KUMJ | VOL. 18 | NO. 1 | ISSUE 69 | JAN.-MARCH, 2020
Study of Dexmedetomidine in Caudal Block for Children Undergoing Inguino-scrotal Surgery
Gautam B, Piya B, Karki D
Abstract: Background
Caudal block is the most common anaesthetic technique employed in children for
managing perioperative pain of inguino-scrotal surgery. However, despite using longacting
local
anaesthetics,
caudal
analgesia
lasts
relatively
shorter.
Dexmedetomidine,
an
alpha-2 agonist,
augments
local
anaesthetic
action.
Objective
To assess the analgesic effect of caudal Dexmedetomidine.
Method
This is a randomized, double-blinded study conducted on otherwise healthy children
(one to five years) undergoing elective inguino-scrotal surgery. General anaesthesia
was administered and a laryngeal mask airway was inserted for assisting ventilation.
The caudal block was applied using 0.8 milliliters/kilogram drug volume comprising
either two milligrams/kilogram Bupivacaine in group A (n=42) or two milligrams/
kilogram Bupivacaine mixed with 0.75 micrograms/kilogram Dexmedetomidine in
group B (n=42). Intraoperatively, inhaled Halothane, intravenous Fentanyl, fluids, and
ventilation were titrated to maintain monitored hemodynamic variables within 15%
from baseline values. The primary endpoint comprised the duration of analgesia,
defined by a time when postoperative pain score (face, legs, activity, cry, consolability;
FLACC scale) reached four out of ten. Perioperative events were studied for 24 hours.
Student’s t-test and Chi-square test were used for analysis, with p-value less than
0.05 considered as significant.
Result
Demographic, surgical, and anaesthetic characteristics were similar between the
groups. Duration of analgesia was significantly prolonged in group B (group B,
413±101 minutes; group A, 204±40 minutes). The intraoperative requirement for
supplement Fentanyl was significantly reduced in group B. Adverse events were
comparable between the groups.
Conclusion
Dexmedetomidine prolongs the duration of analgesia when mixed with caudal
Bupivacaine, without increasing adverse events.
Keyword : Adjuncts, Analgesia, Caudal block, Children, Dexmedetomidine, Paediatric
