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Adjuvant to Caudal Levobupivacaine Versus Levobupivacaine Alone in Paediatric Patient

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Background: As the day care surgery becomes popular, caudal epidural block has become routine intervention in children and infants. But the major limitation with this technique is duration of analgesia after single injection, which is limited by the pharmacology of local anaesthetic agent used. To prolong the duration of caudal analgesia various adjuvants such as opioids, ketamine midazolam and α2 agonists are used with single shot technique.We have deigned this study to elucidate the efficacy and safety of dexmedetomidine as an adjuvant to caudal Levobupivacaine versus Levobupivacaine alone in paediatric patient. Material and Method: Present study is a randomized, prospective comparative study conducted at department of anaesthesia.Based on exclusion and inclusion criteria 80 patients were enrolled for this study. The patients were randomly allocated into two groups.Group L:- 0.75 ml/kg Levobupivacaine 0.25%, diluted in normal saline 0.9% Group LD: - 0.75 ml/kg Levobupivacaine 0.25% with Dexmedetomidine 1 µg/kg. Various parameters like cardiovascular parameter, duration of analgesia, FLACC score and adverse drug reaction was recorded and compared. Result: Both groups were comparable to each other with respect to age, sex, weight, duration of surgery and ASA scare, The P value was more than 0.05 which was statistically insignificant.After induction at 5 min, heart rate was 105.26 + 11.61 /min in group L and 106.52 + 15.22/min in group LD. The P value was 0.2162. After 15min of induction the heart rate was 107.27 + 14.41 in group L and 108.36 + 14.24/min in group LD. The P value was 0.2019 which is not significant. The time of analgesia was 342.8 + 12.4 mins in group L and in group LD it was 486.40 + 14.6 mins. Duration of analgesia was longer in group LD and is significant statistically. Discussion and Conclusion: From present study we can conclude that caudal administration of 1 µg /kg dexmedetomidine along with 0.75 ml/kg Levobupivacaine is resulted in prolongation of the duration of analgesia, less postoperative analgesic requirement as compared with 0.75ml/kg Levobupivacaine alone. There is no significant difference in hemodynamic parameters and increase incidence of adverse drug reaction.

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Background: As the day care surgery becomes popular, caudal epidural block has become routine intervention in children and infants. But the major limitation with this technique is duration of analgesia after single injection, which is limited by the pharmacology of local anaesthetic agent used. To prolong the duration of caudal analgesia various adjuvants such as opioids, ketamine midazolam and α2 agonists are used with single shot technique.We have deigned this study to elucidate the efficacy and safety of dexmedetomidine as an adjuvant to caudal Levobupivacaine versus Levobupivacaine alone in paediatric patient. Material and Method: Present study is a randomized, prospective comparative study conducted at department of anaesthesia.Based on exclusion and inclusion criteria 80 patients were enrolled for this study. The patients were randomly allocated into two groups.Group L:- 0.75 ml/kg Levobupivacaine 0.25%, diluted in normal saline 0.9% Group LD: - 0.75 ml/kg Levobupivacaine 0.25% with Dexmedetomidine 1 µg/kg. Various parameters like cardiovascular parameter, duration of analgesia, FLACC score and adverse drug reaction was recorded and compared. Result: Both groups were comparable to each other with respect to age, sex, weight, duration of surgery and ASA scare, The P value was more than 0.05 which was statistically insignificant.After induction at 5 min, heart rate was 105.26 + 11.61 /min in group L and 106.52 + 15.22/min in group LD. The P value was 0.2162. After 15min of induction the heart rate was 107.27 + 14.41 in group L and 108.36 + 14.24/min in group LD. The P value was 0.2019 which is not significant. The time of analgesia was 342.8 + 12.4 mins in group L and in group LD it was 486.40 + 14.6 mins. Duration of analgesia was longer in group LD and is significant statistically. Discussion and Conclusion: From present study we can conclude that caudal administration of 1 µg /kg dexmedetomidine along with 0.75 ml/kg Levobupivacaine is resulted in prolongation of the duration of analgesia, less postoperative analgesic requirement as compared with 0.75ml/kg Levobupivacaine alone. There is no significant difference in hemodynamic parameters and increase incidence of adverse drug reaction.

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This page is a summary of: A Prospective Comparative Study of Efficacy and Safety of Dexmedetomidine as an Adjuvant to Caudal Levobupivacaine Versus Levobupivacaine Alone in Paediatric Patient, Indian Journal of Anaesthesia and Analgesia, January 2019, Red Flower Publication Private, Ltd.,
DOI: 10.21088/ijaa.2349.8471.6319.19.
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