Regional anesthesia in neonates and infants outside the immediate perioperative period: A systematic review of studies with efficacy and safety considerations.

Autor: Relland LM; Center for Clinical and Translational Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.; Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.; Department of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, USA., Neel ML; Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.; Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA., Gehred A; Grant Morrow III Library, Nationwide Children's Hospital, Columbus, OH, USA., Maitre NL; Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.; Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA.
Jazyk: angličtina
Zdroj: Paediatric anaesthesia [Paediatr Anaesth] 2021 Feb; Vol. 31 (2), pp. 132-144. Date of Electronic Publication: 2020 Nov 07.
DOI: 10.1111/pan.14042
Abstrakt: This review examines the quality and quantity of literature regarding methods that measure efficacy in the context of reported safety of regional anesthesia techniques in preterm and term infants <1 year of age. Because the role of anesthesiologists continues to expand outside the operating room, we focused on all relevant settings with assessments that extend beyond 24 hours from the intraoperative period. All study designs were included from a search of MEDLINE, EMBASE, CINAHL, Scopus, and Cochrane databases from 1946 to the end of 2019. A total of 31 studies were included (n = 1038 participants), consisting of five randomized controlled trials and 26 observational studies. Twenty-three studies examined neuraxial procedures, seven studies examined peripheral procedures, and one study examined both. Efficacy measures included pain assessment tools, analgesic use, and factors pertaining to the recovery of patients. Safety was assessed in multiple systems (neurological, cardiovascular, respiratory, pathological) and with vital signs and/or measures of systemic toxicity. Evidence in this review establishes that neuraxial and peripheral anesthesia treatments may be applied to neonates and infants with a high degree of safety. However, large gaps in the consistency of methods used to assess pain in these studies underline the need for rigorous prospective efficacy studies of these techniques in this population. This systematic review was registered on PROSPERO (CRD42018114466).
(© 2020 John Wiley & Sons Ltd.)
Databáze: MEDLINE
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