Analgesic effects of caudal dexmedetomidine versus midazolam combined with bupivacaine on postoperative pain following paediatric infraumbilical surgeries

Abstract

Background: There is continued search for an ideal adjuvant necessitated by the limited duration of singleshot caudal block. The study aimed to compare the analgesic effects of caudal 1.5 µg/kg dexmedetomidine versus 50 µg/kg midazolam combined with 0.20% bupivacaine in children.Methods: Following ethical approval and parental consent, 66 American Society of Anesthesiologists (ASA) class I or II children aged 1-6 years were randomized into three groups (A, B, and C) of 22 each. All patients had laryngeal mask airway (LMA) general anaesthesia induced with propofol and maintained with isoflurane in 100% oxygen. Group A received 1 ml/kg 0.20% bupivacaine and 1.5 µg/kg dexmedetomidine (1 ml), B received 1 ml/kg 0.20% bupivacaine plus 50 µg/kg midazolam (1 ml) while C received 1 ml/kg 0.20% bupivacaine and 0.9% normal saline (1 ml), via the caudal space. Pain was assessed using the face, leg, arm, cry, consolability (FLACC) scale. The time to first analgesic request, (TTFAR) was defined as the period from caudal injection to pain score of ≥4. Analgesic was given when FLACC score was ≥4.Results: All 66 children completed the study. The TTFAR was longest in group A (14.4±2.36), followed by group B (12.0±3.69), and shortest in group C (5.6±1.45), p=0.01, with greatest 24 hours analgesic consumption in group C, p=0.01.Conclusions: Caudal dexmedetomidine or midazolam combined with bupivacaine significantly prolonged the analgesic duration, with superiority of dexmedetomidine over midazolam group in analgesic profile.

Comparison of Analgesic Efficacy of Caudal Ropivacaine and Ketamine Vs. Ropivacaine and Midazolam in Paediatric Patients Undergoing Infraumbilical Surgery

“…Caudal blockade is commonly used as popular regional technique in children. It is simple and safe and produces dense peri-operative analgesia with high success rate [17,18] . Patients enrolled into the study were randomly divided into two groups by Group A -1.0 ml/kg, 0.15% ropivicane with 0.3 mg/kg of Ketamine and Group B -1.0 ml/kg, 0.15% ropivicane with 0.03 mg/kg of Midazolam.…”

“…As an adjunct in the caudal block, midazolam is believed to extend the duration of analgesia [16] . There is a paucity of literature comparing analgesia, sedation, and side effects of these two non-opioid adjuvants (midazolam and dexmedetomidine) with ropivacaine in the caudal block [17] . As a result, we would want to examine the use of these adjuvants in conjunction with caudal ropivacaine for children undergoing infraumbilical surgeries.…”