Caudal Dexmedetomidine and Fentanyl as Adjuvants to Levobupivacaine in Paediatric Infraumbilical Surgeries for Perioperative Pain Management: A Comparative Study

Abstract

Background: Postoperative pain control is an essential component of anaesthesia care. Preemptive caudal analgesia is one strategy for managing perioperative pain in paediatric patients. In caudal block, dexmedetomidine and fentanyl are useful adjuvants to levobupivacaine that offer better and longer-lasting postoperative analgesia. In this study, the effects of preemptive administration of caudal levobupivacaine with either fentanyl or dexmedetomidine were compared in terms of perioperative haemodynamic stability, pain intensity, and duration of postoperative analgesia, the number of patients who needed rescue analgesics, sedation level, and adverse events.
Methods: This study was carried out in the Department of Anaesthesia, Analgesia and Intensive Care Medicine, Bangladesh Medical University after obtaining approval from the institutional review board (IRB). Preemptive caudal block was used for perioperative analgesia in 60 children, aged 1-6 years, who were undergoing infraumbilical surgeries under general anaesthesia with ASA grade I–II. Children were divided into two groups: Group FL (control) received levobupivacaine 0.25% with 1 μg/kg of fentanyl diluted with distilled water to make total volume 0.75 ml/kg. Group DL received levobupivacaine 0.25% with 0.8 mcg/kg of dexmedetomidine diluted with distilled water to make total volume 0.75 ml/kg. Perioperative haemodynamic parameters, the face, leg, activity, cry and consolability (FLACC) pain scale, the sedation score, duration of analgesia and adverse effects were noted after the medications were administered. The data was recorded on a predesigned data collection sheet.
Results: In this study, demographic characteristics showed no significant differences. The findings revealed that the mean heart rate was lower in the dexmedetomidine group (Group DL) compared to the fentanyl group (Group FL) throughout the perioperative period but significant at 30 and 60 minutes after block as p-value was < 0. 001. The FLACC scores for both groups were measured at various postoperative time points. Significant differences were found between the groups at the 4-to-6 hour time point after surgery with mean FLACC scores of 3.02±0.49 in Group DL versus 3.42±0.41 in Group FL at 4 hours (p = 0.001) and 3.12 ± 0.12 in Group DL compared to 5.30 ± 0.18 in Group FL at 6 hours (p < 0.001). A statistically significant higher RSS score in Group DL compared to Group FL at various time points up to 4 hours after surgery (P < 0.001) suggests better sedation in Group DL. The mean time to first rescue analgesic requirement was significantly longer in Group DL (480.63 ± 5.39 minutes) as opposed to Group FL (360.20 ± 3.35 minutes, P < 0.001).There is no significant adverse event between the group with more parental satisfaction in DL group compared to the FL group.
Conclusion: Dexmedetomidine is a better adjuvant to levobupivacaine compared to fentanyl in preemptive caudal block as it maintains better perioperative haemodynamic stability, perioperative analgesia and better sedation without an increase in adverse event in children undergoing infraumbilical surgeries.