Effect of dexmedetomidine on the characteristics of bupivacaine in a caudal block in pediatrics.
BACKGROUND
Dexmedetomidine (DEX) is a highly selective alpha(2)-adrenoceptor agonist that has been used increasingly in children. However, the effect of caudal DEX has not been evaluated before in children. This prospective randomized double-blinded study was designed to evaluate the analgesic efficacy of caudal DEX with bupivacaine in providing pain relief over a 24-h period.


METHODS
Sixty children (ASA status I) aged 1-6 years undergoing unilateral inguinal hernia repair/orchidopexy were allocated randomly to two groups (n = 30 each). Group B received a caudal injection of bupivacaine 2.5 mg/ml, 1 ml/kg; Group BD received the same dose of bupivacaine mixed with DEX 1 microg/kg during sevoflurane anesthesia. Processed electroencephalogram (bispectral index score), heart rate, blood pressure, pulse oximetry and end-tidal sevoflurane were recorded every 5 min. The characteristics of emergence, objective pain score, sedation score and quality of sleep were recorded post-operatively. Duration of analgesia and requirement for additional analgesics were noted.


RESULTS
The end-tidal sevoflurane concentration and the incidence of agitation were significantly lower in the BD group (P < 0.05). The duration of analgesia was significantly longer (P < 0.001) and the total consumption of rescue analgesic was significantly lower in Group BD compared with Group B (P < 0.01). There was no statistically significant difference in hemodynamics between both groups. However, group BD had better quality of sleep and a prolonged duration of sedation (P < 0.05).


CONCLUSIONS
Caudal DEX seems to be a promising adjunct to provide excellent analgesia without side effects over a 24-h period. It has the advantage of keeping the patients calm for a prolonged time. Implications statement: Caudally administered DEX (1 microg/kg), combined with bupivacaine, was associated with an extended duration of post-operative pain relief.
Saadawy
I
I
Department of Anesthesia, Cairo University, Cairo, Egypt. ninaeg2001@yahoo.com
Boker
A
A
Elshahawy
M A
MA
Almazrooa
A
A
Melibary
S
S
Abdellatif
A A
AA
Afifi
W
W
D000759:Adjuvants, Anesthesia / Q000008:administration & dosage / Q000494:pharmacology*; D000316:Adrenergic alpha-Agonists / Q000493:pharmacokinetics / Q000627:therapeutic use*; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use*; D000763:Anesthesia, Caudal / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000494:pharmacology*; D002045:Bupivacaine / Q000008:administration & dosage / Q000494:pharmacology*; D002648:Child; D002675:Child, Preschool; D020927:Dexmedetomidine / Q000008:administration & dosage / Q000494:pharmacology*; D004311:Double-Blind Method; D004357:Drug Synergism; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000494:pharmacology*; D007223:Infant; D008297:Male; D010149:Postoperative Pain / Q000188:drug therapy*; D011446:Prospective Studies; D011595:Psychomotor Agitation / Q000517:prevention & control; D018341:Receptors, Adrenergic, alpha-2 / Q000187:drug effects; D012890:Sleep / Q000187:drug effects
D000759:Adjuvants, Anesthesia; D000316:Adrenergic alpha-Agonists; D018712:Analgesics, Non-Narcotic; D000779:Anesthetics, Local; D006993:Hypnotics and Sedatives; D018341:Receptors, Adrenergic, alpha-2; D020927:Dexmedetomidine; D002045:Bupivacaine