archana S, et al. Caudal levobupivacaine supplemented with caudal or intravenous clonidine in children undergoing infraumbilical surgery: A randomized, prospective double-blind study. Anesth: essays res. 2017;11(1):211-5.
  • 22. Yang Y, Yu LY, Zhang WS. Clonidine versus other adjuncts added to local anesthetics for pediatric neuraxial blocks: a systematic review and meta-analysis. J Pain Res. 2018;11:1027-36.
  • 23. Constant I, Gall O, Gouyet L, et al. Addition of clonidine or fentanyl to local anaesthetics prolongs the duration of surgical analgesia after single shot caudal block in children. Br J Anaesth. 1998;80(3):294-8.
  • 24. Kelleher AA, Black A, Penman S, et al. Comparison of caudal bupivacaine and diamorphine with caudal bupivacaine alone for repair of hypospadias. Br J Anaesth. 1996;77(5):586-90.
  • 25. Parikh TJ, Divecha V, Dalwadi D. Comparative study between epidural morphine and bupivacaine with epidural clonidine and bupivacaine for postoperative pain relief in abdominal surgeries. Anesth: essays res. 2015;9(1):28-33.
  • 26. De Beer DAH, Thomas ML. Caudal additives in children—solutions or problems? Br J Anaesth. 2003;90(4):487-98.

Çocuklarda Levobupivakain ile Yapılan Kaudal Bloğa Kaudal veya İntravenöz Morfin ve Klonidin Eklenmesinin Sonuçları; Geriye Dönük Bir Çalışma

Yıl 2023, Cilt: 10 Sayı: 1, 34 - 41, 10.04.2023
https://doi.org/10.47572/muskutd.1088900

Öz

Çocuklarda Postoperatif ağrı tedavisinin etkin şeklide yapılamaması kronik ağrı ile ilişkili olabilmektedir. Yaşları 6 ay ile 12 arasında değişen, hipospadias cerrahisi için kaudal levobupivakain uygulanan 98 pediatrik hasta retrospektif olarak değerlendirildi. Kaudal levopubivakaine intravenöz klonidin eklenmiş hastalar grup 1; intravenöz morfin eklenmiş hastalar grup 2, kaudal klonidin eklenmiş hastalar grup 3 ve kaudal morfin eklenen hastalar grup 4 olarak adlandırıldı. İntravenöz morfin grubunda 8 olgu (%40), intravenöz klonidin grubunda 5 olgu (%25) ve kaudal morfin grubunda 3 olgu (%15)’da 1. saatte CHEOPS ağrı skoru 6 ve üzerinde idi. Bununla birlikte kaudal klonidin grubundaki tüm olguların 1. saat CHEOPS değerleri 6'nın altındaydı (p<0.05). 12. saatte; intravenöz morfin grubunda 5 olguda (%25), intravenöz klonidin grubunda 10 olguda (%50) ve kaudal morfin grubunda (%20) 4 hastada CHEOPS değerleri 6 ve üzerinde idi. 24. saatte ise; intravenöz morfin grubunda 10 olgu (%50), intravenöz klonidin grubunda 10 olgu (%50), kaudal morfin grubunda 9 olgu (%45) ve kaudal klonidin grubunda 2 olguda (%10) CHEOPS değerleri 6 ve üzerinde idi (p<0.05). Sedasyon skorları açısından gruplar arasında tüm saatlerde fark yoktu (p>0.05). En düşük ağrı skorları 1., 12. ve 24. saatlerde kaudal klonidin grubunda kaydedildi. Tüm gruplar değerlendirildiğinde 6 saatte en düşük, en iyi ağrı skorları ile karşılaşıldı. Bizim çalışmamızda klonidin grubu lehine analjezinin postoperatif 12 saat boyunca sürdüğünü, böylece çocukların ve ailelerinin postoperatif streslerinin en aza indirilebileceğini kabul ettik.

Kaynakça

  • 1. Collins VJ. Principles of anesthesiology. Philadelphia. Lea Febiger, 1993;1317-49.
  • 2. Kayhan Z. Klinik Anestezi 3. Baskı. Logos yayıncılık 2004; 655-704.
  • 3. Friedrichsdorf SJ, Goubert L. Pediatric pain treatment and prevention for hospitalized children. Pain reports. 2020;5(1): e804.
  • 4. Cramton RE, Gruchala NE. Managing procedural pain in pediatric patients. Curr. Opin. Pediatr. 2012;24:530-8.
  • 5. Lee JY, Jo YY. Attention to postoperative pain control in children. Korean J Anesthesiol. 2014;66:183-8.
  • 6. Ecoffey C, Lacroix F, Giaufré E, et al. Epidemiology and morbidity of regional anesthesia in children: a follow‐up one‐year prospective survey of the French‐Language Society of Paediatric Anaesthesiologists (ADARPEF). Paediatr Anaesth. 2010;20(12):1061-9.
  • 7. Polaner DM, Taenzer AH, Walker BJ, et al. Pediatric Regional Anesthesia Network (PRAN): a multi-institutional study of the use and incidence of complications of pediatric regional anesthesia. Anesth Analg. 2012;115(6):1353-64.
  • 8. Dalens BJ. Regional anesthesia in children. İn: Miller RD. Ed., Anesthesia 5th Ed, Volume II, Philadelphia: Churchill Livingstone Inc. 2000:1549-85.
  • 9. Hansen TG, Henneberg SW, Walther‐Larsen S, et al. Caudal bupivacaine supplemented with caudal or intravenous clonidine in children undergoing hypospadias repair: a double‐blind study. Br J Anaesth. 2004;92:223-7.
  • 10. Xing M, Liang X, Li L, et al. Efficacy of caudal vs intravenous administration of α2 adrenoceptor agonists to prolong analgesia in pediatric caudal block: A systematic review and meta‐analysis. Paediatr Anaesth. 2020;30:1322-30.
  • 11. Wiegele M, Marhofer P, Lönnqvist PA. Caudal epidural blocks in paediatric patients: a review and practical considerations. Br J Anaesth. 2019;122:509-17.
  • 12. Karl HW, Tyler DC, Krane EJ. Respiratory depression after low-dose caudal morphine. Can J Anaesth. 1996;43:1065–7.
  • 13. Cucchiaro G, Adzick SN, Rose JB, et al. A comparison of epidural bupivacaine-fentanyl and bupivacaine-clonidine in children undergoing the Nuss procedure. Anesth Analg. 2006;103(2):322-7.
  • 14. Vetter TR, Carvallo D, Johnson JL, et al. A comparison of single-dose caudal clonidine, morphine, or hydromorphone combined with ropivacaine in pediatric patients undergoing ureteral reimplantation. Anesth Analg. 2007;104(6):1356-63.
  • 15. Bonisson ACM, Fernandes ML, Araújo GF, et al. Combination of clonidine-bupivacaine in caudal epidural anesthesia for hypospadias surgery in children: prospective, randomized, blind study☆. Rev Bras Anestesiol. 2019;69:27-34.
  • 16. Motsch J, Böttiger BW, Bach A, et al. Caudal clonidine and bupivacaine for combined epidural and general anaesthesia in children. Acta Anaesthesiol Scand. 1997;41(7): 877-83.
  • 17. Rauck RL, Eisenach JC, Jackson K, et al. Epidural clonidine treatment for refractory reflex sympathetic dystrophy. Anesthesiology. 1993;79(6):1163-9.
  • 18. Kaabachi O, Zerelli Z, Methamem M, et al. Clonidine administered as adjuvant for bupivacaine in ilioinguinal–iliohypogastric nerve block does not prolong postoperative analgesia. Paediatr Anaesth. 2005;15(7):586-90.
  • 19. Jamali S, Monin S, Begon C, et al. Clonidine in pediatric caudal anesthesia. Anesth Analg. 1994;78(4):663-6.
  • 20. Singh R, Kumar N, Singh P. Randomized controlled trial comparing morphine or clonidine with bupivacaine for caudal analgesia in children undergoing upper abdominal surgery. Br J Anaesth. 2011;106:96-100.
  • 21. Potti LR, Bevinaguddaiah Y, Archana S, et al. Caudal levobupivacaine supplemented with caudal or intravenous clonidine in children undergoing infraumbilical surgery: A randomized, prospective double-blind study. Anesth: essays res. 2017;11(1):211-5.
  • 22. Yang Y, Yu LY, Zhang WS. Clonidine versus other adjuncts added to local anesthetics for pediatric neuraxial blocks: a systematic review and meta-analysis. J Pain Res. 2018;11:1027-36.
  • 23. Constant I, Gall O, Gouyet L, et al. Addition of clonidine or fentanyl to local anaesthetics prolongs the duration of surgical analgesia after single shot caudal block in children. Br J Anaesth. 1998;80(3):294-8.
  • 24. Kelleher AA, Black A, Penman S, et al. Comparison of caudal bupivacaine and diamorphine with caudal bupivacaine alone for repair of hypospadias. Br J Anaesth. 1996;77(5):586-90.
  • 25. Parikh TJ, Divecha V, Dalwadi D. Comparative study between epidural morphine and bupivacaine with epidural clonidine and bupivacaine for postoperative pain relief in abdominal surgeries. Anesth: essays res. 2015;9(1):28-33.
  • 26. De Beer DAH, Thomas ML. Caudal additives in children—solutions or problems? Br J Anaesth. 2003;90(4):487-98.
Toplam 26 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Cerrahi
Bölüm Araştırma Makalesi
Yazarlar

Eylem Yaşar 0000-0002-5144-3077

Çiğdem Tütüncü 0000-0003-2608-4778

Güner Kaya 0000-0002-8438-8406

Yayımlanma Tarihi 10 Nisan 2023
Gönderilme Tarihi 17 Mart 2022
Yayımlandığı Sayı Yıl 2023 Cilt: 10 Sayı: 1

Kaynak Göster

APA Yaşar, E., Tütüncü, Ç., & Kaya, G. (2023). The Outcomes of Caudal or Intravenous Addition of Morphine and Clonidine into The Caudal Block Performed with Levobupivacaine In Children; A Retrospective Study. Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi, 10(1), 34-41. https://doi.org/10.47572/muskutd.1088900
AMA Yaşar E, Tütüncü Ç, Kaya G. The Outcomes of Caudal or Intravenous Addition of Morphine and Clonidine into The Caudal Block Performed with Levobupivacaine In Children; A Retrospective Study. MMJ. Nisan 2023;10(1):34-41. doi:10.47572/muskutd.1088900
Chicago Yaşar, Eylem, Çiğdem Tütüncü, ve Güner Kaya. “The Outcomes of Caudal or Intravenous Addition of Morphine and Clonidine into The Caudal Block Performed With Levobupivacaine In Children; A Retrospective Study”. Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi 10, sy. 1 (Nisan 2023): 34-41. https://doi.org/10.47572/muskutd.1088900.
EndNote Yaşar E, Tütüncü Ç, Kaya G (01 Nisan 2023) The Outcomes of Caudal or Intravenous Addition of Morphine and Clonidine into The Caudal Block Performed with Levobupivacaine In Children; A Retrospective Study. Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi 10 1 34–41.
IEEE E. Yaşar, Ç. Tütüncü, ve G. Kaya, “The Outcomes of Caudal or Intravenous Addition of Morphine and Clonidine into The Caudal Block Performed with Levobupivacaine In Children; A Retrospective Study”, MMJ, c. 10, sy. 1, ss. 34–41, 2023, doi: 10.47572/muskutd.1088900.
ISNAD Yaşar, Eylem vd. “The Outcomes of Caudal or Intravenous Addition of Morphine and Clonidine into The Caudal Block Performed With Levobupivacaine In Children; A Retrospective Study”. Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi 10/1 (Nisan 2023), 34-41. https://doi.org/10.47572/muskutd.1088900.
JAMA Yaşar E, Tütüncü Ç, Kaya G. The Outcomes of Caudal or Intravenous Addition of Morphine and Clonidine into The Caudal Block Performed with Levobupivacaine In Children; A Retrospective Study. MMJ. 2023;10:34–41.
MLA Yaşar, Eylem vd. “The Outcomes of Caudal or Intravenous Addition of Morphine and Clonidine into The Caudal Block Performed With Levobupivacaine In Children; A Retrospective Study”. Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi, c. 10, sy. 1, 2023, ss. 34-41, doi:10.47572/muskutd.1088900.
Vancouver Yaşar E, Tütüncü Ç, Kaya G. The Outcomes of Caudal or Intravenous Addition of Morphine and Clonidine into The Caudal Block Performed with Levobupivacaine In Children; A Retrospective Study. MMJ. 2023;10(1):34-41.