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Efficacy of caudal vs intravenous administration of α 2 adrenoceptor agonists to prolong analgesia in pediatric caudal block: A systematic review and meta‐analysis
Author(s) -
Xing Manyu,
Liang Xia,
Li Lin,
Liao Liping,
Liang Shuang,
Jiang Shasha,
Li Jingyi,
Zhang Chengliang,
Zou Wangyuan
Publication year - 2020
Publication title -
pediatric anesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.704
H-Index - 82
eISSN - 1460-9592
pISSN - 1155-5645
DOI - 10.1111/pan.14025
Subject(s) - medicine , confidence interval , anesthesia , meta analysis , relative risk , analgesic , randomized controlled trial , surgery
Abstract Background α 2 adrenoceptor agonists have been proposed as adjuncts to prolong analgesia in pediatric caudal block. The aim of this meta‐analysis was to compare the analgesic efficacy of caudal vs intravenous α 2 adrenoceptor agonists during pediatric caudal block. Methods A systematic search, data extraction, bias risk assessment, and pooled data analysis were performed following the PRISMA guidelines. All randomized controlled trials comparing caudal with intravenous α 2 adrenoceptor agonists in pediatric caudal block were included. Relative risk and weighted mean differences (the corresponding 95% confidence intervals) were calculated for dichotomous and continuous data, respectively. Trial sequential analyses were performed to evaluate the credibility of the meta‐analysis. Results A total of 244 patients in five trials were identified. Compared with the intravenous group (9.56 ± 4.23 hours), the time to the first rescue analgesia was prolonged in the caudal α 2 adrenoceptor agonists group (12.72 ± 5.99 hours) by a weighted mean difference of 2.98 hours [95% confidence interval: 0.59‐5.36 hours; P = .01]. The number of children requiring rescue analgesia in the caudal group (64, 66.67%) was lower than that in the intravenous group (80, 81.63%) [relative risk = 0.82; 95% confidence interval: 0.69‐0.97; P = .02]. These findings were also verified by trial sequential analysis. There were no significant differences in the side effects. Conclusion Caudal α 2 adrenoceptor agonists as adjuncts to local anesthetic during pediatric caudal block are more effective than intravenous injection. However, the results were affected by small sample size and significant heterogeneity.