title: The effects of caudal or intravenous dexmedetomidine on postoperative analgesia produced by caudal bupivacaine in children: a randomized controlled double-blinded study.
abstract: OBJECTIVE
  The aim of this study was to compare the effects of caudal and intravenous (IV) dexmedetomidine (1 μg/kg) on postoperative analgesia after caudal bupivacaine in pediatric patients undergoing lower abdominal and perineal surgeries.
  
  
  METHODS
  A randomized controlled double-blind study.
  
  
  METHODS
  University-affiliated teaching hospital.
  
  
  METHODS
  Seventy-five American Society of Anesthesiologists I children, aged 1 to 6 years.
  
  
  METHODS
  Patients were randomly allocated to 3 groups. All patients received 1 mL/kg caudal 0.25% bupivacaine. In addition, those in group B (n=25) received 10-mL IV saline, those in group B-Dcau (n=25) received 1 μg/kg caudal dexmedetomidine and 10-mL IV saline, and those in group B-DIV (n=25) received 1 μg/kg IV dexmedetomidine in 10-mL saline.
  
  
  METHODS
  Intraoperative mean blood pressure, heart rate, peripheral oxygen saturation, end-tidal sevoflurane, and bispectral index as well as postoperative pain and behavior scores and time to first analgesia were assessed.
  
  
  RESULTS
  Group B-Dcau had a significantly longer time to first rescue analgesia than groups B-DIV and B, with mean (SD) values of 14.4 (7.5), 9.18 (2.7), and 6.6 (2.5) hours, respectively (P<.05). Fewer patients in group B-Dcau (n=16) required rescue analgesia during the first 24 hours postoperatively compared to group B (n=24) and group B-DIV (n=20) (P<.05). Groups B-Dcau and B-DIV had lower pain and behavior scores than Group B. Eight patients Group B had agitation compared to 2 in Group B-DIV and 0 in Group B-Dcau. Four patients in Group B-DIV developed bradycardia and hypotension during surgery.
  
  
  CONCLUSIONS
  Compared to IV administration, caudal administration of dexmedetomidine during caudal bupivacaine anesthesia provided prolonged postoperative analgesia and a greater analgesic sparing effect without significant side effects. This suggests a greater role of neuraxial compared to that of peripheral α-2 adrenoceptors in pain processing.
authors.affiliation: Department of Anesthesia, Faculty of Medicine, University of Jordan, Amman, Jordan. Electronic address: kalzaben@ju.edu.jo.
authors.forename: Khaled R
authors.initials: KR
authors.lastname: Al-Zaben
authors.affiliation: Department of Anesthesia, Faculty of Medicine, University of Jordan, Amman, Jordan.
authors.forename: Ibraheem Y
authors.initials: IY
authors.lastname: Qudaisat
authors.affiliation: Department of Anesthesia, Faculty of Medicine, University of Jordan, Amman, Jordan.
authors.forename: Aboud N
authors.initials: AN
authors.lastname: Alja'bari
authors.affiliation: Department of Anesthesia, Faculty of Medicine, University of Jordan, Amman, Jordan.
authors.forename: Omar A
authors.initials: OA
authors.lastname: Ababneh
authors.affiliation: Faculty of Pharmacy, Department of Biopharmaceutics and Clinical Pharmacy, University of Jordan, Amman, Jordan.
authors.forename: Al-Motassem M
authors.initials: AM
authors.lastname: Yousef
authors.affiliation: Department of Neurosurgery, Faculty of Medicine, University of Jordan, Amman, Jordan.
authors.forename: Abdulrahman M
authors.initials: AM
authors.lastname: Al-Shudifat
mesh_terms: D058647:Adrenergic alpha-2 Receptor Agonists / Q000008:administration & dosage / Q000627:therapeutic use*; D000763:Anesthesia, Caudal / Q000379:methods*; D000779:Anesthetics, Local / Q000627:therapeutic use*; D002045:Bupivacaine / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D056805:Consciousness Monitors; D020927:Dexmedetomidine / Q000008:administration & dosage / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007223:Infant; D007275:Injections, Intravenous; D053208:Kaplan-Meier Estimate; D008297:Male; D016343:Monitoring, Intraoperative; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D011595:Psychomotor Agitation / Q000453:epidemiology / Q000517:prevention & control
chemical_list: D058647:Adrenergic alpha-2 Receptor Agonists; D000779:Anesthetics, Local; D020927:Dexmedetomidine; D002045:Bupivacaine
keywords: Bupivacaine; Caudal block; Children; Dexmedetomidine