Dexmedetomidine versus clonidine adjuvants to levobupivacaine for ultrasound‐guided transversus abdominis plane block in paediatric laparoscopic orchiopexy: Randomized, double‐blind study

Abstract

BackgroundLaparoscopic surgeries are associated with less postoperative pain and adverse events compared to open procedures. But, it still reduces the quality of life in children. Transversus abdominis plane (TAP) block is used to reduce pain. We hypothesized that dexmedetomidine or clonidine could improve the analgesic profile of levobupivacaine to the same extent during TAP block in children.MethodsNinety children were randomly allocated in a randomized double‐blind trial to receive bilateral TAP block with levobupivacaine plus normal saline (group B, n = 30), or dexmedetomidine (group D, n = 30) or clonidine (group C, n = 30). Primary outcome was the modified Children's Hospital of Eastern Ontario Pain Scale score. Secondary outcomes included time to initial analgesic request, number of analgesic claims, total analgesic consumption, parents' satisfaction, sedation score and complications.ResultsChildren of group D showed reduced pain scores compared to other groups. They represented the longest period of analgesia (565.00 ± 71.5 min) with p < 0.001, and fewer patients required two doses of analgesia during the first postoperative day. The cumulative amount of backup analgesia was significantly different between these groups (p = 0.026). Higher parents’ satisfaction scores were recorded in groups D and C compared to group B. Sedation among the study groups revealed significant differences (p = 0.035), but no severe complications were recorded.ConclusionsAdding dexmedetomidine to levobupivacaine can extend the time of analgesia and reduce the use of postoperative backup analgesics with minimal sedation effects when used in TAP block in paediatrics undergoing laparoscopic orchiopexy. Clonidine can be used as an alternative adjuvant to local anaesthetics with good postoperative analgesic profiles.SignificanceClonidine can alternate dexmedetomidine during TAP block with local anesthetics for pediatrics laparoscopies. Both can lead to better postoperative analgesic profiles. Clonidine may be preferred, especially in our developing regions, because of its easy availability and lower cost than that of dexmedetomidine.

Dexmedetomidine as an Adjuvant in Peripheral Nerve Block

“…In addition to kidney transplantation and Caesarean section, dexmedetomidine has been successfully applied as an adjuvant in hernia repair Madangopal et al 87 open treatment of gynecological malignant tumor, 88 minimally invasive colorectal surgery, 161 laparoscopic cholecystectomy, 89 laparoscopic bile duct exploration in children 90 and other operations. It has obvious advantages in postoperative analgesia.…”

“…It also enhanced the quality of the block as compared with clonidine [ 132 ] Dexmedetomidine vs clonidine Compare dexmedetomidine or clonidine could improve the analgesic profile of levobupivacaine to the same extent during TAPB Adding dexmedetomidine to levobupivacaine can extend the time of analgesia and reduce the use of postoperative backup analgesics with minimal sedation effects when used in TAPB in pediatrics undergoing laparoscopic orchiopexy. Clonidine can be used as an alternative adjuvant to local anesthetics with good postoperative analgesic profiles [ 90 ] Dexmedetomidine vs clonidine Compare dexmedetomidine and clonidine added to bupivacaine in infraclavicular BPB Dexmedetomidine provides a quicker and prolonged analgesic action without major adverse effects [ 133 ] Dexmedetomidine vs clonidine Review the efficacy and safety of dexmedetomidine and clonidine as perineural or systemic adjuvants for BPB Alpha2-receptor agonists used as adjuvants for BPB lead to a prolonged duration of analgesia, with dexmedetomidine as the most efficient. Alpha2-receptor agonists were associated with an increased risk of cardiovascular adverse events [ 54 ] Dexmedetomidine vs nalbuphine Compare dexmedetomidine and nalbuphine in BPB Compared with dexmedetomidine, nalbuphine had significantly shorter sensory and motor block onset time, longer block duration, less analgesic need, and fewer side effects [ 135 ] Dexmedetomidine vs nalbuphine Compare nalbuphine and dexmedetomidine for ESPB in VATS Nalbuphine and dexmedetomidine are comparable in terms of the associated analgesia, sensory block duration, need for rescue analgesia, and incidence of chronic pain in patients after VATS in ESPB [ 136 ] Dexmedetomidine vs nalbuphine Compare dexmedetomidine and nalbuphine in TVPB in breast cancer surgeries Adding nalbuphine to TPVB improved the block’s quality and decreased postoperative analgesic requirements.…”

Injectable electrospun fiber-hydrogel composite sequentially releasing clonidine and ropivacaine for prolonged and walking regional analgesia

“…Clonidine (Clo) is a centrally acting antihypertensive agent with α2 adrenoceptor agonist properties. Recently, Clo has been used to extend the duration of local anesthetics in some clinical studies, showing favorable effects 17 , 18 , but the exact mechanism is unclear yet.…”

A Comparative Study on the Effects of Ketofol, Dexmedetomidine, and Isofol in Anesthesia of Candidates for Dilatation and Curettage

“…The preferred method for surgeons and patients is often general anesthesia. Due to the common bleeding in this surgery, it is crucial to maintain hemodynamics during anesthesia ( 11 ). Thus, selecting the type of drug in general anesthesia should be carefully examined, and the best drug should be selected ( 12 ).…”