Analgesic efficacy of bupivacaine alone versus bupivacaine plus dexmedetomidine in penile block for hypospadias surgery

Introduction: Hypospadias is a common pediatric surgical procedure. Early postoperative pain management is essential to inhibit pain impulses and endocrine responses; leading to decreased mortality and morbidity and lower rate of agitation and faster return to normal functional status. This study evaluates the analgesic efficacy of bupivacaine alone versus bupivacaine plus dexmedetomidine in penile block for hypospadias surgery.Materials and Methods: In this randomized clinical trial, 64 children undergoing hypospadias surgery in a referral center in Tehran, Iran during 2018 were enrolled and randomly assigned to receive either bupivacaine 0.25% alone 0.2 ml/kg or bupivacaine 0.25% 0.2 ml/kg plus dexmedetomidine 0.3 μg/kg. After performing penile block, reversion of anesthesia was carried out and patients were extubated after regaining complete consciousness. Patients were monitored for 24 hours for pain according to FLACC scale and also the analgesia and block duration was determined.Results: Mean analgesia duration was 2.63±0.9 and 2.03±0.5 hours in the combination group and alone group respectively which was significant (P=0.003). The mean duration of block was significantly longer in the combination group (P=0.001).Conclusions: According to the results it may be concluded that addition of dexmedetomidine to bupivacaine in hypospadias surgeries would result in longer analgesia and block duration; without addition of adverse effects

Eculizumab in Pediatric Kidney Disorders: A Review: Eculizumab in Kidney Disorders

Eculizumab is a humanized monoclonal antibody targeting the C5 (complement 5) memberof complement proteins and inhibiting its cleavage to C5a and C5b. Eculizumab has beenproven to be effective in a wide array of nephrologic, neurologic, and hematologic pediatricdisorders. Kidney disorders, particularly those with immune-mediated pathomechanism,are the most common indications of eculizumab, including atypical hemolytic uremicsyndrome (aHUS), hemolytic uremic syndrome (HUS), membranoproliferativeglomerulonephritis (MPGN), immunoglobulin A (IgA) nephropathy, hematopoietic stemcell transplant-associated thrombotic microangiopathy, and less commonly post-infectiousglomerulonephritis and diffuse proliferative lupus nephritis. In this review, we aimed tosummarize the current evidence on approved and off-label applications of eculizumab andtheir specific considerations in pediatric kidney disorders