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

Abstract

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.

Comparison of Dexmedetomidine and Dexamethasone as Adjuvants to Ultra-Sound Guided Interscalene Block in Arthroscopic Shoulder Surgery: A Double-Blinded Randomized Placebo-Controlled Study

“…With the rapidly growing number of surgeries being performed in an ambulatory setting, regional blockade is increasingly used as a modality for controlling pain while reducing common side effects of opioid-centered analgesia (1)(2)(3)(4). The addition of adjuvants to local anesthetics for nerve block prolongation is a common practice in regional anesthesia (5)(6)(7). Many efforts have studied adjuvants that increase the duration of analgesia while simultaneously maintaining a safe side effect profile (8)(9)(10).…”

Comparison of Intercostal Nerve Block with Ropivacaine and Ropivacaine-Dexmedetomidine for Postoperative Pain Control in Patients Undergoing Thoracotomy: A Randomized Clinical Trial

“…Dexmedetomidine, an alpha-2 receptor agonist, is a drug with strong analgesic effects that appears to have synergistic effects with opioids due to opioid-sparing effects (18,19). It has been shown to prolong analgesic effects of peripheral nerve and neuraxial blocks, with hypotension and bradycardia as its side effects (20)(21)(22)(23)(24)(25)(26). Ropivacaine is a long-acting topical analgesic with lowfat solubility, cardiac and central nervous system toxicity, and potency similar to bupivacaine (27).…”

Adjuvant Drugs for Peripheral Nerve Blocks: The Role of Alpha-2 Agonists, Dexamethasone, Midazolam, and Non-steroidal Anti-inflammatory Drugs

“…The proposed mechanism for perineural dexmedetomidine in PNBs as first studied in rat models is similar to that of clonidine, which relies not on alpha-2 agonism mechanism, but instead blocks hyperpolarizationactivated Ih cation currents and causes vasoconstriction for prolonged analgesia (27)(28)(29)(30)(31)(32). Perineural dexmedetomidine adjunct use is off-label, and proper risk-benefit analysis, especially in patients where bradycardia and hypotension would be concerning, would be necessary before even more widespread use of dexmedetomidine in PNBs can be expected (17,(33)(34)(35).…”

“…Dexmedetomidine is a newer alpha-2 agonist that has an eight-fold higher alpha-2 selectivity than clonidine, with an alpha-2: alpha-1 receptor specificity of 1,600:1 and a safer side effect profile (20,(24)(25)(26). Its sedative, anxiolytic, and analgesic properties suitably position DEX as a nonopioid adjuvant to local anesthetics (27)(28)(29)(30)(31).…”