Comparison of analgesic efficacy of caudal dexmedetomidine versus caudal tramadol with ropivacaine in paediatric infraumbilical surgeries: A prospective, randomised, double-blinded clinical study

Abstract

Background and Aims:Caudal epidural analgesia is commonly practised regional block technique in children undergoing infraumbilical surgeries but has a short duration of action after single shot local anaesthetic injection. The aim of this study was to compare ropivacaine 0.25% with dexmedetomidine and tramadol in caudal anaesthesia in paediatric infraumbilical surgeries.Methods:In a randomised, prospective, double-blinded study, sixty children (1–8 years) belonging to American Society of Anesthesiologists’ physical status I or II scheduled for infraumbilical surgeries were included. They were randomly assigned into two groups: Group ropivacaine with tramadol (RT) (n = 30) received 0.25% ropivacaine 1 mL/kg with 2 mg/kg of tramadol, and Group ropivacaine with dexmedetomidine (RD) (n = 30) received 0.25% ropivacaine 1 mL/kg with dexmedetomidine 2 μg/kg. The primary outcome variable was the duration of analgesia, and the secondary outcome variables included motor block, sedation score, time from caudal block to skin incision, emergence time and adverse effects.Results:The mean duration of analgesia was 654.20 ± 78.38 min in Group RT, while in Group RD, it was 780.29 ± 71.21 min (P = 0.0001). The difference between the mean sedation score and mean emergence time between the two groups were statistically significant (P = 0.0001 and 0.0411, respectively). No significant difference was observed in the incidence of haemodynamic changes or side effects.Conclusion:Caudal dexmedetomidine with ropivacaine prolongs post-operative analgesia compared to caudal tramadol with ropivacaine.

Evaluation of Adding Dexmedetomidine to Ropivacaine in Pediatric Caudal Epidural Block: A Randomized, Double-blinded Clinical Trial

“…The study by Gupta and Sharma (15) investigated the addition of 2 mg/kg tramadol versus 2 µg/kg dexmedetomidine to caudal ropivacaine 0.25% administered preoperatively in children who were candidates for infra-umbilical surgery under general anesthesia. The results indicated that the addition of dexmedetomidine, as compared to tramadol, induced prolonged analgesia, but changes in the heart rate and mean BP before and after the block, as well as side effects, were alike (15). Notwithstanding, although adequate analgesia (FLACC score < 4) existed in both groups within the first four hours after the surgery, the analgesia decreased rapidly in the tramadol group afterward.…”

Postoperative Pain Management: Efficacy of Caudal Tramadol in Pediatric Lower Abdominal Surgery: A Randomized Clinical Study

“…To manage post-operative pain in pediatric lower abdominal surgery, tramadol and dexmedetomidine were separately added to caudal ropivacaine, and the results showed that the combination of caudal ropivacaine with dexmedetomidine had longer analgesia than its combination with tramadol, but the side effects were similar in the two groups (27). In our study, there existed no third group for further comparison, but it could be a good topic for future research.…”

Effect of tramadol as a local anesthetic adjuvant in epidural labor analgesia: Randomized controlled study

“…Gupta et al [24] reported that 14 patients out of 30 patients had sedation in tramadol group when compared to butorphanol group in epidural analgesia. However, Gupta et al [25] in their study comparing the effect of adding either dexmedetomidine or tramadol to ropivacaine in caudal anesthesia in pediatric, they reported that the level of sedation in tramadol group was generally less than 2. Also, Results from Swathi et al [26] reported a lower sedation score.…”