{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T14:11:43Z","timestamp":1788012703974,"version":"build-2784847793"},"reference-count":60,"publisher":"BMJ","issue":"5","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Reg Anesth Pain Med"],"accepted":{"date-parts":[[2020,12,30]]},"published-print":{"date-parts":[[2021,5]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Dexmedetomidine is used as a local-anesthetics adjuvant in caudal block to prolong analgesia in pediatric infra-umbilical surgery.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>We evaluated the analgesic efficacy and safety of the addition of caudal dexmedetomidine to local anesthetics (vs local anesthetics alone) in pediatric infra-umbilical surgery.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Evidence review<\/jats:title>\n                  <jats:p>We searched 10 databases for randomized controlled trials (RCTs) of pediatric patients undergoing infra-umbilical surgery, comparing caudal block with and without dexmedetomidine as local anesthetic adjuvant. We performed a frequentist random-effects meta-analysis (R statistical package). We analyzed continuous outcomes as a ratio of means (ROM) and dichotomous data as relative risk (RR), along with 95% CI. We included 19 RCTs (n=1190 pediatric patients) in the meta-analysis. The primary outcome was duration of analgesia (defined as \u2018the time from caudal injection to the time at which the study-specific pain score was greater than a cut-off threshold\u2019).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Findings<\/jats:title>\n                  <jats:p>Data from 19 included RCTs (n=1190) suggested that compared with control (mean duration 346 min), the addition of caudal dexmedetomidine significantly prolonged the duration of analgesia (ratio of means 2.14, 95% CI 1.83 to 2.49, p&lt;0.001; \u2018moderate\u2019 evidence). Trial-sequential analysis showed adequate \u2018information size\u2019 for the primary outcome. Caudal dexmedetomidine also reduced the number of analgesic administrations (\u2018low\u2019 evidence), total acetaminophen dose (\u2018moderate\u2019 evidence) and the risk of emergence delirium (\u2018moderate\u2019 evidence). There were no significant differences in adverse effects such as hypotension, bradycardia, post-operative nausea and vomiting, urinary retention and respiratory depression.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Our results suggest that the addition of dexmedetomidine to local anesthetic in caudal block significantly improves the duration of analgesia and reduces the analgesic requirements, while maintaining a similar risk-profile compared with local anesthetic alone. Further data on neurological safety are needed.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/rapm-2020-102024","type":"journal-article","created":{"date-parts":[[2021,1,15]],"date-time":"2021-01-15T11:41:22Z","timestamp":1610710882000},"page":"422-432","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":16,"title":["Efficacy and safety of caudal dexmedetomidine in pediatric infra-umbilical surgery: a meta-analysis and trial-sequential analysis of randomized controlled trials"],"prefix":"10.1136","volume":"46","author":[{"given":"Ushma Jitendra","family":"Shah","sequence":"first","affiliation":[{"name":"Anesthesia & Perioperative Medicine, Western University, London, Ontario, Canada"},{"name":"Anesthesia & Perioperative Medicine, London Health Sciences Centre Children's Hospital, London, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Derek","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Bachelor of Medical Sciences, Western University Schulich School of Medicine and Dentistry, London, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niveditha","family":"Karuppiaah","sequence":"additional","affiliation":[{"name":"Anesthesia & Perioperative Medicine, London Health Sciences Centre Children's Hospital, London, Ontario, Canada"},{"name":"Centre for Medical Evidence, Decision Integrity & Clinical Impact (MEDICI), Western University, London, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janet","family":"Martin","sequence":"additional","affiliation":[{"name":"Anesthesia & Perioperative Medicine, Western University, London, Ontario, Canada"},{"name":"Centre for Medical Evidence, Decision Integrity & Clinical Impact (MEDICI), Western University, London, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3558-8962","authenticated-orcid":false,"given":"Herman","family":"Sehmbi","sequence":"additional","affiliation":[{"name":"Anesthesia & Perioperative Medicine, Western University, London, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,1,15]]},"reference":[{"key":"2025101111021998000_46.5.422.1","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1213\/ANE.0000000000000446","article-title":"Are caudal blocks for pain control safe in children? an analysis of 18,650 caudal blocks from the pediatric regional anesthesia network (PRAN) database","volume":"120","author":"Suresh","year":"2015","journal-title":"Anesth Analg"},{"key":"2025101111021998000_46.5.422.2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1460-9592.2010.03448.x"},{"key":"2025101111021998000_46.5.422.3","doi-asserted-by":"publisher","DOI":"10.1097\/AAP.0000000000000707"},{"key":"2025101111021998000_46.5.422.4","doi-asserted-by":"crossref","DOI":"10.4103\/0970-9185.74900","article-title":"A comparative study between clonidine and dexmedetomidine used as adjuncts to ropivacaine for caudal analgesia in paediatric patients","volume":"26","author":"Neogi","year":"2010","journal-title":"J Anaesthesiol Clin Pharmacol"},{"key":"2025101111021998000_46.5.422.5","doi-asserted-by":"crossref","first-page":"2008","DOI":"10.1213\/ANE.0000000000002014","article-title":"Perineural dexmedetomidine is more effective than clonidine when added to local anesthetic for supraclavicular brachial plexus block: a systematic review and meta-analysis","volume":"124","author":"El-Boghdadly","year":"2017","journal-title":"Anesth Analg"},{"key":"2025101111021998000_46.5.422.6","doi-asserted-by":"publisher","DOI":"10.1111\/pan.12519"},{"key":"2025101111021998000_46.5.422.7","doi-asserted-by":"crossref","first-page":"836","DOI":"10.23736\/S0375-9393.18.12523-5","article-title":"Dexmedetomidine as an adjunct for caudal anesthesia and analgesia in children","volume":"84","author":"Trifa","year":"2018","journal-title":"Minerva Anestesiol"},{"key":"2025101111021998000_46.5.422.8","doi-asserted-by":"crossref","first-page":"165","DOI":"10.12659\/MSM.913098","article-title":"The efficacy and safety of dexmedetomidine combined with bupivacaine on caudal epidural block in children: a meta-analysis","volume":"25","author":"Tu","year":"2019","journal-title":"Med Sci Monit"},{"key":"2025101111021998000_46.5.422.9","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1000097"},{"key":"2025101111021998000_46.5.422.10","unstructured":"Higgins JPT , Sterne JAC , Savovi\u0107 J . 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