CC BY-NC-ND 4.0 · International Journal of Recent Surgical and Medical Sciences 2020; 6(01): 30-37
DOI: 10.1055/s-0040-1713564
Original Article

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

Rajashree Godbole
1  Department of Anesthesiology, KEM Hospital, Pune, Maharashtra, India
,
Jasmeet Gill
1  Department of Anesthesiology, KEM Hospital, Pune, Maharashtra, India
,
Brishnik Bhattacharya
1  Department of Anesthesiology, KEM Hospital, Pune, Maharashtra, India
,
Shashank Shrotriya
2  Department of Pediatric Surgery, KEM Hospital, Pune, Maharashtra, India
,
Siddhartha Shrivastava
3  Department of Otorhinolaryngology, KEM Hospital, Pune, Maharashtra, India
,
Abhilash Bandari
1  Department of Anesthesiology, KEM Hospital, Pune, Maharashtra, India
› Author Affiliations
  

Abstract

Objectives This study aimed to clinically evaluate and compare the efficacy of caudal epidural bupivacaine in prolonging the postoperative analgesia, with adjuvants like fentanyl or dexmedetomidine among children of Indian genotype.

Materials and Methods A prospective double-blind randomized comparative study. The study population of 68 patients of Indian phenotype were randomly taken from a random number table and divided into two groups with 34 patients in each group. They received single shot caudal epidural blocks, with group A receiving 0.75 mL/kg of 0.25% bupivacaine + 1 mcg/kg fentanyl, group B receiving 0.75 mL/kg of 0.25% bupivacaine + 1 mcg/kg dexmedetomidine. Global Assessment of anesthesia, defined as the time from caudal injection to the first administration of rescue analgesia, will be recorded for both the groups.

Results The addition of either fentanyl or dexmedetomidine as adjuvants in caudal block provided excellent postoperative analgesia, and sedation was significantly longer duration with dexmedetomidine (18.0 hours) than fentanyl (13.1 hours). We observed good hemodynamic stability in both the groups.

Conclusion Addition of dexmedetomidine over fentanyl to bupivacaine for caudal epidural analgesia in pediatric age group has multiple advantages like better control of intraoperative and postoperative hemodynamics, significantly longer duration of postoperative analgesia, lesser bleeding during surgery, and achieving good surgical satisfaction. As the children are pain-free, calm, quiet, and sedated but arousable, the parents’ satisfaction is rewarding. The caudal epidural dose of 0.25% bupivacaine 0.75 mL/kg with adjuvants like dexmedetomidine or fentanyl is effective for postoperative analgesia in lower abdominal surgeries and is without side effects among the Indian population.



Publication History

Publication Date:
09 June 2020 (online)

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