Comparison of caudal dexmedetomidine and fentanyl combined with bupivacaine in pediatric patients undergoing urogenital surgery

Abstract

Introduction: Caudal epidural block is one of the most popular, reliable, and safe techniques in pediatric patients that can provide analgesia for a variety of supra- and infra-umblical surgical procedures. This study aimed to compare the efficacy of dexmedetomidine–bupivacaine, fentanyl-bupivacaine mixture and bupivacaine alone on duration of postoperative analgesia, sedation, emergence agitation, duration of sensory and motor block, hemodynamic stability and side effects.

Methodology: After approval from ethical committee 90 pediatric patients of age 2-7 y were enrolled. The children were randomly allocated to three equal groups of 30 each using a computer generated randomization list. Group BD (n=30) received 1 µg/kg dexmedetomidine with 0.5 ml/kg bupivacaine 0.25%; Group BF (n=30) received 1 µg/kg fentanyl with 0.5 ml/kg bupivacaine 0.25%, and Group B (n=30) received 0.5 ml/kg of bupivacaine 0.25% for caudal epidural analgesia.

Caudal block was given after induction of general anesthesia for urogenital surgery. General anesthesia was maintained with sevoflurane at a concentration adjusted to maintain BIS at 40-60. Hemodynamic parameters, Pediatric Anaesthesia Emergence Delirium (PAED) score, Richmond agitation sedation scale (RASS), and Children’s Hospital of Eastern Ontario Pain Scale (CHEOPS) were recorded immediate postoperatively and then regularly every hour for the next 12 hours.

Results: PAED score was less in group BD than group B and BF from baseline. RASS Score was less in Group BD than Group BF from base line to 12 h except at 240 min and Group BF is less than Group B from base line to 12 h. Group BD was less than B from base line to 12 h. CHEOP score was less in Group BD than Group BF and Group B from base line to 12 h.

Conclusion: Dexmedetomidine (1 µg/kg) added to bupivacaine in caudal block increases the duration of postoperative analgesia, provides arousable sedation, and decreases emergence delirium with stable hemodynamics and minimal side effects in pediatric patients.