Abstract
Introduction: Caudal block is widely used in children for analgesia. Adequate intra and post operative analgesia will not only modify the stress response but also has been shown to reduce morbidity and mortality. Hence, we have conducted a study by using two doses (1µg/kg & 2µg/kg) of Dexmedetomidine with 0.2% Ropivacaine to maintain stable hemodynamics and provide better analgesia with minimal complications.
Aim: The aim was to compare efficacy and safety of two Different doses of Dexmedetomidine in respect to the duration & quality of perioperative analgesia and sedation as adjuvant to Ropivacaine 0.2% in paediatric caudal anaesthesia.
Method: We performed a Double blind, prospective study in 60 patients aged 3-8 years scheduled for infraumblical surgeries were randomly allocated into two groups. Group-I - 0.20% Ropivacaine 1ml/kg + 1µgm/kg of Dexmedetomidine, Group-II - 0.20% Ropivacaine 1ml/kg + 2µgm/kg of Dexmedetomidine. Patient’s hemodynamics, duration of analgesia and four point sedation score were compared between the groups and analyzed.
Result: Mean Onset time of sensory and motor block was found earlier in group-RD2 (6.36 min & 9.06 min) than group-RD1 (11.76 min & 15.2min) (p value < 0.05). Hemodynamics was comparable at all stages of surgery except the MBP was higher in group-RD1. Mean duration of Analgesia was prolonged in Group-RD2 (906.17min.) as compared with Group-RD1 (587.27 min)(p value < 0.05).Surgeons were more satisfied in group-RD2.
Conclusion: Caudal dexmedetomidine 2 µg/kg with ropivacaine 0.2% for paediatric infraumblical surgeries achieved significant postoperative pain relief up to 14 hours, which resulted in a better quality of sleep and a prolonged duration of arousable sedation upto 4 hours.
Keywords: Caudal Block, Ropivacaine, Dexmedetomidine, infraumblical surgeries
References
1. Anand KJS, Phil D, Hickey PR: Pain and its effects in the human neonate and fetus. N Engl J Med 1987; 317: 1321–9.
- Richard F. Howard. Current Status of Pain Management in Children; JAMA. November 12, 2003; 290: 2464-2469.
- Rawal : Analgesia for day care surgery. Br J Anaesth 2001; 87: 73-87
- Scott D.B., Lee A., Fagan D., Geoffrey M. R. Bowler, Bloomfield P., Lundh R: Acute toxicity of roipvacaine compared with that of bupivacaine. Anaesthesia analgesia 1989; 69,563-569.
- Maze M, Tranquilli W: Alpha-2 adrenoceptor agonists: Defining the role in clinical anesthesia. Anesthesiology 1991; 74: 581-605.
- Yoshitomi et al: Dexmedetomidine Enhances the Local Anesthetic Action of Lidocaine via α-2A Adrenoceptor. Anesth & Analg 2008; 107: 96-101.
- de Beer DAH, Thomas ML: Caudal additives in children—solutions or problems? Br J Anaesth 2003; 90: 487–98
- Giovannitti J A., Thoms Sean M., and Crawford . Alpha-2 Adrenergic Receptor Agonists: A Review of Current Clinical Applications Anesth Prog. 2015 spring; 62(1): 31–38.
- Kuthiala G andChaudhary Ropivacaine: A review of its pharmacology and clinical use Indian J Anaesth. 2011 Mar-Apr; 55(2): 104–110. doi: 10.4103/0019-5049.79875.
- El-Hennawy AM, Abd-Elwahab AM, Abd-Elmaksoud AM, El-Ozairy HS, Boulis SR: Addition of clonidine or dexmedetomidine to bupivacaine prolongs caudal analgesia in children. Br J Anaesth 2009; 103 :268–274.
- Neogi M, Bhattacharjee DP, Dawn S, Chatterjee N: A Comparative Study between Clonidine and Dexmedetomidine used as Adjuncts to Ropivacaine for Caudal Analgesia in Paediatric Patients. J Anaesth Clin Pharmacol 2010; 26(2): 149-153.
- Saadawy I, Boker A, Elshahawy MA, Almazrooa A, Melibary S, Abdellatif AA, et al: Effect of dexmedetomidine on the characteristics of bupivacaine in a caudal block in pediatrics. Acta Anaesthesiol Scand 2009;53:251-6
- Manohar P, Yachendra: A comparative clinical study of 0.25% bupivacaine with dexmedetomidine and 0.25% ropivacaine with dexmedetomidine in pediatric. IOSR J Dent Med Sci (IOSR-JDMS) 2015; 14:1-8.
- Arpita Laha, Sarmila Ghosh, Haripada Das: Comparison of caudal analgesia between Ropivacaine and Ropivacaine with Clonidine in children: A randomized controlled trial. Saudi journal of Anaesthesia. Vol.6, Issue 3 July-September 2012.
- Xiang Q, Huang DY, Zhao YL, Wang GH, Liu YX, Zhong L, et al: Caudal dexmedetomidine combined with bupivacaine inhibit the response to hernial sac traction in children undergoing inguinal hernia repair. Br J Anaesth 2013; 110 :420–424.
- Gertler R, H. Cleighton Brown, Mitchell DH. , and Erin N. Silvius, Dexmedetomidine: a novel sedative-analgesic agent; Proc (Bayl Univ Med Cent). 2001 Jan; 14(1): 13–21
Corresponding Author
Praveen Kumar Gupta
Resident, Department of Anaesthesia,
Sardar Patel Medical College & AGH, Bikaner, Rajasthan
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.