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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
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.
09 June 2020 (online)
Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India
- 1 Dahl JB, Kehlet H. Preventive analgesia. Curr Opin Anaesthesiol 2011; 24 (03) 331-338
- 2 Srouji R, Ratnapalan S, Schneeweiss S. Pain in children: assessment and nonpharmacological management. Int J Pediatr 2010; 2010: 474838
- 3 Polomano RC, Fillman M, Giordano NA, Vallerand AH, Nicely KL, Jungquist CR. Multimodal analgesia for acute postoperative and trauma –related pain. Am J Nurs 2017; 117 (03) (Suppl. 01) S12-S26
- 4 Miller RD. Miller’s Anaesthesia. 8th ed. Philadelphia: Elsevier Saunders 1600
- 5 Lönnqvist PA. Adjuncts to caudal block in children–Quo vadis?. Br J Anaesth 2005; 95 (04) 431-433
- 6 Caudal Epidural Block A. Review. Anaesthesia Today. 2010
- 7 Lundblad M, Eksborg S, Lönnqvist PA. ary spread of caudal block as assessed by ultrasonography. Br J Anaesth 2012; 108 (04) 675-681
- 8 Wiegele M, Marhofer P, Lönnqvist PA. Caudal epidural blocks in paediatric patients: a review and practical considerations. Br J Anaesth 2019; 122 (04) 509-517
- 9 Tandon M, Singh A, Saluja V, Dhankhar M, Pandey CK, Jain P. Validation of a new “objective pain score” vs. “numeric rating scale” for the evaluation of acute pain: a comparative study. Anesth Pain Med 2016; 6 (01) e32101
- 10 Naaz S, Ozair E. Dexmedetomidine in current anaesthesia practice- a review. J Clin Diagn Res 2014; 8 (10) GE01-GE04
- 11 Kaur M, Singh PM. Current role of dexmedetomidine in clinical anesthesia and intensive care. Anesth Essays Res 2011; 5 (02) 128-133
- 12 McCallum JB, Boban N, Hogan Q, Schmeling WT, Kampine JP, Bosnjak ZJ. The mechanism of alpha2-adrenergic inhibition of sympathetic ganglionic transmission. Anesth Analg 1998; 87 (03) 503-510
- 13 Sudheesh K, Harsoor S. Dexmedetomidine in anaesthesia practice: A wonder drug. ? Indian J Anaesth 2011; 55 (04) 323-324
- 14 Guo TZ, Jiang JY, Buttermann AE, Maze M. Dexmedetomidine injection into the locus ceruleus produces antinociception. Anesthesiology 1996; 84 (04) 873-881
- 15 Stoelting RK. Pharmacology and Physiology in Anaesthesia Practice. 3rd ed. Philadelphia, Pennsylvania: Lippincott-Raven Publishers 1999: pp. 93-97
- 16 Elfawal SM, Abdelaal WA, Hosny MR. A comparative study of dexmedetomidine and fentanyl as adjuvants to levobupivacaine for caudal analgesia in children undergoing lower limb orthopedic surgery. Saudi J Anaesth 2016; 10 (04) 423-427
- 17 Kannojia UK, Meena RK, Paswan AK, Meena K, Prakash S, Loha S. Comparison of caudal dexmedetomidine and fentanyl combined with bupivacaine in pediatric patients undergoing urogenital surgery. Anaesth Pain Intensive Care 2017; 21 (02) 204-211
- 18 Jarineshin H, Fekrat F, Kargar Kermanshah A. Treatment of postoperative pain in pediatric operations: comparing the efficiency of bupivacaine, bupivacaine-dexmedetomidine and bupivacaine-fentanyl for caudal block. Anesth Pain Med 2016; 6 (05) e39495
- 19 Zeben KR, Qudaisat IY, Halaweh SA. et al. Comparison of caudal bupivacaine alone with bupivacaine with two doses of dexmedetomidine for postoperative analgesia in pediatric patients undergoing infra -umbilical surgery. Paediatr Anaesth 2015; 25 (09) 883-890
- 20 Goyal V, Kubre J, Radhakrishnan K. Dexmedetomidine as an adjuvant to bupivacaine in caudal analgesia in children. Anesth Essays Res 2016; 10 (02) 227-232
- 21 Sengupta S, Mukherji S, Sheet J, Mandal A, Swaika S. Caudal-epidural bupivacaine versus ropivacaine with fentanyl for paediatric postoperative analgesia. Anesth Essays Res 2015; 9 (02) 208-212
- 22 Anand VG, Kannan M, Thavamani A, Bridgit MJ. Effects of dexmedetomidine added to caudal ropivacaine in paediatric lower abdominal surgeries. Indian J Anaesth 2011; 55 (04) 340-346
- 23 Saini S, Patodi V, Sethi S, Jain N, Mathur P, Thada B. Comparison of caudal epidural clonidine with fentanyl as an adjuvant to ropivacaine 0.25% for postoperative analgesia in children undergoing various infraumbilical surgeries: a prospective randomized study. Ai-Shams J Anaesthesiol 2016; 9 (04) 493-500
- 24 Khatavkar SS, Lonkar SS, Panchal PB, Thatte WS, Nagendra S, Tewari D. The efficacy of ropivacaine-fentanyl versus ropivacaine-clonidine for pre-emptive caudal anesthesia in children. Anaesth Pain Intensive Care 2016; 20 (01) 54-58
- 25 Reddy M, Gangadharaiah R. A comparative clinical study between equal volumes and concentrations of clonidine and dexmeditomidine as adjuvants to 0.25% ropivacaine in pediatric caudal block for circumcision. J Evol Med Dent Sci 2014; 3 (10) 2470-2477