A comparative study of caudal anesthesia with bupivacaine v/s bupivacaine with dexmedetomidine in lower abdominal surgeries in pediatric age group
DOI:
https://doi.org/10.31636/pmjua.v6i3.3Keywords:
bupivacaine, dexmedetomidine, hemodynamics, postoperative painAbstract
Background: caudal anaesthesia has shortterm effect. Alpha2 adenoreceptors when used as adjuvant to local anaesthetic in children prolongs analgesic duration. The study is aimed to assess the efficacy of addition of dexmedetomidine with Bupivacaine in caudal block for extending postoperative analgesia and its safety profile in pediatric infraumbilical surgeries.
Method: the prospective interventional longitudinal double blinded study was conducted on 60 patients randomly divided into two groups by simple lottery method: group B who received (0.25 %) bupivacaine 1 ml/kg plus 1 ml normal saline (NS), and those in group BD who received (0.25 %) bupivacaine 1 ml/kg plus 0.5 μg/kg dexmedetomidine in 1 ml NS. Postsurgery, both groups were compared in R studio v1.2.5001. Association between the adverse effect and other variables (age, gender, type of surgery, groups) were assessed by Multiple linear regression.
Results: in group BD, duration of analgesia prolonged significantly (P < 0.05). In group BD, FLACC score at initial four hours and at 12th hour was significantly less (P < 0.05). Group B was more likely to receive high number of rescue analgesia (P = 0.0005; OR = 11.769). No significant difference was observed concerning hemodynamics, respiratory parameters and adverse effect between both groups (P > 0.05).
Conclusion: in children, dexmedetomidine when used along with bupivacaine prolongs postoperative analgesia duration, without any significant side effects.
Downloads
References
Sayed JA, Kamel EZ, Riad MAF, Abd-Elshafy SK, Hanna RS. Dexmedetomidine with magnesium sulphate as adjuvants in caudal block to augment anaesthesia and analgesia in paediatric lower abdominal surgeries. Egyptian Journal of Anaesthesia [Internet]. Informa UK Limited; 2018 Oct;34(4):114–22. Available from: https://doi.org/10.1016/j.egja.2018.06.001
Goyal V, Kubre J, Radhakrishnan K. Dexmedetomidine as an adjuvant to bupivacaine in caudal analgesia in children. Anesthesia: Essays and Researches [Internet]. Medknow; 2016;10(2):227. Available from: https://doi.org/10.4103/0259-1162.174468
Bailey B, Trottier ED. Managing Pediatric Pain in the Emergency Department. Pediatric Drugs [Internet]. Springer Science and Business Media LLC; 2016 Jun 3;18(4):287–301. Available from: https://doi.org/10.1007/s40272-016-0181-5
Abdel-Ghaffar H, Moeen S, Moeen A. Topical versus caudal ketamine/bupivacaine combination for postoperative analgesia in children undergoing inguinal herniotomy. Saudi Journal of Anaesthesia [Internet]. Medknow; 2017;11(1):41. Available from: https://doi.org/10.4103/1658-354x.197338
Kalappa S. Dexmedetomidine as an Adjuvant to Pre-Emptive Caudal Epidural Ropivacaine for Lumbosacral Spine Surgeries. JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH [Internet]. JCDR Research and Publications; 2016; Available from: https://doi.org/10.7860/jcdr/2016/15286.7145
Singhal NR, Jones J, Semenova J, Williamson A, McCollum K, Tong D, et al. Multimodal anesthesia with the addition of methadone is superior to epidural analgesia: A retrospective comparison of intraoperative anesthetic techniques and pain management for 124 pediatric patients undergoing the Nuss procedure. Journal of Pediatric Surgery [Internet]. Elsevier BV; 2016 Apr;51(4):612–6. Available from: https://doi.org/10.1016/j.jpedsurg.2015.10.084
Alam A, Suen KC, Hana Z, Sanders RD, Maze M, Ma D. Neuroprotection and neurotoxicity in the developing brain: an update on the effects of dexmedetomidine and xenon. Neurotoxicology and Teratology [Internet]. Elsevier BV; 2017 Mar;60:102–16. Available from: https://doi.org/10.1016/j.ntt.2017.01.001
Jarineshin H, Fekrat F, Kargar Kermanshah A. Treatment of Postoperative Pain in Pediatric Operations: Comparing the Efficiency of Bupivacaine, Bupivacaine-Dexmedetomidine and Bupivacaine-Fentanyl for Caudal Block. Anesthesiology and Pain Medicine [Internet]. Kowsar Medical Institute; 2016 Jul 26;6(5). Available from: https://doi.org/10.5812/aapm.39495
Nelson LE, Lu J, Guo T, Saper CB, Franks NP, Maze M. The α2-Adrenoceptor Agonist Dexmedetomidine Converges on an Endogenous Sleep-promoting Pathway to Exert Its Sedative Effects. Anesthesiology [Internet]. Ovid Technologies (Wolters Kluwer Health); 2003 Feb 1;98(2):428–36. Available from: https://doi.org/10.1097/00000542-200302000-00024
Fernandes ML, do Carmo Santos M, Gomez RS. Sedation with dexmedetomidine for conducting electroencephalogram in a patient with Angelman syndrome: a case report. Brazilian Journal of Anesthesiology (English Edition) [Internet]. Elsevier BV; 2016 Mar;66(2):212–4. Available from: https://doi.org/10.1016/j.bjane.2013.06.020
Brummett CM, Hong EK, Janda AM, Amodeo FS, Lydic R. Perineural Dexmedetomidine Added to Ropivacaine for Sciatic Nerve Block in Rats Prolongs the Duration of Analgesia by Blocking the Hyperpolarization-activated Cation Current. Anesthesiology [Internet]. Ovid Technologies (Wolters Kluwer Health); 2011 Oct 1;115(4):836–43. Available from: https://doi.org/10.1097/aln.0b013e318221fcc9
Practice Guidelines for Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration: Application to Healthy Patients Undergoing Elective Procedures. Anesthesiology [Internet]. Ovid Technologies (Wolters Kluwer Health); 2017 Mar 1;126(3):376–93. Available from: https://doi.org/10.1097/aln.0000000000001452
Konakci S, Adanir T, Yilmaz G, Rezanko T. The efficacy and neurotoxicity of dexmedetomidine administered via the epidural route. European Journal of Anaesthesiology [Internet]. Ovid Technologies (Wolters Kluwer Health); 2008 May;25(5):403–9. Available from: https://doi.org/10.1017/s0265021507003079
El-Feky EM, Abd El Aziz AA. Fentanyl, dexmedetomidine, dexamethasone as adjuvant to local anesthetics in caudal analgesia in pediatrics: A comparative study. Egyptian Journal of Anaesthesia [Internet]. Informa UK Limited; 2015 Apr;31(2):175–80. Available from: https://doi.org/10.1016/j.egja.2014.11.005
Meenakshi Karuppiah N, Shetty S, Patla K. Comparison between two doses of dexmedetomidine added to bupivacaine for caudal analgesia in paediatric infraumbilical surgeries. Indian Journal of Anaesthesia [Internet]. Medknow; 2016;60(6):409. Available from: https://doi.org/10.4103/0019-5049.183394
Hassan A, Hassan P, Elmetwally S. Caudal analgesia for hypospadias in pediatrics: Comparative evaluation of adjuvants dexamethasone and dexmedetomidine combination versus dexamethasone or dexmedetomidine to bupivacaine: A prospective, double-blinded, randomized comparative study. Anesthesia: Essays and Researches [Internet]. Medknow; 2018;12(3):644. Available from: https://doi.org/10.4103/aer.aer_77_18
El-Hennawy AM, Abd-Elwahab AM, Abd-Elmaksoud AM, El-Ozairy HS, Boulis SR. Addition of clonidine or dexmedetomidine to bupivacaine prolongs caudal analgesia in children. British Journal of Anaesthesia [Internet]. Elsevier BV; 2009 Aug;103(2):268–74. Available from: https://doi.org/10.1093/bja/aep159
Biondi A, Di Stefano C, Ferrara F, Bellia A, Vacante M, Piazza L. Laparoscopic versus open appendectomy: a retrospective cohort study assessing outcomes and cost-effectiveness. World Journal of Emergency Surgery [Internet]. Springer Science and Business Media LLC; 2016 Aug 30;11(1). Available from: https://doi.org/10.1186/s13017-016-0102-5
H g m, a s. A prospective, randomized, double blind, controlled clinical study of adjuvant effect of fentanyl (1 µg/kg) or clonidine (2µg / kg) to ropivacaine 0.2% 1ml/kg for caudal analgesia in children undergoing lower abdominal surgeries. Journal of evolution of medical and dental sciences [internet]. Akshantala enterprises private limited; 2014 oct 10;3(52):12036–72. Available from: https://doi.org/10.14260/jemds/2014/3594
SAADAWY I, BOKER A, ELSHAHAWY MA, ALMAZROOA A, MELIBARY S, ABDELLATIF AA, et al. Effect of dexmedetomidine on the characteristics of bupivacaine in a caudal block in pediatrics. Acta Anaesthesiologica Scandinavica [Internet]. Wiley; 2008 Dec 8;53(2):251–6. Available from: https://doi.org/10.1111/j.1399-6576.2008.01818.x

Downloads
Published
How to Cite
Issue
Section
License

This work is licensed under a Creative Commons Attribution 4.0 International License.
This work is licensed under a Creative Commons Attribution 4.0 International License