Dexmedetomidine as an Adjuvant to Ropivacaine in Ultrasound Guided Paediatric Caudal Epidural Block: A Randomised Controlled Study
Published: June 1, 2019 | DOI: https://doi.org/10.7860/JCDR/2019/41703.12916
B Sarvesh, Prashanth G Raj, MS Soumya, Vasantha Kumar, Kanchan Sharma, Amit Agarwal
1. Assistant Professor, Department of Anesthesiology, Adichunchanagiri Institute of Medical Sciences, Mandya, Karnataka, India.
2. Assistant Professor, Department of Anesthesiology, Adichunchanagiri Institute of Medical Sciences, Mandya, Karnataka, India.
3. Resident, Department of Radiology, KMCH, Coimbatore, Karnataka, India.
4. Professor, Department of Anesthesiology, Adichunchanagiri Institute of Medical Sciences, Mandya, Karnataka, India.
5. Consultant Pain Physician, Department of Pain Management, Aadhya Pain Management Centre, Jaipur, Rajasthan, India.
6. Consultant Anesthesiologist, Department of Anesthesiology, Rukmani Birla Hospital, Jaipur, Rajasthan, India.
Correspondence
Dr. Prashanth G Raj,
Number 90, Belaku, Vivekananada Block, Teachers Layout, Mysore, Karnataka, India.
E-mail: drsarveshb83@gmail.com
Introduction: Caudal epidural block is a reliable technique to provide perioperative analgesia for infra-umbilical surgeries in paediatric population. Several adjuvants are used along with local anaesthetics to prolong the postoperative anaesthesia.
Aim: To evaluate the efficacy of Dexmedetomidine as an adjuvant to ropivacaine in prolonging the duration of postoperative analgesia and reduction of pain scores in paediatric patients undergoing infra-umbilical surgeries.
Materials and Methods: This was a double-blinded randomised study, conducted at a tertiary care institution. Sixty patients (2-12 years) of ASA physical status classes 1 and 2 were randomly allocated into two groups. After general anaesthesia, each patient received an ultrasound-guided caudal block. Group R (n=30) received 0.25% ropivacaine (1 mL/kg) +0.5 mL saline and Group RD (n=30) received 0.25% ropivacaine 1 mL/kg +1 µg/kg dexmedetomidine (in 0.5 mL volume). Duration of postoperative analgesia, FLACC pain scores, consumption of rescue analgesics, sedation and adverse-effects were assessed during the 24-hours. The present authors used Student’s t-test and chi-square test for statistical analysis.
Results: The duration of postoperative analgesia was significantly prolonged in Group RD, 790.77±7.70 minutes as compared to Group R, 377.97±12.20 minutes (p-value <0.001). Group RD achieved lower FLACC pain scores compared to group R. There were no significant differences in the incidence of adverse-effects.
Conclusion: Dexmedetomidine (1 µg/kg) as an adjuvant to ropivacaine 0.25% (1 mL/kg) in an ultrasound-guided caudal block significantly prolongs the duration of postoperative analgesia and reduces FLACC pain score in paediatric patients undergoing infra-umbilical surgeries without any significant adverse-effects.
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