Safety and Efficacy of Regional Anesthesia in Pediatric Patients with Systemic Illnesses: A Systematic Review and Meta-Analysis | ||||
| Egyptian Journal of Anaesthesia | ||||
| Volume 41, Issue 1, 2025, Page 1-12 PDF (1.03 MB) | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/egja.2025.378669.1061 | ||||
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| Authors | ||||
Hany A. Zaki 1; Ahmed Shaban 2; Waseem Ahmad Malik3; Eman E Shaban 4; Amira Shaban 2; Mohammed F. Abosamak  5
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| 1Department of Emergency Medicine, College of Medicine, Qatar University, Doha, Qatar Department of Emergency Medicine, Hamad Medical Corporation, Doha - Qatar. | ||||
| 2Department of Internal Medicine, Mansoura General Hospital, Egypt. | ||||
| 3Department of Emergency Medicine, Hamad Medical Corporation, Doha – Qatar. | ||||
| 4Department of Cardiology, Al Jufairi Diagnosis and Treatment, MOH, Qatar. | ||||
| 5Department 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. | ||||
| Keywords | ||||
| Epidural anesthesia; Hemodynamic stability; Pediatric anesthesia; Regional anesthesia; Spinal anesthesia | ||||
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