day-stay unit. Int J Paediatr Dent 2004; 14:9–16.90 Gazal G, Mackie IC. Distress related todental extraction for children under generalanaesthesia <strong>and</strong> their parents. Eur J PaediatrDent 2007; 8: 7–12.91 O’Donnell A, Henderson M, Fearne J et al.<strong>Management</strong> of postoperative pa<strong>in</strong> <strong>in</strong> childrenfollow<strong>in</strong>g extractions of primary teethunder general anaesthesia: a comparison ofparacetamol, Voltarol <strong>and</strong> no analgesia. IntJ Paediatr Dent 2007; 17: 110–115.92 Townsend JA, Ganzberg S, Thikkurissy S.The effect of local anesthetic on quality ofrecovery characteristics follow<strong>in</strong>g dentalrehabilitation under general anesthesia <strong>in</strong>children. Anesth Prog 2009; 56: 115–122.93 Littlejohn IH, Tarl<strong>in</strong>g MM, Flynn PJ et al.Post-operative pa<strong>in</strong> relief <strong>in</strong> children follow<strong>in</strong>gextraction of carious deciduous teethunder general anaesthesia: a comparison ofnalbuph<strong>in</strong>e <strong>and</strong> diclofenac. Eur J Anaesthesiol1996; 13: 359–363.94 Purday J, Reichert C, Merrick P. Comparativeeffects of three doses of <strong>in</strong>travenousketorolac or morph<strong>in</strong>e on emesis <strong>and</strong> analgesiafor restorative dental surgery <strong>in</strong> children.Can J Anaesth 1996; 43: 221–225.95 Alhashemi JA, Daghistani MF. Effect of <strong>in</strong>traoperative<strong>in</strong>travenous acetam<strong>in</strong>ophen vs.<strong>in</strong>tramuscular meperid<strong>in</strong>e on pa<strong>in</strong> <strong>and</strong> dischargetime after paediatric dental restoration.Eur J Anaesthesiol 2007; 24: 128–133.96 Bhananker SM, Azavedo LF, Spl<strong>in</strong>ter WM.Addition of morph<strong>in</strong>e to local anesthetic<strong>in</strong>filtration does not improve analgesia afterpediatric dental extractions. Paediatr Anaesth2008; 18: 140–144.97 Ho D, Keneally J. Analgesia follow<strong>in</strong>g paediatricday-surgical orchidopexy <strong>and</strong> herniotomy.Paediatr Anaesth 2000; 10: 627–631.98 Anatol TI, Pitt-Miller P, Holder Y. Trial ofthree methods of <strong>in</strong>traoperative bupivaca<strong>in</strong>eanalgesia for pa<strong>in</strong> after paediatric gro<strong>in</strong> surgery.Can J Anaesth 1997; 44: 1053–1059.99 Ivani G, DeNegri P, Conio A et al. Comparisonof racemic bupivaca<strong>in</strong>e, ropivaca<strong>in</strong>e,<strong>and</strong> levo-bupivaca<strong>in</strong>e for pediatric caudalanesthesia: effects on postoperative analgesia<strong>and</strong> motor block. Reg Anesth Pa<strong>in</strong> Med2002; 27: 157–161.100 Ivani G, Conio A, De NP et al. Sp<strong>in</strong>al versusperipheral effects of adjunct clonid<strong>in</strong>e:comparison of the analgesic effect of a ropivaca<strong>in</strong>e-clonid<strong>in</strong>emixture when adm<strong>in</strong>isteredas a caudal or ilio<strong>in</strong>gu<strong>in</strong>aliliohypogastricnerve blockade for <strong>in</strong>gu<strong>in</strong>alsurgery <strong>in</strong> children. Paediatr Anaesth 2002;12: 680–684.101 Suraseranivongse S, Chowvanayot<strong>in</strong> S, PirayavarapornS et al. Effect of bupivaca<strong>in</strong>ewith ep<strong>in</strong>ephr<strong>in</strong>e wound <strong>in</strong>stillation for pa<strong>in</strong>relief after pediatric <strong>in</strong>gu<strong>in</strong>al herniorrhaphy<strong>and</strong> hydrocelectomy. Reg Anesth Pa<strong>in</strong> Med2003; 28: 24–28.102 Ivani G, De Negri P, Lonnqvist PA et al.Caudal anesthesia for m<strong>in</strong>or pediatric surgery:a prospective r<strong>and</strong>omized comparisonof ropivaca<strong>in</strong>e 0.2% vs levobupivaca<strong>in</strong>e0.2%. Paediatr Anaesth 2005; 15: 491–494.103 Fredrickson MJ, Pa<strong>in</strong>e C, Hamill J.Improved analgesia with the ilio<strong>in</strong>gu<strong>in</strong>alblock compared to the transversus abdom<strong>in</strong>isplane block after pediatric <strong>in</strong>gu<strong>in</strong>al surgery:a prospective r<strong>and</strong>omized trial.Paediatr Anaesth 2010; 20: 1022–1027.104 Giaufre E, Dalens B, Gombert A. Epidemiology<strong>and</strong> morbidity of regional anesthesia<strong>in</strong> children: a one-year prospective survey ofthe French-Language Society of PediatricAnesthesiologists. Anesth Analg 1996; 83:904–912.105 Cook TM, Counsell D, Wildsmith JA.Major complications of central neuraxialblock: report on the Third National AuditProject of the Royal College of Anaesthetists.Br J Anaesth 2009; 102: 179–190.106 Ecoffey C, Lacroix F, Giaufre E et al. Epidemiology<strong>and</strong> morbidity of regional anesthesia<strong>in</strong> children: a follow-up one-yearprospective survey of the French-LanguageSociety of Paediatric Anaesthesiologists(ADARPEF). Paediatr Anaesth 2010; 20:1061–1069.107 Brenner L, Kettner SC, Marhofer P et al.Caudal anaesthesia under sedation: a prospectiveanalysis of 512 <strong>in</strong>fants <strong>and</strong> children.Br J Anaesth 2010; 104: 751–755.108 Breschan C, Jost R, Krumpholz R et al. Aprospective study compar<strong>in</strong>g the analgesicefficacy of levobupivaca<strong>in</strong>e, ropivaca<strong>in</strong>e <strong>and</strong>bupivaca<strong>in</strong>e <strong>in</strong> pediatric patients undergo<strong>in</strong>gcaudal blockade. Paediatr Anaesth 2005; 15:301–306.109 Ingelmo P, Frawley G, Astuto M et al. Relativeanalgesic potencies of levobupivaca<strong>in</strong>e<strong>and</strong> ropivaca<strong>in</strong>e for caudal anesthesia <strong>in</strong>children. Anesth Analg 2009; 108: 805–813.110 Luz G, Innerhofer P, Haussler B et al.Comparison of ropivaca<strong>in</strong>e 0.1% <strong>and</strong> 0.2%with bupivaca<strong>in</strong>e 0.2% for s<strong>in</strong>gle-shot caudalanaesthesia <strong>in</strong> children. Paediatr Anaesth2000; 10: 499–504.111 Bosenberg A, Thomas J, Lopez T et al. Theefficacy of caudal ropivaca<strong>in</strong>e 1, 2 <strong>and</strong>3mg· l()1) for postoperative analgesia <strong>in</strong>children. Paediatr Anaesth 2002; 12: 53–58.112 Ivani G, De NP, Lonnqvist P et al. A comparisonof three different concentrations oflevobupivaca<strong>in</strong>e for caudal block <strong>in</strong> children.Anesth Analg 2003; 97: 368–371.113 Gulec S, Buyukkidan B, Oral N et al. Comparisonof caudal bupivaca<strong>in</strong>e, bupivaca<strong>in</strong>emorph<strong>in</strong>e<strong>and</strong> bupivaca<strong>in</strong>e-midazolam mixturesfor post-operative analgesia <strong>in</strong> children.Eur J Anaesthesiol 1998; 15: 161–165.114 Ivani G, De Negri P, Conio A et al. Ropivaca<strong>in</strong>e-clonid<strong>in</strong>ecomb<strong>in</strong>ation for caudalblockade <strong>in</strong> children. Acta AnaesthesiolSc<strong>and</strong> 2000; 44: 446–449.115 Khan F, Memon G, Kamal R. Effect ofroute of buprenorph<strong>in</strong>e on recovery <strong>and</strong>postoperative analgesic requirement <strong>in</strong> paediatricpatients. Paediatr Anaesth 2002; 12:786–790.116 Anserm<strong>in</strong>o M, Basu R, V<strong>and</strong>ebeek C et al.Nonopioid additives to local anaestheticsfor caudal blockade <strong>in</strong> children: a systematicreview. Paediatr Anaesth 2003; 13: 561–573.117 Turan A, Memis D, Basaran UN et al. Caudalropivaca<strong>in</strong>e <strong>and</strong> neostigm<strong>in</strong>e <strong>in</strong> pediatricsurgery. Anesthesiology 2003; 98: 719–722.118 Weber F, Wulf H. Caudal bupivaca<strong>in</strong>e <strong>and</strong>s(+)-ketam<strong>in</strong>e for postoperative analgesia<strong>in</strong> children. Paediatr Anaesth 2003; 13: 244–248.119 Bano F, Haider S, Sultan ST. Comparisonof caudal bupivaca<strong>in</strong>e <strong>and</strong> bupivaca<strong>in</strong>e-midazolamfor peri <strong>and</strong> postoperative analgesia<strong>in</strong> children. J Coll Physicians Surg Pak2004; 14: 65–68.120 Mart<strong>in</strong>dale S, Dix P, Stoddart P. Doublebl<strong>in</strong>dr<strong>and</strong>omized controlled trial of caudalversus <strong>in</strong>travenous S(+)-ketam<strong>in</strong>e for supplementationof caudal analgesia <strong>in</strong> children.Br J Anaesth 2004; 92: 344–347.121 Saadawy I, Boker A, Elshahawy MA et al.Effect of dexmedetomid<strong>in</strong>e on the characteristicsof bupivaca<strong>in</strong>e <strong>in</strong> a caudal block <strong>in</strong>pediatrics. Acta Anaesthesiol Sc<strong>and</strong> 2009; 53:251–256.122 Shukla U, Prabhakar T, Malhotra K. <strong>Postoperative</strong>analgesia <strong>in</strong> children when us<strong>in</strong>gclonid<strong>in</strong>e or fentanyl with ropivaca<strong>in</strong>e givencaudally. J Anaesthesiol Cl<strong>in</strong> Pharmacol2011; 27: 205–210.123 Disma N, Frawley G, Mameli L et al. Effectof epidural clonid<strong>in</strong>e on m<strong>in</strong>imum localanesthetic concentration (ED50) of levobupivaca<strong>in</strong>efor caudal block <strong>in</strong> children. PaediatrAnaesth 2011; 21: 128–135.124 Pradhan B, Bajracharya GR. Midazolamfor caudal analgesia <strong>in</strong> children: comparisonwith caudal bupivaca<strong>in</strong>e. Kathm<strong>and</strong>u UnivMed J (KUMJ) 2008; 6: 166–172.125 Birbicer H, Doruk N, C<strong>in</strong>el I et al. Couldadd<strong>in</strong>g magnesium as adjuvant to ropivaca<strong>in</strong>e<strong>in</strong> caudal anaesthesia improve postoperativepa<strong>in</strong> control ? Pediatr Surg Int 2007;23: 195–198.126 Erol A, Tavlan A, Tuncer S et al. Caudalanesthesia for m<strong>in</strong>or subumbilical pediatricsurgery: a comparison of levobupivaca<strong>in</strong>ealone <strong>and</strong> levobupivaca<strong>in</strong>e plus sufentanil. JCl<strong>in</strong> Anesth 2008; 20: 442–446.127 Ak<strong>in</strong> A, Ocalan S, Esmaoglu A et al. Theeffects of caudal or <strong>in</strong>travenous clonid<strong>in</strong>e onpostoperative analgesia produced by caudal58 ª 2012 Blackwell Publish<strong>in</strong>g Ltd, Pediatric Anesthesia, 22 (Suppl. 1), 1–79
levobupivaca<strong>in</strong>e <strong>in</strong> children. Paediatr Anaesth2010; 20: 350–355.128 Luz G, Innerhofer P, Oswald E et al. Comparisonof clonid<strong>in</strong>e 1 microgram kg-1 withmorph<strong>in</strong>e 30 micrograms kg-1 for post-operativecaudal analgesia <strong>in</strong> children. Eur JAnaesthesiol 1999; 16: 42–46.129 Passariello M, Almenrader N, Canneti A etal. Caudal analgesia <strong>in</strong> children: S(+)-ketam<strong>in</strong>evs S(+)-ketam<strong>in</strong>e plus clonid<strong>in</strong>e. PaediatrAnaesth 2004; 14: 851–855.130 Dalens B, Ecoffey C, Joly A et al. Pharmacok<strong>in</strong>etics<strong>and</strong> analgesic effect of ropivaca<strong>in</strong>efollow<strong>in</strong>g ilio<strong>in</strong>gu<strong>in</strong>al/iliohypogastricnerve block <strong>in</strong> children. Paediatr Anaesth2001; 11: 415–420.131 Willschke H, Marhofer P, Bosenberg A etal. Ultrasonography for ilio<strong>in</strong>gu<strong>in</strong>al/iliohypogastricnerve blocks <strong>in</strong> children. Br J Anaesth2005; 95: 226–230.132 Kaabachi O, Zerelli Z, Methamem M et al.Clonid<strong>in</strong>e adm<strong>in</strong>istered as adjuvant for bupivaca<strong>in</strong>e<strong>in</strong> ilio<strong>in</strong>gu<strong>in</strong>al-iliohypogastric nerveblock does not prolong postoperative analgesia.Paediatr Anaesth 2005; 15: 586–590.133 Cyna AM, Middleton P. Caudal epiduralblock versus other methods of postoperativepa<strong>in</strong> relief for circumcision <strong>in</strong> boys. CochraneDatabase Syst Rev 2008; CD003005.134 McGowan P, May H, Molnar Z et al. Acomparison of three methods of analgesia <strong>in</strong>children hav<strong>in</strong>g day case circumcision. PaediatrAnaesth 1998; 8: 403–407.135 Matsota P, Papageorgiou-Brousta M. Intraoperative<strong>and</strong> postoperative analgesia withsubcutaneous r<strong>in</strong>g block of the penis withlevobupivaca<strong>in</strong>e for circumcision <strong>in</strong> children.Eur J Pediatr Surg 2004; 14: 198–202.136 Irw<strong>in</strong> M, Cheng W. Comparison of subcutaneousr<strong>in</strong>g block of the penis with caudalepidural block for post-circumcision analgesia<strong>in</strong> children. Anaesth Intensive Care 1996;24: 365–367.137 Holder K, Peutrell J, Weir P. Regionalanaesthesia for circumcision. Subcutaneousr<strong>in</strong>g block of the penis <strong>and</strong> subpubic penileblock compared. Eur J Anaesthesiol 1997;14: 495–498.138 Gauntlett I. A comparison between localanaesthetic dorsal nerve block <strong>and</strong> caudalbupivaca<strong>in</strong>e with ketam<strong>in</strong>e for paediatriccircumcision. Paediatr Anaesth 2003; 13: 38–42.139 Weksler N, Atias I, Kle<strong>in</strong> M et al. Is penileblock better than caudal epidural block forpostcircumcision analgesia? J Anesth 2005;19: 36–39.140 Soh CR, Ng SB, Lim SL. Dorsal penilenerve block. Paediatr Anaesth 2003; 13:329–333.141 S<strong>and</strong>eman DJ, Re<strong>in</strong>er D, Dilley AV et al. Aretrospective audit of three different regionalanaesthetic techniques for circumcision<strong>in</strong> children. Anaesth Intensive Care 2010; 38:519–524.142 Naja Z, Al-Tannir MA, Faysal W et al. Acomparison of pudendal block vs dorsalpenile nerve block for circumcision <strong>in</strong> children:a r<strong>and</strong>omised controlled trial. Anaesthesia2011; 66: 802–807.143 Kargi E, Isikdemir A, Tokgoz H et al.Comparison of local anesthetic effects oftramadol with priloca<strong>in</strong>e dur<strong>in</strong>g circumcisionprocedure. Urology 2010; 75: 672–675.144 Choi W, Irw<strong>in</strong> M, Hui T et al. EMLAcream versus dorsal penile nerve block forpostcircumcision analgesia <strong>in</strong> children.Anesth Analg 2003; 96: 396–399.145 Margetts L, Carr A, McFadyen G et al. Acomparison of caudal bupivaca<strong>in</strong>e <strong>and</strong> ketam<strong>in</strong>ewith penile block for paediatric circumcision.Eur J Anaesthesiol 2008; 25:1009–1013.146 Lee HM, S<strong>and</strong>ers GM. Caudal ropivaca<strong>in</strong>e<strong>and</strong> ketam<strong>in</strong>e for postoperative analgesia <strong>in</strong>children. Anaesthesia 2000; 55: 806–810.147 Sharpe P, Kle<strong>in</strong> JR, Thompson JP et al.Analgesia for circumcision <strong>in</strong> a paediatricpopulation: comparison of caudal bupivaca<strong>in</strong>ealone with bupivaca<strong>in</strong>e plus two dosesof clonid<strong>in</strong>e. Paediatr Anaesth 2001; 11:695–700.148 Brady-Fryer B, Wiebe N, L<strong>and</strong>er JA. Pa<strong>in</strong>relief for neonatal circumcision. CochraneDatabase Syst Rev 2004; CD004217.149 Banieghbal B. Optimal time for neonatalcircumcision: an observation-based study. JPediatr Urol 2009; 5: 359–362.150 Taeusch HW, Mart<strong>in</strong>ez AM, Partridge JC etal. Pa<strong>in</strong> dur<strong>in</strong>g Mogen or PlastiBell circumcision.J Per<strong>in</strong>atol 2002; 22: 214–218.151 Taddio A, Ohlsson A, E<strong>in</strong>arson TR et al. Asystematic review of lidoca<strong>in</strong>e-priloca<strong>in</strong>ecream (EMLA) <strong>in</strong> the treatment of acutepa<strong>in</strong> <strong>in</strong> neonates. Pediatrics 1998; 101: E1.152 Lehr VT, Cepeda E, Frattarelli DA et al.Lidoca<strong>in</strong>e 4% cream compared with lidoca<strong>in</strong>e2.5% <strong>and</strong> priloca<strong>in</strong>e 2.5% or dorsalpenile block for circumcision. Am J Per<strong>in</strong>atol2005; 22: 231–237.153 Prosser D, Davis A, Booker P et al. Caudaltramadol for postoperative analgesia <strong>in</strong>pediatric hypospadias surgery. Br J Anaesth1997; 79: 293–296.154 Abdulatif M, El-Sanabary M. Caudal neostigm<strong>in</strong>e,bupivaca<strong>in</strong>e, <strong>and</strong> their comb<strong>in</strong>ationfor postoperative pa<strong>in</strong> managementafter hypospadias surgery <strong>in</strong> children.Anesth Analg 2002; 95: 1215–1218,table ofcontents.155 Gunes Y, Gunduz M, Unlugenc H et al.Comparison of caudal vs <strong>in</strong>travenous tramadoladm<strong>in</strong>istered either preoperatively orpostoperatively for pa<strong>in</strong> relief <strong>in</strong> boys. PaediatrAnaesth 2004; 14: 324–328.156 Hansen TG, Henneberg SW, Walther-LarsenS et al. Caudal bupivaca<strong>in</strong>e supplementedwith caudal or <strong>in</strong>travenous clonid<strong>in</strong>e<strong>in</strong> children undergo<strong>in</strong>g hypospadias repair:a double-bl<strong>in</strong>d study. Br J Anaesth 2004; 92:223–227.157 Mahajan R, Grover V, Chari P. Caudalneostigm<strong>in</strong>e with bupivaca<strong>in</strong>e produces adose-<strong>in</strong>dependent analgesic effect <strong>in</strong> children.Can J Anaesth 2004; 51: 702–706.158 Cho JE, Kim JY, Hong JY et al. The additionof fentanyl to 1.5 mg/ml ropivaca<strong>in</strong>ehas no advantage for paediatric epiduralanalgesia. Acta Anaesthesiol Sc<strong>and</strong> 2009; 53:1084–1087.159 Silvani P, Camporesi A, Agost<strong>in</strong>o MR et al.Caudal anesthesia <strong>in</strong> pediatrics: an update.M<strong>in</strong>erva Anestesiol 2006; 72: 453–459.160 Kelleher A, Black A, Penman S et al. Comparisonof caudal bupivaca<strong>in</strong>e <strong>and</strong> diamorph<strong>in</strong>ewith caudal bupivaca<strong>in</strong>e alone forrepair of hypospadias. Br J Anaesth 1996;77: 586–590.161 Laiq N, Khan MN, Tahmeedullah K. et al.Comparison of caudal bupivaca<strong>in</strong>e <strong>and</strong> bupivaca<strong>in</strong>e-tramadolfor postoperative analgesia<strong>in</strong> children undergo<strong>in</strong>g hypospadiassurgery. J Coll Physicians Surg Pak 2009;19: 678–681.162 De Mey JC, Strobbet J, Poelaert J et al.The <strong>in</strong>fluence of sufentanil <strong>and</strong>/or clonid<strong>in</strong>eon the duration of analgesia after a caudalblock for hypospadias repair surgery <strong>in</strong>children. Eur J Anaesthesiol 2000; 17: 379–382.163 Hansen T, Henneberg S. Caudal clonid<strong>in</strong>e<strong>in</strong> neonates <strong>and</strong> small <strong>in</strong>fants <strong>and</strong> respiratorydepression. Paediatr Anaesth 2004; 14:529–530.164 Ozbek H, Bilen A, Ozcengiz D et al. Thecomparison of caudal ketam<strong>in</strong>e, alfentanil<strong>and</strong> ketam<strong>in</strong>e plus alfentanil adm<strong>in</strong>istrationfor postoperative analgesia <strong>in</strong> children. PaediatrAnaesth 2002; 12: 610–616.165 Batra YK, Arya VK, Mahajan R et al.Dose response study of caudal neostigm<strong>in</strong>efor postoperative analgesia <strong>in</strong> paediatricpatients undergo<strong>in</strong>g genitour<strong>in</strong>ary surgery.Paediatr Anaesth 2003; 13: 515–521.166 Gunes Y, Secen M, Ozcengiz D et al. Comparisonof caudal ropivaca<strong>in</strong>e, ropivaca<strong>in</strong>eplus ketam<strong>in</strong>e <strong>and</strong> ropivaca<strong>in</strong>e plus tramadoladm<strong>in</strong>istration for postoperative analgesia<strong>in</strong> children. Paediatr Anaesth 2004; 14:557–563.167 De Negri P, Ivani G, Tirri T et al. A comparisonof epidural bupivaca<strong>in</strong>e, levobupivaca<strong>in</strong>e,<strong>and</strong> ropivaca<strong>in</strong>e on postoperativeanalgesia <strong>and</strong> motor blockade. Anesth Analg2004; 99: 45–48.168 Lerman J, Nolan J, Eyres R et al. Efficacy,safety, <strong>and</strong> pharmacok<strong>in</strong>etics of levobupivaca<strong>in</strong>ewith <strong>and</strong> without fentanyl after con-ª 2012 Blackwell Publish<strong>in</strong>g Ltd, Pediatric Anesthesia, 22 (Suppl. 1), 1–79 59
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RecommendationsChildren’s self-re
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