Effect of caudal dexmedetomidine versus ketamine in prevention of emergence delirium in pediatric patients undergoing congenital inguinal hernia repair under sevoflurane anesthesia

Abstract

Study objective The aim of this study was to compare the effect of dexmedetomidine versus ketamine when added to caudal bupivacaine on the incidence of emergence delerium (ED), postoperative sedation, and analgesia in pediatric patients undergoing inguinal hernia repair under sevoflurane anesthesia. Methods Eighty seven pediatric patients who underwent elective inguinal hernia repair under sevoflurane anesthesia were randomly distributed into one of three equal groups. Group B (bupivacaine, n = 29), group BK (bupivacaine ketamine, n = 29), and group BD (bupivacaine dexmedetomidine, n = 29). Patients of group B received caudal injectate of 1 ml/kg bupivacaine 0.25%, while group BK patients received caudal injectate of 1 ml/kg bupivacaine 0.25% mixed with ketamine 0.5 mg/kg, and group BD patients received caudal injectate of 1 ml/kg bupivacaine 0.25% mixed with dexmedetomidine 1 μg/kg. Primary outcome measure was the assessment of the incidence of postoperative ED. Secondary outcomes included the postoperative sedation scores and postoperative Face, Legs, Activity, Cry, and Consolability (FLACC) pain scores, time to 1st postoperative analgesic, and total postoperative analgesic consumption. Also, the incidence of perioperative complications were assessed. Results The incidence of ED was significantly lower in group BD and BK compared with group B (P < 0.05) with no significant difference between group BD and BK (P > 0.05). Postoperative sedation scores were significantly higher in group BK and BD compared with group B (P < 0.05) at the 1st 30 min and 1st 2 h postoperative respectively; they were also significantly higher in group BD compared with group BK at (10 min–2 h) postoperative (P < 0.05). The duration of analgesia was significantly longer, and the total postoperative paracetamol consumption was significantly lower in group BD and BK compared with group B (P < 0.05); they were also significantly lower in group BD compared with group BK (P < 0.05). There was no intergroup significant difference as regards the incidence of perioperative complications. Conclusions Both dexmedetomidine (1 μg/kg) and ketamine (0.5 mg/kg) added to pediatric caudal block were effective to control pediatric ED after sevoflurane anesthesia. Patients received caudal dexmedetomidine had longer time to 1st postoperative analgesia and less postoperative analgesic consumption but longer postoperative sedation when compared with ketamine with no significant difference between both drugs as regards the incidence of perioperative adverse events.

The efficacy and safety of dexmedetomidine in preventing emergence delirium in paediatric patients following ophthalmic surgery: a systematic review and meta-analysis of randomised controlled trials

“…Postoperative pain is considered a significant contributing factor to ED, which is also associated with anaesthetic agents such as sevoflurane since many patients experience emergence agitation during recovery, mimicking ED [24].…”