Effects of dexmedetomidine added to caudal ropivacaine in paediatric lower abdominal surgeries

Abstract

Purpose: The objectives of this study were to compare the effects of caudal dexmedetomidine combined with ropivacaine to provide postoperative analgesia in children and also to establish its safety in the paediatric population.

Methods: In a randomised, prospective, parallel group, double-blinded study, 60 children were recruited and allocated into two groups: Group RD (n=30) received 0.25% ropivacaine 1 ml/kg with dexmedetomidine 2 μg/kg, making the volume to 0.5 ml and Group R (n=30) received 0.25% ropivacaine 1 ml/kg + 0.5 ml normal saline. Induction of anaesthesia was achieved with 50% N(2)O and 8% sevoflurane in oxygen in spontaneous ventilation. An appropriate-sized LMA was then inserted and a caudal block performed in all patients. Behaviour during emergence was rated with a 4-point scale, sedation with Ramsay's sedation scale, and pain assessed with face, legs, activity, cry, consolability (FLACC) pain score.

Results: The duration of postoperative analgesia recorded a median of 5.5 hours in Group R compared with 14.5 hours in Group RD, with a P value of <0.001. Group R patients achieved a statistically significant higher FLACC score compared with Group RD patients. The difference between the means of mean sedation score, emergence behaviour score, mean emergence time was statistically highly significant (P<0.001). The peri-operative haemodynamics were stable among both the groups.

Conclusion: Caudal dexmedetomidine (2 μg/kg) with 0.25% ropivacaine (1 ml/kg) for paediatric lower abdominal surgeries achieved significant postoperative pain relief that resulted in a better quality of sleep and a prolonged duration of arousable sedation and produced less incidence of emergence agitation following sevoflurane anaesthesia.

Keywords: Analgesia; anaesthesia; caudal; dexmedetomidine; emergence agitation; postoperative period; ropivacaine; sevoflurane.

Figure 1

Comparison of duration of analgesia (Kaplan-Meier survival curve)

Figure 2

FLACC score of and RD and R group children. There was a significant difference between the groups in the FLACC score measured 4^th hourly in the postoperative period. Group R patients achieved significantly higher FLACC score compared with Group RD children. Twenty out of 30 children achieved a FLACC score of 4 at 6^th hour in Group R compared with 0 patients in Group RD, whereas in Group RD, the children had FLACC score 4 at 16^th hour of the postoperative period

Figure 3

Comparison of haemodynamic variables. The pre-op, intra-op and post-op haemodynamic changes between the groups were comparable and were not statistically significant and therapeutic interventions were not required