Evaluation of Safety and Efficacy of Caudal Administration of Bupivacaine/Dexmedetomidine versus Bupivacaine/Fentanyl in Paediatric Unilateral Hernia Repair

Abstract

Great attention is now given to day case surgeries in different fields, with the expanding urge to lower the costs while raising the quality of health services provided to the community by lowering hospital stay, perioperative side effects and complications, with raising benefits like early rehabilitation and regain of the normal functions. In the field of paediatric day case surgeries early discharge of the children allows reduction of hospitalization stress for them and their family and causing less disruption to family life by returning to the familiar home environment. This is backed up by the European Charter of Children’s rights, which states that “children should be admitted to hospital only if the care they require cannot be equally well provided at home or on a day basis” In attempts to minimize these drawbacks and achieve these benefits mentioned above the current study was conducted. The aim of the present study was to evaluate the effects of the caudal administration of bupivacaine/ fentanyl versus bupivacaine/ dexmedetomidine in paediatric day case surgery on; patient safety, analgesic efficacy and incidence of side effects.

This was a prospective, single-blinded, randomized controlled study conducted at the Paediatric Surgical Department, Ain Shams University Hospitals. All children presenting to the Paediatric Surgical Department, were assessed for eligibility according to the inclusion and exclusion criteria. Fifty healthy paediatric patients aged from 2-4 years, with uncomplicated unilateral inguinal hernia, American Society of Anesthesiology (ASA) grade I children were included. All children were screened for suitability by detailed clinical assessment of their medical history and physical examination and those who met the inclusion criteria were randomly assigned into one of two study groups (25 patients in each); Group 1; received caudal bupivacaine 0.25 % 1ml / kg plus fentanyl, 1μg/kg. Group 2; received caudal bupivacaine, 0.25 % 1 ml /kg plus dexmedetomidine, 1 μg/kg. Intraoperative monitoring included; pulse oximetry, 5-lead ECG, Non-invasive blood pressure monitoring. Postoperative assessment. After completion of surgery, patients were transferred to the recovery room awake and were evaluated in terms of pain and sedation using the FLACC(Face, Legs, Activity, Cry and Consolability) scale and Ramsay sedation scale, respectively. Assessments were done immediately after the transfer and then after 30 min then every hour until they were ready to leave the hospital. The post-operative data was recorded at fixed intervals as follows: Immediate, half, 1, 2, 3, 4, 5, 6, 7, and 8 hrs intervals. Analgesics were administered when needed and the time of administration was recorded and need for postoperative analgesia was reported. Monitoring of patient safety was done by determination of the following side effects: sedation, respiratory depression, nausea and vomiting. Hypotension, bradycardia, urinary retention, dry mouth and itching. The results showed that caudal dexmedetomidine/bupivacaine resulted in better analgesia, better sedation and lower respiratory rate than caudal fentanyl/bupivacaine. Yet, there was no significant difference between both groups inthe total doses of analgesics needed. The caudal dexmedetomidine/bupivacaine administration resulted in a lesser frequency of nausea, vomiting and dry mouth versus the bupivacaine/fentanyl combination administration.