Caudal and intravenous dexmedetomidine similarly prolong the duration of caudal analgesia in children: A randomized controlled trial

Abstract

Summary Background Dexmedetomidine can prolong the duration of action of a local anesthetic agent, but the route of administration that is the most beneficial remains unclear. The purpose of this study was to compare the clinical effectiveness of caudal or intravenous dexmedetomidine administration on postoperative analgesia in children undergoing inguinal hernia repair given caudal levobupivacaine. Methods This was a prospective, randomized, double‐blinded, placebo‐controlled trial. Ninety ASA I subjects, aged 2‐5 year, undergoing unilateral inguinal hernia repair were enrolled. The children were randomized in a double‐blind fashion to three groups. The L‐Dcau group received 1 mL/kg of caudal 0.25% levobupivacaine plus 1 μg/kg dexmedetomidine and IV 20 mL saline. The L‐Div group received 1 mL/kg of caudal 0.25% levobupivacaine and IV 1 μg/kg dexmedetomidine in 20 mL saline. The L group received 1 mL/kg of caudal 0.25% levobupivacaine and IV 20 mL saline. The primary outcome was the duration of analgesia, which was defined as the time from the caudal block to a Postoperative Pain Scale (CHIPPS) score ≥4. Secondary outcomes were the number of patients requiring rescue analgesia, pain intensity, the incidence of emergence agitation, intraoperative hemodynamic variations, residual motor block, and adverse effects. Results The median duration of analgesia in the L‐Dcau group was 14.2 hour compared to 6 hour in the L group with a median difference of 8.5 hour [95% CI (6.5, 10.5), P < 0.001]. The median duration of analgesia in the L‐Div group was 12.4 hour compared to 6 hour in the L group with a median difference of 6.4 hour [95% CI (4, 8.5), P < 0.001]. Fewer patients in the L‐Dcau and L‐Div groups required rescue analgesia in the first 24 hour postoperatively compared to the L group, although there was no significant difference between the L‐Dcau and L‐Div groups for these outcomes. Both dexmedetomidine routes reduced the pain and the incidence of emergence agitation. No bradycardia, hypotension, or motor block was observed in any of the three groups. Conclusion Caudal and IV dexmedetomidine similarly prolong the duration of analgesia produced by caudal levobupivacaine.

Dexmedetomidine Addition For Pediatric Hernia Repair: A Meta-Analysis of Randomized Controlled Studies

“…315 potentially relevant articles are identi ed initially. Finally, six RCTs are included in the meta-analysis [11,13,[17][18][19]25].…”

“…The dose of dexmedetomidine ranged from 0.3 µg/kg to 1.0 µg/kg. Among the six included RCTs, two trials reported analgesic consumption [19,25], two trials reported number of rescue analgesics and time to rst analgesia [18,19], two trials reported emergence agitation [18,25], as well as two trials reported pain scores at 1 h and 2 h [17,19]. Jadad scores of the six included studies vary from 3 to 5, and all six studies have high-quality based on the quality assessment.…”

“…Recently, several studies have investigated the e cacy of dexmedetomidine supplementation for pediatric hernia repair, but the results are con icting [11,[17][18][19]. This systematic review and metaanalysis of RCTs aims to assess the impact of dexmedetomidine supplementation on pain control after pediatric hernia repair.…”

Efficacy of caudal vs intravenous administration of α2 adrenoceptor agonists to prolong analgesia in pediatric caudal block: A systematic review and meta‐analysis

“…The PRISMA flowchart shows the process of literature screening, study selection, and reasons for exclusion ( Figure 1). Among the trials identified from the literature search strategy, five RCTs [22][23][24][25][26] including 244 children met the inclusion criteria. [23][24][25][26] hydrocele, 24 circumcision, 24 and hypospadias 22,24,25 operation.…”

“…Among the trials identified from the literature search strategy, five RCTs [22][23][24][25][26] including 244 children met the inclusion criteria. [23][24][25][26] hydrocele, 24 circumcision, 24 and hypospadias 22,24,25 operation. All trials combined A2AAs with long-acting local anesthetics (0.25% bupivacaine 22,24 or levobupivacaine 23,25,26 ) in dosages of 1 mL/kg, [24][25][26] 0.75 mL/kg, 23 or 0.5 mL/ kg.…”