Nonopioid (Dexmedetomidine, Dexamethasone, Magnesium) adjuvant to ropivacaine caudal anesthesia in pediatric patients undergoing infraumbilical surgeries: A comparative study

Abstract

Background:Desirable adjuvants to caudal ropivacaine are the one which prolongs analgesia and free of side effects. We compared nonopioid drugs dexmedetomidine, dexamethasone, and magnesium as adjuvants to ropivacaine caudal analgesia in pediatric patients undergoing infraumbilical surgeries.Materials and Methods:This study was done on 128 pediatric patients (3–12-year olds) undergoing infraumbilical surgeries; they were randomly allocated to four groups to receive normal saline, dexmedetomidine 1 μg/kg, dexamethasone 0.1 mg/kg, and magnesium sulfate 50 mg with injection ropivacaine 0.2% in the dose 0.5 ml/kg caudally. Modified Objective Pain Score and Ramsay Sedation Score, duration of analgesia, hemodynamic changes, and side effects were assessed. ANOVA test was used for numerical values as data were expressed in mean and standard deviation. Kruskal–Wallis test was used for postoperative pain and sedation score as data were expressed as median and range.Results:The demographic data and hemodynamics were comparable. There was a significant prolongation of duration of analgesia in all study groups, dexmedetomidine (406.2 ± 45.5 min), dexamethasone (450.0 ± 72.6 min), and magnesium (325.0 ± 45.8 min) as compared to ropivacaine (285.9 ± 52.7 min) group. None of the adjuvants resulted in either excess or prolonged sedation. No side effects were encountered.Conclusion:The adjuvants dexmedetomidine, dexamethasone, and magnesium added to ropivacaine prolong caudal analgesic duration without any sedation or side effect.

Effect of magnesium added to local anesthetics for caudal anesthesia on postoperative pain in pediatric surgical patients: A systematic review and meta-analysis with Trial Sequential Analysis

“…All studies included patients with an American Society of Anesthesiologists physical status of I or II. In the trial by Sridhar et al [ 16 ], the participants underwent infraumbilical surgery with no more details given, while in the rest of the trials, the patients underwent surgery of the male genitalia or the groin. In all trials, participants were predominantly male.…”

“…Askar et al reported that FLACC scores were better in the magnesium group at 2, 4, and 6 h after surgery than in the control group. [ 17 ] Sridhar et al reported that the Modified Objective Pain Score was significantly better at 6 h and 12 h after surgery in the magnesium group [ 16 ]. The pain scores were similar in the other two trials.…”

“…No serious adverse events, such as persistent nerve injury, were reported in any of the six trials. In one trial, it was reported that no adverse events were noted in the postanesthesia care unit (PACU) [ 16 ]. Non-serious adverse events such as shivering, sedation, and motor block were reported.…”

“…Yousef et al reported that shivering occurred in 20% of patients in their control group and in no patient in their magnesium group (p < 0.05) [ 21 ]. Sedation was assessed in four trials, and there was no significant difference between the treatment groups in three trials [ 16 , 18 , 19 ]. Askar et al reported that the Ramsay Sedation Score was slightly higher in the magnesium group after 30 and 60 min [ 17 ].…”

“…Respiratory depression was evaluated in two trials but not found in either of the treatment groups [ 18 , 21 ]. Blood pressure and heart rate were recorded in three trials, and found to be comparable between the groups in two trials [ 16 , 19 ]; in one trial they were slightly lower in the magnesium group for 30 min after admission to the PACU [ 17 ]. Time to first micturition was evaluated in two studies and found to be comparable between groups [ 20 , 21 ].…”