Bayesian enhanced meta‐analysis of post‐operative analgesic efficacy of additives for caudal analgesia in children

摘要: Background The authors calculated the effect size for post-operative analgesia of three additives, clonidine, neostigmine, and tramadol to bupivacaine, ropivacaine, or levobupivacaine used single-dose caudal extradural blockade in children. Methods A meta-analysis was performed end points efficacy: increase time until administration analgesic drugs, proportion patients requiring drugs during initial 24 hours, amounts drugs. A Bayesian inference supporting direct statements about probability magnitude an compare effects size. Results Neostigmine increased duration by 9.96 h (95% confidence interval: 7.75 12.16), as compared with 3.68 h (2.65 4.7) clonidine 4.45 (2.84 6.07) tramadol. There is a 95% that neostigmine increases more than 8 h, 2.8 h, 3.25 h, local anesthetics alone. The odds ratios were 0.22 [0.13 0.37] 0.28 [0.10 0.75] neostigmine. With tramadol, there no statistically significant difference. All additives reduced Neostigmine nausea vomiting (PONV). Conclusions Neostigmine provides longest analgesia. shorter sedation increased, but PONV could be decreased.