A comparative study between Levobupivacaine alone and in combination with Dexmedetomidine in caudal analgesia of hernia repair in pediatrics

Background Inguinal hernia repair is one of the most frequently performed surgical procedures in the pediatric population. Using optimal analgesic regimen provides safe and effective analgesia, reduce postoperative stress response and accelerate recovery from surgery. Aim of the Work to examine the effect of Dexmedetomidine as an adjuvant to Levobupivacaine in caudal anesthesia, mainly its effect in enhancing and prolonging post-operative analgesia. Patients and Methods The study was conducted on 50 randomly chosen patients in Ain Shams University Hospitals after approval of the medical ethical committee. Patients were divided randomly into two groups, each group consisted of 25 patients. After preoperative assessment and obtaining baseline vital data, all patients received general anesthesia. Group A: Patients in this group received caudal anesthesia with Levobupivacaine 0.25% at a dose of 2 mg·kg−1 (0.8 ml·kg−1) before the beginning of the procedure. Group B: Patients in this group received Levobupivacaine 0.25% at a dose of 2 mg·kg−1 (0.8 ml·kg−1) in addition to Dexmedetomidine 1 μg·kg−1 in 1 ml normal saline before the beginning of the procedure. Results The results of the study revealed that there was significant reduction in FLACC score in group B at 4, 8, and 12 hours postoperatively compared to group A, at the twenty-fourth hour there was no significant difference. Regarding the duration of analgesia postoperatively we found statistically significant increase in group B compared to that in group A (p-value <0.001). Regarding the number of doses of analgesia required post operatively (Paracetamol 15ml/kg/dose) there was a statistically significant decrease in patients requirement in group B compared to that in group A (p-value <0.001). Conclusion Dexmedetomidine as adjuvant to Levobupivacaine provided significantly prolonged postoperative analgesia, reduced the postoperative analgesic requirements and better parents’ satisfaction as compared with caudal analgesia using Levobupivacaine alone in children undergoing hernia repair.

Combination of Dexmedetomidine and Bupivacaine for Caudal Anesthesia In Children

Background: Caudal anesthesia is one of the most popular, reliable and safe methods of pain relief in children and can provide pain relief for various surgical procedures below the navel. Aim: To evaluate the efficacy and safety of the caudal use of dexmedetomidine in caudal anesthesia in children. Methods: The subject of the study was 46 children with physical status I and II class of the American Society of Anesthesiologists (ASA), aged 0 to 12 years, who underwent elective surgeries below the navel, such as hernia repair, orchiopexy, hypospadias repair, epispadias, etc. Results: The duration of caudal analgesia was determined from the moment the anesthetic was injected until the moment the child first complained of pain or the time when the first postoperative analgesia was required. The average duration of postoperative caudal analgesia in patients of group A was 4.21 ± 0.88, while in patients of group B this duration was 10.18 ± 0.85 hours. Conclusions. Our results show that the addition of dexmedetomidine to the local anesthetic for caudal block significantly increases the duration of analgesia and reduces the need for analgesics. More data is also needed on the neurological safety of dexmedetomidine. Key words: dexmedetomidine,caudal block, bupivacaine.

Efficacy of Dexmedetomidine Versus Morphine as an Adjunct to Bupivacaine in Caudal Anesthesia for Pediatric Thoracic Surgeries: A Randomized Controlled Trial

Background: Caudal anesthesia is an effective method of pain management, which can be successfully employed to minimize post-thoracotomy pain in pediatric patients. However, its main disadvantage is the short postoperative analgesic period, which can be prolonged by the concurrent administration of one of many adjuvants. Objectives: This prospective randomized, blinded study aimed to compare the efficacy of dexmedetomidine versus morphine as adjuvants to bupivacaine in caudal anesthesia for thoracic surgeries in pediatric patients. Methods: Fifty patients were randomly allocated into two equal groups. To achieve caudal epidural block anesthesia, the patients in group M (n = 25) were administered morphine and bupivacaine, while group D (n = 25) received a mixture of dexmedetomidine and bupivacaine. The primary outcome of this study was the postoperative analgesic duration achieved. The secondary outcomes included morphine administration in the first 24 hours following caudal block anesthesia, the face, legs, activity, cry, consolability (FLACC) scale scores, and adverse effects, including vomiting, itching, bradycardia, hypotension, and respiratory depression. Results: The results showed that patients who had received dexmedetomidine achieved a longer postoperative analgesia as compared to those who had received morphine (P < 0.001). Postoperatively, the heart rate, blood pressure, pain score, and mean consumption of morphine were lower in group D as compared to the group M. There was no significant difference in the adverse effects between the two groups. Conclusions: The use of dexmedetomidine as an adjuvant to bupivacaine for caudal anesthesia during pediatric thoracic surgeries induced better and prolonged postoperative analgesia as compared to morphine.

The Successful Awake Caudal Anesthesia for Bilateral Inguinal Hernia Repair in Triple Premature Infants: Case report and Review of Literature

Introduction: Inguinal hernia is a more frequent problem in male infants with an increased incidence in twin ones. Prematurity is considered as a risk factor. During open surgery of hernia under general anesthesia, there is a high incidence of apnea especially in the preterm infants. Caudal anesthesia could been a more effective approach for induction of anesthesia and analgesia. Case presentation: Here, we presented three two-months-old infants (3.5-3.9 kg) for inguinal hernia repair, simultaneously who were born at 35 weeks’ gestation al age. They were undergone bilateral inguinal hernia repair with single shot awake caudal anaesthesia. Conclusion: Although herrniorraphy is a common procedure in preterm infants, the induction of simultaneous caudal anesthesia for this procedure is rare event. On the other hand, the complications of anestethic techniques such as apnea are important.Indeed, triple infants with based same genetic background didn’t show any undesirable events after anaesthesia.