Caudal dexmedetomidine combined with bupivacaine inhibit the response to hernial sac traction in children undergoing inguinal hernia repair

Xiang, Qiang; Huang, Dan; Zhao, Yuchong; Wang, G.H.; Liu, Y.X.; Zhong, Liang; Luo, Tao

doi:10.1093/bja/aes385

Cited by 47 publications

(71 citation statements)

References 23 publications

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“…These results come with agreement with the study done by Xiang et al who studied the effect of addition of dexmedetomidine to ropivacaine in caudal block in children underwent inguinal hernia repair and concluded that the addition of dexmedetomidine to caudal bupivacaine could reduce the response to hernial sac traction, prolong the duration of postoperative analgesia and decrease postoperative analgesic requirements [17].…”

Section: Discussionsupporting

confidence: 91%

Fentanyl, dexmedetomidine, dexamethasone as adjuvant to local anesthetics in caudal analgesia in pediatrics: A comparative study

El-Feky

Aziz

2015

Egyptian Journal of Anaesthesia

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Background: Caudal analgesia is a good, reliable and easy method to provide intraoperative and postoperative analgesia in the infraumbilical surgery in pediatrics. Many additives were used in combination with local anesthetics in caudal block to prolong the postoperative analgesia (fentanyl, dexmedetomidine and dexamethasone). Aim of the study: This study aimed to compare the intraoperative hemodynamics, postoperative analgesia, postoperative sedation and postoperative side effects of fentanyl, dexmedetomidine and dexamethasone as adjuvant to bupivacaine in caudal analgesia in pediatrics. Methods: 120 pediatric patients (3-10 years old) scheduled for lower abdominal surgeries under general anesthesia allocated to 4 groups. Group I (control), in this group the patients received 0.5 ml of a equal mixture of bupivacaine 0.25% and lidocaine 1% diluted in saline (in a dose of 0.5 ml/kg) caudally. In Group II (fentanyl group), the patients received the same mixture of Group I + fentanyl (1 lg/kg) caudally. In Group III (dexmedetomidine group), the patients received the same mixture of Group I + dexmedetomidine (1 lg/kg) caudally. In Group IV (dexamethasone group), the patients received the same mixture of Group I + dexamethasone (0.1 mg/kg) caudally. Results: The demographics and hemodynamics were comparable among the studied groups. The dexmedetomidine group and dexamethasone group were less in pain score, prolong the duration of analgesia and less in number of patients required analgesia compared to control and fentanyl groups. More sedation was present in the fentanyl and dexmedetomidine groups. The fentanyl group showed significant increase in the adverse effect incidence. Conclusion: Both caudal dexmedetomidine and caudal dexamethasone added to local anesthetics are good alternatives in prolongation of postoperative analgesia compared to caudal local anesthetic alone or added to caudal fentanyl. Also they showed less side effects compared to caudal fentanyl.

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Section: Discussionsupporting

confidence: 91%

Fentanyl, dexmedetomidine, dexamethasone as adjuvant to local anesthetics in caudal analgesia in pediatrics: A comparative study

El-Feky

Aziz

2015

Egyptian Journal of Anaesthesia

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“…19) As the sacral region has the largest concentration of α 2 -adrenoceptors than the lumbar or thoracic regions in humans, 20,21) caudally administered DEX combined with local anesthetics could provide effective analgesia. In this current study, although the analgesic duration was shorter than that in other studies that used a higher concentration (0.25%) of bupivacaine 4,[10][11][12][13] or ropivacaine, 17) the analgesic duration Pre-incision, value before surgical incision; Incision, value after surgical incision; 10 min, value 10 min after iincision; End, value at the end of surgery. * p<0.05. was significantly longer in DEX group than in control group.…”

Section: Discussionmentioning

confidence: 62%

“…Additionally, caudal DEX with a low-concentration of local anesthetics induces less adverse effects (motor weakness, delayed micturition of urinary retention) that may affect early discharge from hospital, compared with a higher concentration of local anesthetics. 3,4,10,12,13,23) DEX has anxiolytic, sedative, and hypnotic properties caused by stimulation of the α2-adrenoceptor in the locus coeruleus in brain where it decreases a neuronal activation 9,24) and can reduce the requirement of concomitantly administered hypnotics, analgesics, or anesthetics. 25) Intravenous DEX significantly decreases the sevoflurane requirement 5,26) for anesthesia and EA during recovery.…”

Section: Discussionmentioning

confidence: 99%

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The Effect of 1 µg/kg Dexmedetomidine Combined with High-Volume/Low-Concentration Caudal Ropivacaine in Children Undergoing Ambulatory Orchiopexy

Cho

Kim

Park

et al. 2015

Biological & Pharmaceutical Bulletin

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When local anesthetics are used, the administration of dexmedetomidine (DEX) can prolong analgesic duration. However, the effect of caudal DEX on high volume/low concentration (HVLC) local anesthetics has not been studied. We investigated the analgesic effect of DEX added to a HVLC of ropivacaine for caudal block in children. Eighty children (the American Society of Anesthesiologists (ASA) status I; age, 1-6 years) undergoing ambulatory orchiopexy were enrolled in the study. Children were randomly assigned to undergo a caudal block with 1.5 mL/kg of 0.15% ropivacaine and either 1 µg/kg of DEX (DEX group, n 40) or the same amount of saline (Control group, n 40) under general anesthesia. The results showed that the time to first analgesic request was significantly longer in the DEX group than in the control group. The sevoflurane requirement for anesthesia and frequency of emergence agitation (EA) were also significantly lower in the DEX group. There was no difference in adverse events between the two groups. In conclusion, a dose of 1 µg/ kg of caudal DEX prolonged the first analgesic request time, although the immediate postoperative pain scores were comparable in both groups. Furthermore, caudal DEX significantly reduced the sevoflurane requirement and the frequency of EA.Key words dexmedetomidine; caudal block; child; orchiopexy Caudal block is common method for postoperative analgesia in children undergoing infra-umbilical surgery. One major limitation of caudal block is a relatively short analgesic duration owing to the single-injection. Thus, adjuvants such as ketamine, clonidine, or opioids are frequently added to the local anesthetics in order to improve analgesic efficacy and duration.1,2) The effectiveness of local anesthetics using in caudal block is dependent upon the dose, volume, and concentration of the local anesthetic solution, but high-concentration local anesthetics can increase the incidence of motor weakness, delayed micturition, or urinary retention. In children undergoing ambulatory surgery, such adverse effects can prolong the discharge time and may result in inadvertent admission. Recently, high-volume/low-concentration (HVLC) regimens for caudal blocks in children (1.5 mL/kg of 0.1-0.2% local anesthetics) have gained popularity following a report by Silvani et al. that demonstrated that a HVLC regimen provides a longer analgesic duration with less adverse effects than conventional dose/concentration. [3][4][5][6][7][8] However, the analgesic duration is still limited in caudal block with single-injection.Dexmedetomidine (DEX) is a highly selective α 2 adrenoceptor agonist with an α2/α1 selectivity ratio of 1600 : 1, and is eight times more potent than clonidine. 9) DEX is successfully used as an adjuvant in caudal blocks for children in order to reduce pain without inducing any significant respiratory and hemodynamic effects. Several studies have reported that in children, caudal DEX (1-2 µg/kg) with 0.25% bupivacaine (1 mL/kg) prolongs postoperative analgesic duration by 2.5-3 fold comp...

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“…The analgesic effect of dexmedetomidine has been investigated in many (23) found that addition of 5 µg dexmedetomidine to 10 mg bupivacaine intrathecally in patients before major abdominal cancer surgery improved the duration and quality of postoperative analgesia. In a previous study, Xiang et al (24) added dexmedetomidine to bupivacaine in 60 children aged 1-6 years. Thirty children received 1 mL/kg volume of 0.25% bupivacaine plus 1 μg/kg dexmedetomidine caudally.…”

Section: Discussionmentioning

confidence: 99%

Intracerebroventricular Application of Dexmedetomidine Produces Antinociception and Does not Cause Neurotoxicity in Rats

Köksal¹,

Karakaya²,

Can³

et al. 2013

Balkan Med J

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Caudal dexmedetomidine combined with bupivacaine inhibit the response to hernial sac traction in children undergoing inguinal hernia repair

Abstract: The addition of dexmedetomidine to caudal bupivacaine could reduce the response to hernial sac traction, and prolong the duration of postoperative analgesia in children undergoing inguinal hernia repair.

Cited by 47 publications

References 23 publications

Fentanyl, dexmedetomidine, dexamethasone as adjuvant to local anesthetics in caudal analgesia in pediatrics: A comparative study

Fentanyl, dexmedetomidine, dexamethasone as adjuvant to local anesthetics in caudal analgesia in pediatrics: A comparative study

The Effect of 1 µg/kg Dexmedetomidine Combined with High-Volume/Low-Concentration Caudal Ropivacaine in Children Undergoing Ambulatory Orchiopexy

Intracerebroventricular Application of Dexmedetomidine Produces Antinociception and Does not Cause Neurotoxicity in Rats

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