Comparative Analysis of Bupivacaine Versus Bupivacaine with Dexmedetomidine in Caudal Block Anesthesia
Comparison of Bupivacaine with Dexmedetomidine in Caudal Anesthesia
DOI:
https://doi.org/10.61919/jhrr.v4i3.1634Keywords:
caudal block anesthesia, pediatric pain management, dexmedetomidine, bupivacaine, postoperative pain, sedation score, hemodynamic stability.Abstract
Background: Postoperative pain in pediatric patients remains a critical concern, with traditional caudal blocks using bupivacaine often providing limited analgesia duration. Adding dexmedetomidine to bupivacaine may enhance analgesic effects and improve hemodynamic stability.
Objective: To compare the effectiveness of bupivacaine alone versus bupivacaine combined with dexmedetomidine in caudal anesthesia for pediatric patients undergoing perurethral cystolithotripsy.
Methods: A prospective cohort study was conducted on 50 pediatric patients, aged 2 months to 7 years, divided into two equal groups. Group A received caudal bupivacaine 0.25% (1 ml/kg), and Group B received caudal bupivacaine 0.25% with dexmedetomidine (1 µg/kg). Heart rate, mean arterial pressure (MAP), respiratory rate, FLACC score, and Ramsay sedation score were recorded intraoperatively and at multiple postoperative intervals. Data were analyzed using SPSS version 25, with an independent t-test and chi-square test.
Results: Group B showed significantly lower mean FLACC scores (0.80 vs. 3.08 at 60 min, p=0.024) and higher sedation scores (3.60 vs. 1.60 at 60 min, p=0.000) compared to Group A. Heart rate and MAP were more stable in Group B (p<0.05).
Conclusion: Dexmedetomidine combined with bupivacaine provided superior analgesia and sedation with improved hemodynamic stability compared to bupivacaine alone.
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References
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 Journal of Anaesthesia. 2016;10(4):423-7.
Apfelbaum JL, Chen C, Mehta SS, Gan TJ. Postoperative Pain Experience: Results from a National Survey Suggest Postoperative Pain Continues to Be Undermanaged. Anesthesia & Analgesia. 2003;97(2):534-40.
Astuto M, Rosano G, Rizzo G, Disma N, Di Cataldo A. Methodologies for the Treatment of Acute and Chronic Non-Oncologic Pain in Children. Minerva Anestesiologica. 2007;73(9):459-65.
Morton NS. Management of Postoperative Pain in Children. Archives of Disease in Childhood - Education and Practice Edition. 2007;92(1).
Liu Y, Zhu X, He Z, Sun Z, Wu X, Zhong J. Protective Effect of Dexmedetomidine Infusion Combined with Epidural Blockade on Postoperative Complications After Surgery: A Prospective Randomized Controlled Clinical Trial. Journal of International Medical Research. 2020;48(6):0300060520930168.
Sun Y, Jiang M, Ji Y, Sun Y, Liu Y, Shen W. Impact of Postoperative Dexmedetomidine Infusion on Incidence of Delirium in Elderly Patients Undergoing Major Elective Noncardiac Surgery: A Randomized Clinical Trial [Retraction]. Drug Design, Development and Therapy. 2023;17:2897-8.
Li CJ, Wang BJ, Mu DL, Hu J, Guo C, Li XY, Ma D, Wang DX. Randomized Clinical Trial of Intraoperative Dexmedetomidine to Prevent Delirium in the Elderly Undergoing Major Non-Cardiac Surgery. Journal of British Surgery. 2020;107(2).
Kim JA, Ahn HJ, Yang M, Lee SH, Jeong H, Seong BG. Intraoperative Use of Dexmedetomidine for the Prevention of Emergence Agitation and Postoperative Delirium in Thoracic Surgery: A Randomized-Controlled Trial. Canadian Journal of Anesthesia. 2019;66(4):371-9.
Jöhr M. Practical Pediatric Regional Anesthesia. Current Opinion in Anesthesiology. 2013;26(3):327-32.
Kumar P, Rudra A, Pan AK, Acharya A. Caudal Additives in Pediatrics: A Comparison Among Midazolam, Ketamine, and Neostigmine Coadministered with Bupivacaine. Anesthesia & Analgesia. 2005;101(1):69-73.
Khalil S, Campos C, Farag AM, Vije H, Ritchey M, Chuang A. Caudal Block in Children: Ropivacaine Compared with Bupivacaine. Anesthesiology. 1999;91(5):1279-.
Coviello A, Esposito D, Galletta R, Maresca A, Servillo G. Opioid-Free Anesthesia—Dexmedetomidine as Adjuvant in Erector Spinae Plane Block: A Case Series. Journal of Medical Case Reports. 2021;15:1-4.
Coviello A, Vargas M, Castellano G, Maresca A, Servillo G. Ultrasound-Guided Erector Spinae Plane Block (US-ESPB)—Anesthetic Block: Case Report. Clinical Case Reports. 2020;8(12):2884-7.
El-Hennawy AM, Abd-Elwahab AM, Abd-Elmaksoud AM, El-Ozairy HS, Boulis SR. Addition of Clonidine or Dexmedetomidine to Bupivacaine Prolongs Caudal Analgesia in Children. British Journal of Anaesthesia. 2009;103(2):268-74.
Carollo DS, Nossaman BD, Ramadhyani U. Dexmedetomidine: A Review of Clinical Applications. Current Opinion in Anesthesiology. 2008;21(4):457-61.
Talke P, Richardson CA, Scheinin M, Fisher DM. Postoperative Pharmacokinetics and Sympatholytic Effects of Dexmedetomidine. Anesthesia & Analgesia. 1997;85(5):1136-42.
Ganeshnavar A, Joshi C, ShilpaMasur SY. Comparison of Dexmedetomidine and Clonidine as Adjuvants to 0.25% Bupivacaine in Pediatric Caudal Block for Infraumbilical Surgeries. Journal of Pain Research. 2015;11:12.
Raval DL, Kartik N. A Comparative Study Between Dexmedetomidine and Clonidine Used as Adjuncts to Bupivacaine for Postoperative Analgesia by Caudal Block in Pediatric Patients. Asian Pacific Journal of Health Sciences. 2014;1(2):131-6.
Parameswari A, Dhev AM, Vakamudi M. Efficacy of Clonidine as an Adjuvant to Bupivacaine for Caudal Analgesia in Children Undergoing Sub-Umbilical Surgery. Indian Journal of Anaesthesia. 2010;54(5):458-63.
Gogoi S, Saikia D, Dey S. Addition of Clonidine or Dexmedetomidine with Bupivacaine to Prolong Caudal Analgesia in Children Undergoing Infraumbilical Surgery. Cureus. 2022;14(3).
Srivastava S, Shende S, Bansal E, Tandon N. A Comparative Study of Levobupivacaine Alone and in Combination with Dexamethasone in Caudal Block for Pediatric Patients Undergoing Infraumbilical Surgeries. Asian Journal of Medical Sciences. 2023;14(10):15-20.
Imani F, Zaman B, De Negri P. Postoperative Pain Management: Role of Dexmedetomidine as an Adjuvant. Anesthesiology and Pain Medicine. 2020;10(6).
Trifa M, Tumin D, Tobias JD. Dexmedetomidine as an Adjunct for Caudal Anesthesia and Analgesia in Children. Minerva Anestesiologica. 2018;84(7):836-47.
Wang XX, Dai J, Dai L, Guo HJ, Zhou AG, Pan DB. Caudal Dexmedetomidine in Pediatric Caudal Anesthesia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Medicine. 2020;99(31).
Goyal V, Hooda S, Goyal P, Bhardwaj M, Chhibber P, Sood S. Dexmedetomidine as an Adjuvant to Bupivacaine for Infraumbilical Surgeries in Pediatric Patients. Indian Journal of Anesthesia. 2017;61(5):379-84.
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Copyright (c) 2024 Shakeel Malik, Syed Muhammad Abbas, Haider Ali, Tanzeel Gazder, Vijai Kumar, Faisal Farooq
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