Treatment of Postoperative Pain in Pediatric Operations: Comparing the Efficiency of Bupivacaine, Bupivacaine-Dexmedetomidine and Bupivacaine-Fentanyl for Caudal Block

Abstract

BackgroundCaudal analgesia is a common method for postoperative pain management in pediatric patients. Additive agents such as opioids and α2 agonists have been used to enhance the analgesic effects of local anesthetics for caudal block.ObjectivesThe aim of this study was to compare the additive effects of dexmedetomidine and fentanyl on bupivacaine-induced caudal analgesia in pediatric patients who had undergone elective inguinal hernia repair.MethodsThis randomized, double-blind clinical trial included children aged 1 - 5 years who were divided into three groups: the bupivacaine group (Group B) received 0.25% bupivacaine (1 ml/kg), the bupivacaine-dexmedetomidine group (Group BD) received 0.25% bupivacaine (1 mL/kg) plus 2 µg/kg dexmedetomidine, and the bupivacaine-fentanyl group (Group BF) received 0.25% bupivacaine (1 mL/kg) plus 2 µg/kg fentanyl. The hemodynamic variables (heart rate, systolic blood pressure, respiratory rate, and peripheral arterial oxygen saturation) were measured perioperatively. Pain, sedation and motor block scores and adverse events (nausea and vomiting, pruritis, hypotension, bradycardia, urinary retention and respiratory depression) were documented at 30 and 60 minutes, and the 1st, 2nd, 4th, 6th, 12th and 24th hours after the operation. The other recordings include the duration of surgery and analgesic requirement.ResultsA total of 61 patients were analyzed. The lowest pain scores were found in the BD group at all time points (P < 0.001). The sedation scores were higher in the BD group than in the other two groups at all time points (P < 0.001). No motor block was observed after the operation. Only three patients required analgesic administration 2 to 6 hours after the operation in group B. No side effects were observed in any of the groups, and there was no significant difference in the duration of surgery among the three groups.ConclusionsThe results show that the analgesic and sedative effects were better when dexmedetomidine was added to bupivacaine than when fentanyl was added or bupivacaine alone was administered in the pediatric population studied here that underwent elective inguinal hernia repair.

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

“…Giving our concern for a possible neurotoxicity from neuraxial dexmedetomidine, we selected a dose of 1 µg/kg similar to the study done by Hou et al, which suggested that low doses of intrathecal dexmedetomidine (0.75:1.50 µg/kg) can relieve pain without the risk of neurotoxicity [7]. Al-Zabenetal also mentioned that caudal dexmedetomidine in a dose of 1 µg/kg was comparable to the dose of 2 µg/kg regarding to the prolongation of postoperative analgesia, with shorter duration of postoperative sedation, lower incidence of side effects, and devoid of neurotoxicity [8].…”

“…It appears to be less neurotoxic than other existing agents and has the potential to be neuroprotective in the neonatal and paediatric settings [6]. Its selectivity for α 2-adrenoceptor makes it much more effective sedative and analgesic agent than clonidine [7]. This selectivity is mainly responsible for the proposed neuroprotective effects of dexmedetomidine [8].…”

A Randomized Controlled Double-Blind Comparative Study between Bupivacaine 0.25% Plus Fentanyl and Bupivacaine 0.25% Plus Dexmedetomidine for Caudal Epidural Postoperative Analgesia in Pediatric Lower Abdominal and Urogenital Surgeries in Indian Genotype

“…They noticed no side effects like hypotension, bradycardia, pruritus, nausea, vomiting, and urinary retention in their study. 18 In our study, the dose of bupivacaine is 0.75 mL/kg instead of 1 mL/kg in their study. The doses of dexmedetomidine and fentanyl in our study were 1 mcg/kg instead of 2 mcg/kg in their study.…”

Dexmedetomidine Addition For Pediatric Hernia Repair: A Meta-Analysis of Randomized Controlled Studies

“…Local anesthetics such as bupivacaine and ropivacaine were used for peripheral nerve block, sympathetic nerve block, local in ltration, epidural and caudal blocks [11,[26][27][28]. Combination dexmedetomidine with bupivacaine or ropivacaine can prolong the analgesic effect [14,29,30]. In a prospective randomized study involving 60 patients with the age between 6 months to 6 years scheduled for unilateral inguinal herniorrhaphy, the duration of analgesia is signi cantly higher in patients receiving bupivacaine with dexmedetomidine in comparison to patients receiving bupivacaine alone, but the frequency of analgesic consumption in the rst 24 h and total dose of analgesic consumption had no signi cant difference in the two groups [11].…”

“…Dexmedetomidine, a strong α2 adrenergic agonist, has a sympatholytic, sedative, analgesic effect and is effective in many anesthetic and analgesic techniques [12,13]. The addition of dexmedetomidine to wound in ltration with ropivacaine was reported to reduce post-operative pain after inguinal herniorrhaphy [14][15][16].…”