Evaluation of efficacy of caudal dexmedetomidine with ropivacaine for postoperative analgesia in paediatric lower abdominal surgeries.

Archana Agarwal; Apurva Abhinandan Mittal; Trilok chand; Mukesh Kumar Gautam

Volume : VI, Issue : III, March - 2016

Evaluation of efficacy of caudal dexmedetomidine with ropivacaine for postoperative analgesia in paediatric lower abdominal surgeries.

Archana Agarwal, Apurva Abhinandan Mittal, Trilok Chand, Mukesh Kumar Gautam

Abstract :

Background: Caudal epidural analgesia is reliable, safe and has become most popular and commonly performed regional blocks in paediatric anaesthesia. Dexmedetomine is a potent adjuvant which apart from its analgesic effects has concomitant benefits like sedation and sympatholysis. In this study we determined the efficacy of Dexmedetomidine as an adjuvant to caudal anaesthesia for postoperative analgesia in paediatric patients undergoing lower abdominal surgeries. Methods: The study consisted of 60 infants and children (1yr–6yr) of ASA physical status I, of either sex, undergoing lower abdominal surgery who were randomised into two groups of 30 each namely Group R and group RD. After induction of anaesthesia caudal block was performed on all patients. Depending on results of randomisation, drug used for caudal anaesthesia in R Group was 0.5ml/kg 0.25% ropivacaine whereas in Group RD it was 0.5ml/kg 0.25% ropivacaine with Dexmeditomidine 1 mcg/kg. Heart rate (HR), mean arterial pressure (MAP) and oxygen saturation (SpO2) were recorded before surgery and every 5 min till 20 minutes after skin incision and at the end of surgeries. The time from caudal block to end of surgery, time for first rescue analgesia, total consumption of rescue analgesia in the period of 24 hours were recorded. In the postanaesthesia care unit, FLACC and ramsay sedation scores were assessed on arrival (0) and at 4, 8,12,16, 20 and 24 hours. Results: There was a significant reduction in FLACC score in group RD at 4,8 and 12 hours postoperatively compared to group R. At the 16 ,20 and 24 hours there was no significant difference.The mean duration of postoperative analgesia(time of first rescue analgesia) was significantly prolonged in group RD compared to group R.The mean total consumption of rescue analgesia in 24 hours postoperatively was significantly decreased in group RD (217±65.054) mg when compared with the group R( 464±1.456) mg. Mean sedation score using Ramsay Sedation Scores was very significant (p≤0.001) at 4 and 8 hrs. Perioperative haemodynamic changes between the groups were comparable and were not statistically significant and required no treatment. Conclusion: We find dexmedetomidine is an effective adjuvant for caudal analgesia in paediatrics age group with lower abdominal surgeries.