Comparative Study between Different Additives to Levobupivacaine in Caudal Block for Postoperative Pain Management in Pediatrics Undergoing Hypospadias Repair: Randomized Controlled Study

Abstract

Background: For both children and their caregivers, postoperative pain is an irritating experience. Several approaches have been used to treat postoperative pain in pediatric patients improving sleep quality, and extending sedation time. Objectives: This work aimed to compare the postoperative analgesic effect and any complications of addition of one of these drugs nalbuphine versus fentanyl versus dexamethasone to levobupivacaine in caudal block (CB) in pediatric patients undergoing hypospadias repair. Patient and Methods: 90 ASA status I and II patients aged 2 to 9 years underwent hypospadias repair were prospectively involved in this study. Patients were randomized into three equal groups (Group N, Group F and Group D). Result: There was no statistically significant difference between three groups as regards systolic blood pressure (SBP) except after 60 and 70 minutes after caudal block as there was a significant difference as SBP decreased in the group (N) more than in both groups (F and D). Also there was a significant deference between the three groups in SBP at 1, 1.5, 2 and 4 hours postoperatively. FLACC pain score between three groups showed a significant difference between three groups at 2, 6 and 8 hours postoperatively otherwise no significant difference Conclusion: Adding a nalbuphine to levobupivacaine in caudal block had longer duration for postoperative analgesia and showed more sedation time than that of fentanyl and dexamethasone with more stability in hemodynamics.

A comparative study of levobupivacaine alone and in combination with dexamethasone in caudal block for pediatric patient undergoing infraumbilical surgeries

“…Intraoperative SpO 2 was not statistically significant between the Group A and Group B (P>0.05) according to El Shamaa and Ibrahim. 15 Hassan et al, 5 observed FLACC scores from 30 min to 12 h postoperatively. There was a significant difference between the group N(0.25% levobupivacaine 0.75 mL/kg+0.2 mg/kg nalbuphine+normal saline), Group F (0.25% levobupivacaine 0.75 mL/kg+1 μg/kg fentanyl) and Group D (0.25% levobupivacaine 0.75 mL/ kg+0.1 mg/kg dexamethasone+normal saline) at 2, 6, and 8 h postoperatively; otherwise, no significant difference was found.…”

“…Levobupivacaine is a long-acting amide local anesthetic levobupivacaine is slightly less toxic to the central nervous system than bupivacaine, and it causes less myocardial depression and fatal arrhythmias. 5 Dexamethasone is very effective in prolonging the duration of peripheral nerve blocks, it also improves the quality of sensory blocks. Dexamethasone is commonly used for the management of post-operative pain, nausea, and vomiting.…”