Dexmedetomidine with magnesium sulphate as adjuvants in caudal block to augment anaesthesia and analgesia in paediatric lower abdominal surgeries

Abstract

To investigate the implication of dexmedetomidine and magnesium sulphate addition to bupivacaine in caudal anesthesia in paediatric lower abdominal surgeries. Study design: Randomized controlled trial. Setting: Paediatric University Hospital. Subjects: 120 children undergoing surgeries in the lower half of the body under general anaesthesia with a supplementary caudal block using 1 ml/kg bupivacaine 0.25%. Methods: Participants were randomly allocated into four groups; group C (saline as an additive to bupivacaine), group MG (50 mg magnesium sulphate added to bupivacaine), group D (1 µg/kg dexmedetomidine added to bupivacaine), and group MGD (the same doses of both dexmedetomidine and magnesium sulphate were added to bupivacaine). Time to first analgesia request (1ry outcome), and pain assessment by The Face, Legs, Activity, Cry, Consolability (FLACC) score just after recovery, then every 30 min in the early two hours, then at the 4th, 6th, 12th,18th, and 24th hours were compared between the groups. Results: Time to first analgesia request was significantly longer in the three study groups compared to group C with p < 0.001 (median values of 5, 14.5, 13.5, and 20.47 h in groups C, D, MG, and MGD in consequence). FLACC scores were significantly higher in group C in comparison to the other study groups by the early 2nd, 4th, and 6th postoperative hours. The group MGD has significantly lowest FLACC at the 6th postoperative hour. Conclusion: The combination of dexmedetomidine and magnesium sulphate with bupivacaine caudal block can prolong the time to first analgesia request.

Magnesium Sulfate in Pediatric Abdominal Cancer Surgery: Safety and Efficacy in Ultrasound-Guided Transversus Abdominis Plane (US-TAP) Block in Conjugation with Levobupivacaine

“…In agreement with us, Sayed et al study discovered a substantial decrease in FLACC pain score in the magnesium group. 26 Our findings confirmed Kim et al findings, who used ropivacaine alone and in conjunction with MgSO4 in 80 children performing inguinal herniorrhaphy and found that those who received MgSO4 experienced much less postoperative pain levels. 21 Our findings support a study carried out by Mukherjee et al who found that the MgSO4 group took longer to seek analgesia than the control group did and that the rescue analgesia was used less frequently in MgSO4 group compared to the control group.…”

“…24,25 Furthermore, a previous study found that the mean length of analgesia in the experimental groups was much prolonged than in the control group. 26 In agreement with us, Sayed et al study discovered a substantial decrease in FLACC pain score in the magnesium group. 26 Our findings confirmed Kim et al findings, who used ropivacaine alone and in conjunction with MgSO4 in 80 children performing inguinal herniorrhaphy and found that those who received MgSO4 experienced much less postoperative pain levels.…”

“… 24 , 25 Furthermore, a previous study found that the mean length of analgesia in the experimental groups was much prolonged than in the control group. 26 …”

Application of Different Doses of Dexmedetomidine Combined with General Anesthesia in Anesthesia of Patients with Traumatic Tibiofibular Fractures and Its Effect on the Incidence of Adverse Reactions

“…The orientation recovery time in group D was markedly shorter than that in groups A , B, and C ( P < 0.05). These results are similar to those in the studies of Jehan Ahmed Sayed et al [ 21 ] and Chiara Adami et al [ 22 ], indicating that dexmedetomidine at doses of 0.5 μ g/kg and 0.8 μ g/kg is notably better than 0.3 μ g/kg in promoting orientation recovery of patients. In addition, the incidence of cognitive dysfunction, chills, and restlessness in groups C and D was notably lower compared with groups A and B ( P < 0.05), with a higher incidence of chills, intraoperative hypotension, and delayed awakening in group D than in group C ( P < 0.05).…”

A comparative study of caudal anesthesia with bupivacaine v/s bupivacaine with dexmedetomidine in lower abdominal surgeries in pediatric age group

“…Post-operative pain is strongly associated with emotional component and is difficult to assess specially in the paediatric age group [1]. Several techniques have emerged for pain relief in this group inclusive of both regional and systematic analgesia [2].…”