Dexmedetomidine as an Adjuvant to Ropivacaine in Ultrasound Guided Paediatric Caudal Epidural Block: A Randomised Controlled Study

摘要

Caudal epidural block is a reliable technique to provide perioperative analgesia for infra-umbilical surgeries in paediatric population. Several adjuvants are used along with local anaesthetics to prolong the postoperative anaesthesia.Aim: To evaluate the efficacy of Dexmedetomidine as an adjuvant to ropivacaine in prolonging the duration of postoperative analgesia and reduction of pain scores in paediatric patients undergoing infra-umbilical surgeries.Materials and Methods: This was a double-blinded randomised study, conducted at a tertiary care institution. Sixty patients (2-12 years) of ASA physical status classes 1 and 2 were randomly allocated into two groups. After general anaesthesia, each patient received an ultrasound-guided caudal block. Group R (n=30) received 0.25% ropivacaine (1 mL/kg) +0.5 mL saline and Group RD (n=30) received 0.25% ropivacaine 1 mL/kg +1 μg/kg dexmedetomidine (in 0.5 mL volume). Duration of postoperative analgesia, FLACC pain scores, consumption of rescue analgesics, sedation and adverse-effects were assessed during the 24-hours. The present authors used Student?s t-test and chi-square test for statistical analysis.Results: The duration of postoperative analgesia was significantly prolonged in Group RD, 790.77±7.70 minutes as compared to Group R, 377.97±12.20 minutes (p-value <0.001). Group RD achieved lower FLACC pain scores compared to group R. There were no significant differences in the incidence of adverse-effects.Conclusion: Dexmedetomidine (1 μg/kg) as an adjuvant to ropivacaine 0.25% (1 mL/kg) in an ultrasound-guided caudal block significantly prolongs the duration of postoperative analgesia and reduces FLACC pain score in paediatric patients undergoing infra-umbilical surgeries without any significant adverse-effects.