Document Type : Original Article
Authors
1
Department of Emergency Medicine, College of Medicine, Qatar University, Doha, Qatar Department of Emergency Medicine, Hamad Medical Corporation, Doha - Qatar.
2
Department of Internal Medicine, Mansoura General Hospital, Egypt.
3
Department of Emergency Medicine, Hamad Medical Corporation, Doha – Qatar.
4
Department of Cardiology, Al Jufairi Diagnosis and Treatment, MOH, Qatar.
5
Department of Anesthesia and Intensive Care Medicine, Faculty of Medicine, Tanta University, Egypt.
Abstract
Background
Regional anesthesia (RA) has emerged as a promising alternative to general anesthesia (GA) in pediatric populations. We evaluate the efficacy, safety, and technical considerations of RA versus GA emphasizing hemodynamic stability, respiratory outcomes, and perioperative.
Materials and Methods
We conducted a PRISMA-compliant systematic review across PubMed, Embase, Cochrane Library, and Scopus. Methodological quality was assessed using the Newcastle-Ottawa Scale for observational studies and Cochrane ROB-2 for RCTs.
Results
Fifteen studies met inclusion criteria (9 RCTs, 6 cohort studies). RA demonstrated superior hemodynamic stability across all age groups, with a pooled 12.3mmHg reduction in systolic blood pressure variance compared to GA (95% CI: -14.1 to -10.5; p= 0.003; I²= 32%). This effect was most pronounced in cardiac patients, where RA maintained coronary perfusion pressure more effectively (mean difference: -8.2mmHg vs GA for single-ventricle physiology, p= 0.01). Neonates exhibited the greatest benefit, with 62% fewer hypotensive episodes requiring intervention (OR 0.38, 95% CI 0.25-0.57). The analysis revealed significant respiratory advantages for RA, particularly in preterm infants. Pooled data showed a 79% reduction in postoperative apnea (OR 0.21, 95% CI 0.12-0.38), with effects persisting through 24-hour monitoring. Infants with bronchopulmonary dysplasia derived amplified benefits (OR 0.15, 95% CI 0.08-0.29) compared to healthier preterm (OR 0.38). RA also reduced oxygen desaturation events by 67% (OR 0.33, 95% CI 0.21-0.52) and mechanical ventilation requirements by 82% (OR 0.18, 95% CI 0.09-0.35). Procedural success rates varied by technique: caudal epidural blocks had the highest success (92%, 95% CI 88-95%) compared to spinal anesthesia (80.3%, 95% CI 75.2-84.7%). Failure rates were predominantly due to anatomical challenges (19.7%, 95% CI 15.2-24.9%) rather than pharmacological factors. Sedation requirements affected outcomes, with dexmedetomidine showing the most favorable profile (89% adequacy rate vs 67% for midazolam). Adverse events were rare (3.1% overall) and predominantly minor (e.g., transient paresthesia).
Conclusions
RA provides clinically significant advantages over GA in pediatric populations, particularly for hemodynamic and respiratory stability in high-risk subgroups. These findings support the use of RA in vulnerable populations, though future research should address long-term neurodevelopmental outcomes and disease-specific protocols.
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