Background: Epidural block placement in pediatric patients is technically challenging for anesthesiologists. The use of ultrasound (US) for the placement of an epidural catheter has shown promise. We compared landmark-guided and US-guided lumbar or lower thoracic epidural needle placement in pediatric patients. Methods: This prospective, randomized, comparative trial involved children aged 1–6 years who underwent abdominal and thoracic surgeries. Forty-five children were randomly divided into two groups using a computer-generated random number table, and group allocation was performed by the sealed opaque method into either landmark-guided (group LT) or real-time ultrasound-guided (group UT) epidural placement. The primary outcome was a comparison of the procedure time (excluding US probe preparation). Secondary outcomes were the number of attempts (re-insertion of the needle), bone contacts, needle redirection, skin-to-epidural distance using the US in both groups, success rate, and complications. Results: The median (interquartile range [IQR]) time to reach epidural space was 105.5 (297.0) seconds in group LT and 143.0 (150) seconds in group UT; P = 0.407). While the first attempt success rate was higher in the UT group (87.0% in UT vs. 40.9% in LT; P = 0.004), the number of bone contacts, needle redirections, and procedure-related complications were significantly lower. Conclusions The use of US significantly reduced needle redirection, number of attempts, bone contact, and complications. There was no statistically significant difference in the time to access the epidural space between the US and landmark technique groups.

BACKGROUND: The transversus abdominis plane (TAP) block is an effective technique to block the thoracolumbar nerves innervating the anterolateral abdominal wall. This study was conducted to evaluate the analgesic efficacy and opioid consumption with the use of perineural buprenorphine or dexamethasone in TAP blocks after unilateral inguinal hernioplasties. METHODS: This prospective, randomized, double-blinded, placebo-controlled study enrolled 93 patients scheduled for unilateral inguinal hernioplasty, followed by an ultrasound-guided TAP block. The participants were randomized into 3 groups (31 patients each). Group L received 20 ml 0.25% levobupivacaine + 1 ml normal saline (NS); group LB, 20 ml 0.25% levobupivacaine + 0.3 mg (1 ml) buprenorphine; and group LD, 20 ml 0.25% levobupivacaine + 4 mg (1 ml) dexamethasone. The patients were observed postoperatively for 24 h for first rescue analgesic requirement, total rescue analgesic consumption, and pain scores on the numeric rating scale (NRS). RESULTS: The time to first rescue analgesic requirement was significantly longer in Group LB than in groups LD and L (688.87 ± 36.11 min, 601.45 ± 39.85 min, and 383.06 ± 36.21 min, respectively; P < 0.001). The mean total tramadol consumption in the first 24 h was the lowest in group LB (P < 0.001, L vs. LB / LD). Groups LB and LD displayed significantly lower NRS scores than group L (P < 0.001 both). CONCLUSIONS Levobupivacaine with perineural buprenorphine in a TAP block after unilateral open inguinal hernioplasty facilitates prolonged analgesia and reduced requirement for rescue analgesics compared to perineural dexamethasone, without significant side effects.

Allaying anxiety and providing calm children in the operating room is a challenging task for anesthesiologists. This study was designed to compare the use of nebulized dexmedetomidine and ketamine for premedication in pediatric patients under general anesthesia. Methods: Seventy patients, aged 2 to 8 years of both sexes, with American Society of Anesthesiologists physical status I/II scheduled for hernia repair surgery under general anesthesia, were randomized to two equal groups using a computer-generated random number table. Patients in group D received dexmedetomidine (2 µg/kg), and patients in group K received ketamine (2 mg/kg) by a jet nebulizer before the induction of anesthesia. The study’s primary objective was comparing the level of sedation, which was achieved at 30 min after a study drug administration using the Ramsay sedation scale, between the two groups. The secondary objectives were the two-group comparison of parental separation anxiety scale, acceptance of the mask, hemodynamic variables, recovery time, incidence of emergence agitation, and adverse events. Results: The median Ramsay sedation scale at 30 min was 3 (1–4) in group D and 3 (1–3) in group K (P = 0.002). Patients in group D had a more acceptable parental separation anxiety scale (P = 0.001) and a satisfactory mask acceptance scale (P = 0.042). Conclusions: Nebulized dexmedetomidine (2 µg/kg) provided better sedation along with smooth parental separation and satisfactory mask acceptance during induction of anesthesia with a similar emergence agitation profile and adverse reactions compared to nebulized ketamine in pediatric patients.

Supraglottic airways (SGA) are increasingly used in pediatric anesthesia.Among SGA, I-gelTM is a commonly used device in pediatric patients. The BlockbusterTM laryngeal mask airway (LMA) is latest addition in pediatric airway armamentarium. This studywas conducted to compare the clinical performance of I-gelTM and BlockbusterTM LMA in pediatric patients.Methods: A total of 140 children aged 1–5 years, who were undergoing elective surgery,were randomized into two groups either I-gelTM (Group I) or BlockbusterTM LMA (Group B). Airway was secured with appropriate-sized LMA according to group allocation under generalanesthesia. The primary objective of study was oropharyngeal leak pressures (OPLP), andsecondary objectives were number of attempts of device insertion, success rate, ease ofLMA insertion, hemodynamic parameters, and postoperative pharyngolaryngeal morbidities.Results: The mean OPLP was significantly higher for I-gelTM compared to BlockbusterTM LMA(27.97 ± 1.65 vs. 26.04 ± 2.12; P < 0.001). The devices were successfully inserted on thefirst attempt in 97.14% and 90% of the Group I and Group B respectively. The insertion time,ease of insertion, hemodynamic parameters and postoperative complications were comparable between groups.Conclusions: The I-gelTM was more efficacious device in term of OPLP than BlockbusterTMLMA for positive pressure ventilation in pediatric patients undergoing short surgical procedures under general anesthesia.

BACKGROUND: The transversus abdominis plane (TAP) block is an effective technique to block the thoracolumbar nerves innervating the anterolateral abdominal wall. This study was conducted to evaluate the analgesic efficacy and opioid consumption with the use of perineural buprenorphine or dexamethasone in TAP blocks after unilateral inguinal hernioplasties. METHODS: This prospective, randomized, double-blinded, placebo-controlled study enrolled 93 patients scheduled for unilateral inguinal hernioplasty, followed by an ultrasound-guided TAP block. The participants were randomized into 3 groups (31 patients each). Group L received 20 ml 0.25% levobupivacaine + 1 ml normal saline (NS); group LB, 20 ml 0.25% levobupivacaine + 0.3 mg (1 ml) buprenorphine; and group LD, 20 ml 0.25% levobupivacaine + 4 mg (1 ml) dexamethasone. The patients were observed postoperatively for 24 h for first rescue analgesic requirement, total rescue analgesic consumption, and pain scores on the numeric rating scale (NRS). RESULTS: The time to first rescue analgesic requirement was significantly longer in Group LB than in groups LD and L (688.87 ± 36.11 min, 601.45 ± 39.85 min, and 383.06 ± 36.21 min, respectively; P < 0.001). The mean total tramadol consumption in the first 24 h was the lowest in group LB (P < 0.001, L vs. LB / LD). Groups LB and LD displayed significantly lower NRS scores than group L (P < 0.001 both). CONCLUSIONS: Levobupivacaine with perineural buprenorphine in a TAP block after unilateral open inguinal hernioplasty facilitates prolonged analgesia and reduced requirement for rescue analgesics compared to perineural dexamethasone, without significant side effects.
Abdominal Wall ; Analgesia ; Analgesics ; Buprenorphine ; Dexamethasone ; Hernia, Inguinal ; Herniorrhaphy ; Humans ; Prospective Studies ; Tramadol ; Ultrasonography