Caudal Block
Conditions
Brief summary
One of the most commonly used regional anesthetic techniques in pediatric surgeries is the caudal epidural block. Its main disadvantage remains the short duration of action. Hence, different additives have been used. Dexmedetomidine as an additive to the local anesthetic bupivacaine in caudal epidural analgesia prolongs the duration of postoperative analgesia so is dexamethasone. The investigators aimed to study the effect of combining both additives in the duration of analgesia, decreasing side effects and decreasing anesthetic doses
Detailed description
Sixty three children scheduled for hypospadias randomized into 3 groups. Group I (n=21) (dexamethasone 0.1mg/kg+ 0.5ml/kg bupivacaine 0.25%), group II(n=21)( dexmedetomidine 0.01ug/kg+ 0.5ml/kg bupivacaine 0.25%)and groupIII(n=21)(dexamethasone0.1mg/kg+dexmedetomidine0.01ug/kg +0.5ml/kg bupivacaine 0.25%).intraoperative and postoperative hemodynamics were recorded. In PACU, MOPS scores and sedation scores were recorded at 30min,1,2,3,6and 12hrs. Also the time of first analgesic request was recorded.
Interventions
DRUGDexamethasone
Dexamethasone is used peri -operatively mainly to prevent nausea and vomiting. Also epidural administration of dexamethasone prolong the postoperative analgesia and reduce analgesic needs
DRUGDexmedetomidine
Dexmedetomidine is an alpha 2 agonist which has sedative ,analgesic, opioid sparing effect and was proved to prolong the duration of postoperative analgesia when added to local anesthetics
DRUGBupivacaine
local anesthetic agent
Sponsors
Cairo University
Study design
Allocation
RANDOMIZED
Intervention model
FACTORIAL
Primary purpose
DIAGNOSTIC
Masking
TRIPLE (Subject, Caregiver, Investigator)
Masking description
The Patients allocated to study groups using computer generated random list & group assignment was sealed in sequentially numbered opaque envelopes that opened after induction of anesthesia.
Intervention model description
Sixty-three patients with ASA I-II aged from 1-6 years scheduled for hypospadias surgery in Abu El-Resh pediatric Hospital-Cairo university, were included in this prospective randomized double-blinded clinical study. Patients with contraindication to caudal anesthesia, cardiovascular diseases, drug allergy, type I diabetes, clotting disorders, mentally retarded children or those whose families did not approve inclusion in the study were excluded from the study. Patients were randomly divided on the morning of surgery into three groups group I( dexamethasone 21 patients), Group II ( Dexmedetomidine 21 patients) and group III(Dexmedetomidine and dexamethasone 21 patients).
Eligibility
Sex/Gender
MALE
Age
1 Years to 6 Years
Healthy volunteers
No
Inclusion criteria
1 - ASA I-II 2- Males only 3- Children aged from 1-6 years 4- Children scheduled for hypospadias surgery
Exclusion criteria
1. Contraindication to caudal anesthesia. 2. cardiovascular diseases. 3. drug allergy. 4. Type I diabetes. 5. Clotting disorders. 6. Mentally retarded children or those whose families did not approve inclusion in the study
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Time of first request of analgesia | 12 hours | the time from caudal block to the first time to analgesic needs |
| pain scores | 12 hours | the modified objective pain score |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| sedation score | 12 hours | ramsay sedation score at the time of pain |
| heart rates(beat/minute) | 3 hours. | Intra-operative recording |
| mean arterial pressure (mmhg) | 3 hours | Intra-operative recording |
Outcome results
None listed