A comparative study of the effect of caudal dexmedetomidine versus morphine added to bupivacaine in pediatric infra-umbilical surgery

Abstract

Background:One of the most commonly used regional anesthetic techniques in pediatric surgeries is the caudal epidural block. Its main disadvantage remains the short duration of action. Hence, different additives have been used. Dexmedetomidine is a potent as well as highly selective α2 adrenergic receptor agonist. The aim of this randomized, double-blinded, study was to compare the duration of postoperative analgesia of caudal dexmedetomidine versus morphine in combination with bupivacaine in pediatric patients undergoing lower abdominal or perineal surgery.Patients and Methods:A total of 50 pediatric patients 1-5 years old The American Society of Anesthesiologists status I, II scheduled for lower abdominal and perineal surgeries were included in the study. The patients were enrolled into 2 equal groups: Group A patients (n = 25) received dexmedetomidine with bupivacaine while Group B patients (n = 25) received morphine with bupivacaine. Patients were placed in a supine position then inhalational general anesthesia was induced, and laryngeal mask airway (LMA) was placed. Patients were then given caudal epidural analgesia. By the end of surgery reversal of muscle relaxation was done and the LMA was removed. Post-operatively, the sedation as well as pain score were observed and recorded.Results:The current study showed that minor complications were recorded in the post-anesthesia care unit; in addition, significantly longer periods of analgesia and sedation were detected in Group A. However, no significant differences in demographic data, as well as in the duration of surgery, and the time of emergence from anesthesia and patient condition during recovery were detected.Conclusion:The present study suggested that use of dexmedetomidine, during single dose injection, as an additive to the local anesthetic bupivacaine in caudal epidural analgesia prolongs the duration of post-operative analgesia following lower abdominal as well as perineal surgery compared with caudal morphine with no side-effects on the vital signs. Postoperative side effects were seen with caudal morphine injection rather than with dexmedetomidine.

A Randomized Controlled Trial Study on the Effect of Adding Dexmedetomidine to Bupivacaine in Supraclavicular Block Using Ultrasound Guidance

“…The assessment of postoperative pain was done hourly in the recovery room and in surgical ward with the help of Numeric Rating Scale (1–10) (4). Zero was considered as no pain, 1–3 as mild pain, 4–6 as moderate pain and 7–10 as severe pain.…”

Comparison of two doses of dexmedetomidine for supraclavicular brachial plexus block: A randomized controlled trial

“…Various clinical trials performed in both animals and humans have shown dexmedetomidine to be safe when used as an adjuvant to local anesthetic in subarachnoid, caudal, epidural, and BPBs. [ 3 4 5 ] Dexmedetomidine has been used in a dose ranging from 30 to 100 μg in human BPBs. [ 5 6 ] There have been contradictory reports regarding the safety of dexmedetomidine on increasing its dose.…”

Comparison of caudal ropivacaine‐morphine and paravertebral catheter for major upper abdominal surgery in infants

“…Morphine was one of the first additives used in 1981. Since then, many studies have been reported on its efficacy, its inhibitory effects, and on alternatives to the use of morphine . At our institution, pain management for infants undergoing upper abdominal surgery has evolved over time, transitioning from caudal morphine to PVC.…”