Tafoya Sampaguita P, Tumber Sundeep S
Pediatric Anesthesia, Shriners Hospitals for Children, Northern California, Sacramento, USA.
Cureus. 2022 Mar 15;14(3):e23186. doi: 10.7759/cureus.23186. eCollection 2022 Mar.
Background Postoperative pain management in pediatric population can be very challenging. How to prolong the duration of single-injection peripheral nerve blocks has been widely discussed. Multiple medications are under investigation to accomplish this, yet data specifically focused on their use in pediatric peripheral nerve blocks are limited. Methods Anesthetic electronic medical records were queried for any instances where adjuvant drug(s) were used in peripheral nerve blocks during a two-year period at a pediatric surgical specialty hospital. These included buprenorphine, clonidine, dexamethasone, and dexmedetomidine. Results Out of 1,845 blocks placed during the study period, 1,148 (62.2%) utilized perineural adjuvants. Buprenorphine as a sole agent was the most common choice (49.5%), followed by buprenorphine and dexmedetomidine combined (39.9%), dexmedetomidine alone (10.1%), and the rare combination of all three drugs, buprenorphine, dexmedetomidine, and dexamethasone (0.5%). The mean dose of buprenorphine given was 3.6 mcg/kg total, 2.8 mcg/kg/block. The mean dose of dexmedetomidine given was 0.9 mcg/kg total, 0.6 mcg/kg/block. The mean dose of dexamethasone utilized was 2 mg total, 1 mg/block. Conclusions This report examined one institution's use of multimodal perineural adjuvants in over 1,000 pediatric peripheral nerve blocks. Buprenorphine was the agent most commonly used to prolong the single-injection peripheral nerve block. This highlights the need for future prospective trials evaluating efficacy and safety.
小儿群体的术后疼痛管理极具挑战性。如何延长单次注射外周神经阻滞的持续时间已得到广泛讨论。目前正在研究多种药物来实现这一目标，但专门针对其在小儿外周神经阻滞中应用的数据有限。
查询一家小儿外科专科医院两年期间麻醉电子病历中在周围神经阻滞中使用辅助药物的任何情况。这些药物包括丁丙诺啡、可乐定、地塞米松和右美托咪定。
在研究期间进行的1845例阻滞中，1148例（62.2%）使用了神经周围辅助药物。丁丙诺啡作为单一药物是最常见的选择（49.5%），其次是丁丙诺啡和右美托咪定联合使用（39.9%），单独使用右美托咪定（10.1%），以及三种药物丁丙诺啡、右美托咪定和地塞米松罕见的联合使用（0.5%）。丁丙诺啡的平均给药总量为3.6 mcg/kg，每阻滞剂量为2.8 mcg/kg。右美托咪定的平均给药总量为0.9 mcg/kg，每阻滞剂量为0.6 mcg/kg。地塞米松的平均使用总量为2 mg，每阻滞剂量为1 mg。
本报告研究了一家机构在1000多例小儿外周神经阻滞中使用多模式神经周围辅助药物的情况。丁丙诺啡是最常用于延长单次注射外周神经阻滞的药物。这凸显了未来进行评估疗效和安全性的前瞻性试验的必要性。
