Analgesic efficacy of bupivacaine alone versus bupivacaine plus dexmedetomidine in penile block for hypospadias surgery

Farnaz Kamali, Alireza Mahdavi, Seyed Javad Razavi, Afsaneh Sadeghi, Mehdi Sarafi

Abstract


9

Introduction: Hypospadias is a common pediatric surgical procedure. Early postoperative pain management is essential to inhibit pain impulses and endocrine responses; leading to decreased mortality and morbidity and lower rate of agitation and faster return to normal functional status. This study evaluates the analgesic efficacy of bupivacaine alone versus bupivacaine plus dexmedetomidine in penile block for hypospadias surgery.

Materials and Methods: In this randomized clinical trial, 64 children undergoing hypospadias surgery in a referral center in Tehran, Iran during 2018 were enrolled and randomly assigned to receive either bupivacaine 0.25% alone 0.2 ml/kg or bupivacaine 0.25% 0.2 ml/kg plus dexmedetomidine 0.3 μg/kg. After performing penile block, reversion of anesthesia was carried out and patients were extubated after regaining complete consciousness. Patients were monitored for 24 hours for pain according to FLACC scale and also the analgesia and block duration was determined.

Results: Mean analgesia duration was 2.63±0.9 and 2.03±0.5 hours in the combination group and alone group respectively which was significant (P=0.003). The mean duration of block was significantly longer in the combination group (P=0.001).

Conclusions: According to the results it may be concluded that addition of dexmedetomidine to bupivacaine in hypospadias surgeries would result in longer analgesia and block duration; without addition of adverse effects.


Keywords


Hypospadias; Penile Block; Pediatric Surgery

Full Text:

PDF

10

References


van der Horst HJ, de Wall LL: Hypospadias, all there is to know. Eur J Pediatr 2017; 176(4):435-41.

Keays MA, Dave S: Current hypospadias management: Diagnosis, surgical management, and long-term patient-centred outcomes. Can Urol Assoc J 2017; 11(1-2Suppl1):S48-S53.

Blaise G, Roy WL: Postoperative pain relief after hypospadias repair in pediatric patients: regional analgesia versus systemic analgesics. Anesthesiology 1986; 65(1):84-6.

Wilson CA, Sommerfield D, Drake-Brockman TFE, et al: A prospective audit of pain profiles following general and urological surgery in children. Paediatr Anaesth 2017; 27(11):1155-64.

Prosser DP, Davis A, Booker PD, et al: Caudal tramadol for postoperative analgesia in pediatric hypospadias surgery. Br J Anaesth 1997; 79(3):293-6.

Ong CK, Lirk P, Tan CH, et al: An evidence-based update on nonsteroidal anti-inflammatory drugs. Clin Med Res 2007; 5(1):19-34.

Thies KC, Driessen J, Kho HG, et al: Longer than expected-duration of caudal analgesia with two different doses of levobupivacaine in children undergoing hypospadias repair. J Pediatr Urol 2010; 6(6):585-8.

Kaur M, Singh PM: Current role of dexmedetomidine in clinical anesthesia and intensive care. Anesth Essays Res 2011; 5(2):128-33.

Sarma J, Narayana PS, Ganapathi P, et al: A comparative study of intrathecal clonidine and

dexmedetomidine on characteristics of bupivacaine spinal block for lower limb surgeries. Anesth Essays Res 2015; 9(2):195-207.

Agarwal S, Aggarwal R, Gupta P: Dexmedetomidine prolongs the effect of bupivacaine in supraclavicular brachial plexus block. J Anaesthesiol Clin Pharmacol 2014; 30(1):36-40.

Karkera MM, Harrison DR, Aunspaugh JP, et al: Assessing Caudal Block Concentrations of Bupivacaine With and Without the Addition of Intravenous Fentanyl on Postoperative Outcomes in Pediatric Patients: A Retrospective Review. Am J Ther 2016; 23(3):e792-8.

Goyal V, Kubre J, Radhakrishnan K: Dexmedetomidine as an adjuvant to bupivacaine in

caudal analgesia in children. Anesth Essays Res 2016 ;10(2):227-32.

Raof RA, El Metainy SA, Alia DA, et al: Dexmedetomidine decreases the required amount of bupivacaine for ultrasound-guided transversus abdominis plane block in pediatrics patients: a randomized study. J Clin Anesth 2017; 37:55-60.

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(5):e39495.

Kamal M, Mohammed S, Meena S, et al: Efficacy of dexmedetomidine as an adjuvant to

ropivacaine in pediatric caudal epidural block. Saudi J Anaesth 2016; 10(4):384-9.




DOI: https://doi.org/10.22037/irjps.v5i1.23464

Refbacks

  • There are currently no refbacks.


pISSN: 2423-5067

eISSN: 2423-7612

Creative Commons License
This journal and its contents are licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.