Comparison of Analgesic Effect of Dexmedetomidine versus Tramadol as Adjuvants to Caudal Ropivacaine in Infraumbilical Surgeries among Pediatric Patients: A Randomized Double Blind Interventional Study

Abstract

Objective: To compare the postoperative analgesic effects of 0.2% ropivacaine with Dexmedetomidine (2 g/kg) and tramadol (2 mg/kg) among pediatric patients undergoing infra umbilical surgery.Material and Methods: This hospital based, randomized double blind interventional study included 60 pediatric patients, aged 1–7 years, having American Society of Anaesthesiology grade I and II, weighing 7-25 kg, and undergoing infraumbilical surgeries under general anesthesia. Subjects were randomly allocated into two groups to receive either: 2 mcg/ kg of Dexmedetomidine or 2 mg/kg of Tramadol, as adjuvant to 0.2% of Ropivacaine. Pain intensity was assessed using the pediatric observational Children’s Hospital of Eastern Ontario Pain Scale (CHEOPS) score. Rescue analgesia was given, when the CHEOPS score was ≥6. Duration of analgesia was defined as: the time period between administrations of block until rescue analgesia was given. Level of sedation was assessed by the Ramsay sedation score.Results: Kaplan Meier analysis showed that the median time to first rescue analgesia (duration of analgesia) was significantly (p-value<0.001) prolonged with Dexmedetomidine (780 minutes; 95% CI: 760.68–799.32 minutes) as compared to Tramadol (648 minutes; 95% CI: 635.92–660.38 minutes). Mean emergence time and duration of sedation were also significantly prolonged with Dexmedetomidine as compared to Tramadol.Conclusion: In pediatric patients undergoing infraumbilical surgeries, Dexmedetomidine as adjuvant to Ropivacaine provides an advantage of longer post-operative analgesia and lack of opioid related adverse events associated with Tramadol.