What does this research mean for the field?

Adding epinephrine to bupivacaine in pediatric caudal block induces transient sinus arrhythmia in the first minute without causing sustained blood pressure or hemodynamic changes. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

December 19, 2022Interventional Pain Medicine and NeuromodulationOpen Access

Cardiovascular Effects of Adding Epinephrine to Bupivacaine in Children Undergoing Caudal Block: A Double-blind Randomized Clinical Trial

Q: What are the key findings of this study?

Adding epinephrine to bupivacaine for caudal block in children significantly increased the incidence of transient sinus arrhythmia in the first minute (40% vs 0%, p<0.001) without causing long-lasting hemodynamic changes.

Q: What is the clinical evidence from this study?

Study design: RCT. Population: Elective sub-umbilical surgery (n=60). Intervention: Epinephrine added to bupivacaine vs. Bupivacaine without epinephrine. Primary outcome: Incidence of sinus arrhythmia in the first minute after caudal block (p=<0.001).

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Key result

Adding epinephrine to bupivacaine caudal block triggers transient sinus arrhythmia in 40% without lasting hemodynamic changes.

P<0.001
n=60

Why the study?

This study aimed to evaluate the cardiovascular effects of adjuvant epinephrine in caudal block on heart rate and blood pressure changes in children.

Does adding epinephrine to bupivacaine in caudal block affect heart rate and blood pressure in children undergoing infra-umbilical surgeries?

Study Design

Type

RCT (n=60)

Blinding

Double-blind

Randomization

Random allocation software

Multicenter

Structured PICO

Does adding epinephrine to bupivacaine in caudal block affect heart rate and blood pressure in children undergoing infra-umbilical surgeries?

Population

60 children under 6 years of age with ASA I or II undergoing elective sub-umbilical surgery, randomized to receive a caudal block with or without epinephrine and monitored for 20 minutes.

Intervention

Caudal block with 0.2% bupivacaine and 1/200000 epinephrine (1 mL/kg)

Comparator

Caudal block without epinephrine

Outcome

Heart rate and blood pressure changes before the block and in the first, fifth, and 20th minutes after surgerysafety

Main Result

Absolute Event Rate: 40% vs 0%

p-value: p=<0.001

Adding epinephrine to bupivacaine for caudal block in children causes transient sinus tachycardia in the first minute but is otherwise hemodynamically safe.

Limitations

Lack of cardiac index (CI) and stroke volume (SV) measurement
Small sample size
Short follow-up period
Did not examine influential factors such as block level, injection site, age, and sex

Discussion

No takes yet. Share an insight, caveat, or question.

Implication

Brief monitoring suffices after epinephrine-caudal blocks in children; extends RCT safety data on transient versus sustained effects.

Cite This Study

Seyedhejazi et al. (2022) conducted an RCT in Elective sub-umbilical surgery (n=60). Epinephrine added to bupivacaine vs. Bupivacaine without epinephrine was evaluated on Incidence of sinus arrhythmia in the first minute after caudal block (p=<0.001). Adding epinephrine to bupivacaine for caudal block in children significantly increased the incidence of transient sinus arrhythmia in the first minute (40% vs 0%, p<0.001) without causing long-lasting hemodynamic changes.

synapsesocial.com/papers/6aa86b835d9410427ecdf492 https://doi.org/10.5812/ipmn-134053

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Cardiovascular Effects of Adding Epinephrine to Bupivacaine in Children Undergoing Caudal Block: A Double-blind Randomized Clinical Trial

Study Design

Structured PICO

Main Result

Limitations

Discussion

Implication

Cite This Study

Cardiovascular Effects of Adding Epinephrine to Bupivacaine in Children Undergoing Caudal Block: A Double-blind Randomized Clinical Trial

Study Design

Structured PICO

Main Result

Limitations

Discussion

Implication

Cite This Study

Also Consider

Also Consider