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Objective: Interleukin 12 receptor beta 1 (IL‐12Rβ1) deficiency is a primary immunodeficiency that exposes affected individuals to an augmented risk of intracellular pathogen‐mediated infections. The paradoxical presence of autoimmune manifestations in immune‐deficient patients has been recognized, but the basis of this phenomenon is unclear, with the role of frequent infections being a possible trigger to break tolerance. Our study aimed to analyze extensively a profile of autoantibodies in a clinically well‐defined case series of patients with IL‐12Rβ1 deficiency. Methods: Eight patients with IL‐12Rβ1 deficiency referred to Children's Medical Center in Tunis, Tunisia, during 1995‐2012 were enrolled in the study. Sixteen age‐ and gender‐matched blood donors served as controls. Serum, liver‐related autoantibodies immunoglobulin (Ig)G, IgM, IgA were tested by ELISA and by standard indirect immunofluorescence on Hep‐2 cells. Results: We found a significant prevalence of liver autoantibodies in the study group. Regarding primary biliary cholangitis (PBC), two of eight patients were positive for MIT3 autoantibodies, both confirmed by immunofluorescence, and one patient was positive for PBC‐specific antinuclear antibodies, sp100. Moreover, two patients had significantly increased gamma‐glutamyltransferase levels and one had IgM levels twice the upper limit of normal. Intriguingly two patients were positive for anti‐actin antibodies; a typical feature of autoimmune hepatitis type 1, along with a significant increase in IgG levels. Conclusions: This is the first report of a serological analysis in patients with an IL‐12Rβ1 deficiency. Despite the difficulty in interpreting the role of the IL‐12, the evidence of liver‐specific autoantibodies confirms the importance its signal in liver autoimmunity. [ABSTRACT FROM AUTHOR]

Background Adult meta-analyses have verified that adjunct use of alpha-2 adrenoceptor agonists (A2 AA) together with local anesthetics ( LA) will prolong the duration of peripheral nerve blocks. The standard use of A2 AAs for peripheral nerve blockade has recently been recommended also in children, but the evidence base in support of this suggestion has to date been equivocal. The purpose of this meta-analysis was to produce evidence-based data regarding the effect in children. Methods Following a thorough literature search, five randomized controlled trials were included in a meta-analysis. Raw data from all studies were gathered and aggregated into patients randomized to receive plain LA (Group PLA) or LA mixed with either adjunct clonidine or dexmedetomidine (Group ADJ). The main outcome parameter was block duration (time to first administration of supplemental analgesic based on predetermined pain scores) analyzed by survival statistics. The total number of supplemental analgesic doses during the first 24 postoperative hours and serious side effects were included as secondary outcomes. Results Pooling of the study data generated 141 patients in Group PLA and 142 patients in Group ADJ (overall n = 283; age: 0.8-13 years; weight 8-47 kg). Block duration was significantly prolonged (9.75 h vs 3.75 h) compared to the use of plain LA. Survival statistics verified a beneficial effect of using adjunct A2 AAs [the log rank (Mantel-Cox) test ( P = 0.0078), Gehan-Breslow-Wilcoxon test ( P = 0.0027), and hazard ratio (1.653; 95% CI: 1.142 to 2.395)]. The number of patients that needed ≥2 doses of supplemental analgesics was higher in Group PLA ( n = 19) compared to Group ADJ ( n = 6) ( P = 0.0088). No serious side effects were reported. Conclusion This meta-analysis provides evidence-based support for the use of adjunct alpha-2 adrenoceptor agonists when performing peripheral nerve blocks in children. [ABSTRACT FROM AUTHOR]

Summary Background: The addition of clonidine to peripheral nerve blocks is controversial in children. Objective: The aim of our study was to evaluate the effect of clonidine added to ropivacaine in pediatric axillary brachial plexus block (ABPB). Methods: Children aged 1-6 years, scheduled to undergo forearm or hand surgery, were recruited into this prospective, double-blind controlled trial. Patients were randomly allocated to receive an ABPB either with ropivacaine 0.2% 0.4 ml·kg−1 plus saline in 1 ml (RS) or ropivacaine 0.2% 0.4 ml·kg−1 plus clonidine 1 μg·kg−1 in 1 ml (RC). Primary endpoints were quality of postoperative analgesia as assessed by pain scores and total 24-h postoperative analgesia requirements. Secondary outcomes were time to first analgesia request and duration of motor blockade. Results: Sixty patients were recruited ( n = 30 per group) into the study. Pain scores were comparable throughout the first 24 h between the two groups. Ten children in the (RS) and six in (RC) groups required supplementary analgesia during the first 24 h ( P = 0.24). Children who required further analgesia did so after 288 ± 94 min in the (RS) and 437 ± 204 min in the (RC) group ( P = 0.06). There was no difference in the duration of motor block [186 ± 71 and 154 ± 56 min, P = 0.12 for (RS) and (RC), respectively]. Conclusion: Ropivacaine (0.2% 0.4 ml·kg−1) for ABPB provides sufficient postoperative analgesia in children scheduled for forearm or hand surgery. The addition of clonidine to ABPB does not improve overall postoperative analgesia but may increase the time to first analgesia request. [ABSTRACT FROM AUTHOR]

The article focuses on a study conducted by the authors related to effect of addition of clonidine to bupivacaine in saphenous/sciatic nerve blocks in pediatric patients. Topics discussed include a previous study showing an increase in sensory block duration when clonidine is added to local anesthetics and the study revealing ineffectiveness of clonidine in improving quality of analgesia in children undergoing foot surgery.