Comparison of Analgesic Effect of Dexmedetomidine versus Tramadol as Adjuvants to Caudal Ropivacaine in Infraumbilical Surgeries among Pediatric Patients: A Randomized Double Blind Interventional Study
DOI:
https://doi.org/10.31584/jhsmr.2022893Keywords:
adjuvant, CHEOPS, Dexmedetomidine, Ropivacaine, TramadolAbstract
Objective: To compare the postoperative analgesic effects of 0.2% ropivacaine with Dexmedetomidine (2 g/kg) and tramadol (2 mg/kg) among pediatric patients undergoing infra umbilical surgery.
Material and Methods: This hospital based, randomized double blind interventional study included 60 pediatric patients, aged 1–7 years, having American Society of Anaesthesiology grade I and II, weighing 7-25 kg, and undergoing infra-umbilical surgeries under general anesthesia. Subjects were randomly allocated into two groups to receive either: 2 mcg/ kg of Dexmedetomidine or 2 mg/kg of Tramadol, as adjuvant to 0.2% of Ropivacaine. Pain intensity was assessed using the pediatric observational Children’s Hospital of Eastern Ontario Pain Scale (CHEOPS) score. Rescue analgesia was given, when the CHEOPS score was ≥6. Duration of analgesia was defined as: the time period between administrations of block until rescue analgesia was given. Level of sedation was assessed by the Ramsay sedation score.
Results: Kaplan Meier analysis showed that the median time to first rescue analgesia (duration of analgesia) was significantly (p-value<0.001) prolonged with Dexmedetomidine (780 minutes; 95% CI: 760.68–799.32 minutes) as compared to Tramadol (648 minutes; 95% CI: 635.92–660.38 minutes). Mean emergence time and duration of sedation were also significantly prolonged with Dexmedetomidine as compared to Tramadol.
Conclusion: In pediatric patients undergoing infraumbilical surgeries, Dexmedetomidine as adjuvant to Ropivacaine provides an advantage of longer post-operative analgesia and lack of opioid related adverse events associated with Tramadol.
References
Raja SN, Carr DB, Cohen M, Finnerup NB, Flor H. The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. HHS Public Access 2020;161:1976–82.
Andrews K, Fitzgerald M. Cutaneous flexion reflex in human neonates: a quantitative study of threshold and stimulus response characteristics after single and repeated stimuli. Dev Med Child Neurol 1999;41:696-703.
Taddio A, Katz J, Ilerisch AI, Koren G. Effect of neonatal circumcision on pain response during subsequent routine vaccination. Lancet 1997;349:599-603.
Langlade A, Kriiegel I. Treatment of acute postoperative pain. Ann Chir 1997;51:1013-21.
Silvani P, Camporesi A, Agostino MR, Salvo I. Caudal analgesia in paediatrics: an update. Minerva Anaesthesiol 2006;72:453-9.
Cathelin F. A new study of subarachnoid injection a method of epidural injection via the sacral route. applications to humans. C R Soc Biol (Paris) 1901;53452.
Siccard A. The injection of medications in the epidural space via the saccrococcygeal route. C R Soc Biol (Paris) 1901;53396.
Campbell MF. Caudal naesthesia in children. Am J Urol 1933; 30:2459.
Payen D, Ecoffey C, Carli P, Dubousset AM. Pulsed Doppler ascending aortic, carotid, brachial and femoral artery blood flows during caudal anaesthesia in infants. Anaesthesiology 1987;67:681.
Hansen TG, Henneberg SW, Larsen SW, Lund J, Hansen M. Caudal bupivacaine supplemented with caudal or intravenous clonidine in children undergoing hypospadias repair: a double blinded study. Br J Anaesth 2004;92:223.
Hurley RW, Wu CL. Acute postoperative pain. In: Miller RD, Eriksson LI, Fleisher LA, Wiener-Kronish J, Young WL, editors. Miller's anesthesia. 7th ed. Philadelphia: Elsevier; 2009; p.2757-82.
Leone S, Di Cianni S, Casati A. Pharmacology, toxicology, and clinical use of new long-acting local anesthetics, ropivacaine and levobupivacaine. Acta Biomed 2008;79:92–105.
McClure JH. Ropivacaine, review article. Br J Anaesth 1996; 76:300-7.
Vetter TR, Carvallo D, Johnson JL, Mazurek MS, Presson RG Jr. A comparison of single dose caudal clonidine, morphine, or hydrompophone combined with ropivacaine in pediatric patients undergoing ureteral reimplantation. Anesth Analg 2007;104:1356-63.
Carollo DS, Nossaman BD, Ramadhyani U. Dexmedetomidine. A review of clinical applications. Curr Opin Anaesthesiol 2008; 21:457-61.
Haselman MA. Dexmedetomidine: a useful adjunct to consider in some high-risk situations. AANA J 2008;76:335-9.
Prakash S, Tyagi R. Efficacy of three doses of tramadol with bupivacaine for caudal analgesia in paediatric inguinal herniotomy. Br J Anaesth 2006;97:385-8.
Gupta S, Sharma R. Comparison of analgesic efficacy of caudal dexmedetomidine versus caudal tramadol with ropivacaine in paediatric infraumbilical surgeries. Indian J Anaesth 2017; 61:499-504. 19. Hansen TG, Henneberg SW, Larsen SW, Lund J, Hansen M. Caudal bupivacaine supplemented with caudal or intravenous clonidine in children undergoing hypospadias repair: A double blinded study. Br J Anaesth 2004;92:223-7.
Hurley RW, Wu CL. Acute postoperative pain. Miller’s anaesthesia. 7th ed. Philadelphia: Churchill Livingtone; 2009; p.2757-8.
Verghese ST, Hannallah RS. Postoperative pain management in children. Anesthesiology Clin North America 2005;23:163-84.
Kumaraswamy S, Kalappa S. Dexmedetomidine as an adjuvant to caudal epidural ropivacaine for lumbosacral spine surgery. J Clin Diagn Res 2016;10:UC22-4.
Keshari U, Raikwar SK, Vatsalya T, Agarwal A. Clinical evaluation of efficacy and safety of dexmedetomedine as an adjunct to caudal ropivacaine in pediatric infraumbilical surgeries. J Evolution Med Dent Sci 2014;3:4967-76.
Senthamizh TA, Krishnaprasad P. Comparison of analgesic efficacy of caudal dexmedetomidine vs caudal tramadol with ropivacaine in pediatric urogenital surgeries. IOSR-JDMS 2020;19:2279-861. 25. Sneha BA, Bharti R. Comparison of the efficacy of tramadol and Dexmedetomidine with newer local anaesthetic drug ropivacaine through caudal epidural route. Int J Med Anesth 2019;2:106-11. 26. Anand VG, Kannan M, Thavamani A, Bridgit MJ. Effects of dexmedetomidine added to caudal ropivicaine in paediatric lower abdominal surgeries. Indian J Anaesth 2011;55:340-6.
Bharti N, Praveen K, Bala I. A dose response study of caudal dexmedetomidine with ropivacaine in pediatric day care patients undergoing lower abdominal and perineal surgeries: a randomized controlled trial. Pediatric Anesth 2014;24:1158-63.
Jarineshin H, Fekrat F, Kargar Kermanshah A. Treatment of postoperative pain in pediatric operations: comparing the efficiency of bupivacaine, bupivacaine-dexmedetomidine and bupivacaine fentanyl for caudal block. Anesth Pain Med 2016;6:e39495.
Saadawy I, Boker A, Elshahawy MA, Almazrooa A, Melibary S, Abdellatif AA, et al. Effect of dexmedetomidine on the characteristics of bupivacaine in a caudal block in pediatrics. Acta Anaesthesiol Scand 2008;53:251-6.
Imani F, Farahmand RR. Evaluation of adding dexmedetomidine to ropivacaine in pediatric caudal epidural block. Anesth Pain Med 2021;11;e112880.
EI-Feky EM, Abd EI Aziz AA. Fentanyl, dexmedetomidine, dexamethasone as adjuvant to local anesthetics in caudal analgesia in pediatrics: a comparative study. Egyptian J Anaesth 2015;31:175-80.
Ibacache ME, Muñoz HR, Brandes V, Morales AL. Single-dose dexmedetomidine reduces agitation after sevoflurane anesthesia in children. Anesth Analg 2004;98:60 3.
Westfall TC, Westfall DP. Adrenergic agonists and antagonists. In: Goodman & Gilman's, editors. The pharmacological basis of therapeutics. 12th ed. New York: McGraw Hill; 2012;p.277-88.
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