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Subject Area

Rheumatology and Rehabilitation

Article Type

Original Study

Abstract

Objective The aim of this study was to compare between anesthesia with intrathecal bupivacaine only, intrathecal bupivacaine plus dexmedetomidine, and caudal bupivacaine in children between 1 and 5 years of age. Background Regional anesthesia is mainly used to provide analgesia after surgery. Dexmedetomidine has been used to increase the duration of postoperative analgesia. Our study aimed to compare between intrathecal bupivacaine only, intrathecal bupivacaine plus dexmedetomidine, and caudal bupivacaine in children between 1 and 5 years of age. Patients and methods Sixty-three patients were included in a clinical trial from April 2015 to September 2016 and were divided into three groups of 21 each: patients in group I were given intrathecal bupivacaine only at a dose of 0.4 mg/kg bupivacaine 0.5%; patients in group II were given intrathecal bupivacaine plus dexmedetomidine at a dose of 0.4 mg/kg bupivacaine 0.5% with 0.25 μg dexmedetomidine for every 1 mg bupivacaine; and patients in group III were given caudal bupivacaine 0.5% at a dose of 3 mg/kg. Our primary outcome measures were duration of analgesia (time from the block to first dose of analgesia or observed pain score ≥12) and frequency of analgesic consumption, whereas the secondary outcome measures were onset of block (time from performing block until recording sensory loss using the pin prick method and motor loss, which was recorded using the modified Bromage scale), level of block, effects on hemodynamics, and occurrence of complications. Results Group III had a significantly longer duration of analgesia compared with the other groups and it was longer in group II than in group I (P = 0.000). Frequency of analgesic need was significantly lower in group II compared with the other groups and in group III than in group I (I vs. II and I vs. III, P = 0.000; and II vs. III, P = 0.003). Conclusion Caudal anesthesia has a longer duration of analgesia compared with spinal anesthesia. Adding dexmedetomidine to intrathecal bupivacaine prolongs the duration of analgesia and decreases the total analgesic consumption.

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