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

Abstract

Background: Caudal block is one of the methods of pain management performed following lower abdominal surgery, though having its own limitations. Objectives: In the present study, the effects and side effects of adding dexmedetomidine to ropivacaine in the caudal epidural block were investigated in children after lower abdominal surgery. Methods: In this randomized, double-blinded clinical trial, 46 children aged three to six years were divided into two groups to perform a caudal block following lower abdominal surgery under general anesthesia. The injectable solution contained ropivacaine in the R group (1 mL/kg ropivacaine 0.2%), as the control group, and dexmedetomidine (2 µg/kg) and ropivacaine 0.2% (1 mL/kg) in the DR group. The pain score (modified CHEOPS score), duration of analgesia, amount of analgesia consumed (i.v. paracetamol), hemodynamic changes, and possible adverse effects were assessed at one, two, and six hours in both groups. Results: The pain score at one and two hours showed no significant difference between the two study groups (P > 0.05). In the DR group, however, the pain score at the sixth hour was significantly lower, and the duration of analgesia was longer (P = 0.001). The amount of analgesic consumption was also lower in the DR group (P = 0.001). However, there was no significant difference in systolic blood pressure and heart rate (P < 0.05), in the case of diastolic blood pressure, a significant difference (P < 0.05) was seen (DR group lower than the R group). There was no statistically significant difference between the study groups in the duration of surgery, recovery time, and side effects (P < 0.05). Conclusions: In the present study, the addition of dexmedetomidine to ropivacaine in the caudal epidural blockade improved postoperative analgesia without significant adverse effects in pediatric patients.

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

“…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). The most commonly employed agents are perineural dexamethasone and dexmedetomidine (11)(12)(13).…”

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

“…A similar study by Imani et al revealed that adding dexmedetomidine to ropivacaine in caudal block anesthesia potentiated the analgesic effect and decreased the analgesic requirements following infraumbilical surgeries in children without causing any side effects ( 16 ). Moreover, Al-Zaben et al compared the efficacy of 2 mcg.kg-1 and 1 mcg.kg-1 of dexmedetomidine when used with bupivacaine for caudal block anesthesia.…”

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

“…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).…”