Comparative Evaluation of Dexmedetomidine and Bupivacaine Combination versus Bupivacaine Alone On the Analgesic Effect of Ilioinguinal Nerve Block in Pediatric Patients Undergoing Inguinal Herniorrhaphy

Sedighe Shahhosseini, Alireza Mahdavi

Abstract


30

Introduction: Elective inguinal herniorrhaphy is one of the most prevalent surgical procedures in pediatric age group. |Postoperative pain is prevalent in children undergoing inguinal hernia repair. This study was aimed to compare the analgesic effect of dexmedetomidine with bupivacaine combination versus bupivacaine alone for ilioinguinal nerve block in children undergoing inguinal herniorrhaphy.Materials and Methods: In this prospective randomized study, we studied 60 ASA class I and II patients with the age between 6 months to 6 years scheduled for unilateral inguinal herniorrhaphy. With the help of a computer-generated list, our patients were assigned randomly to two groups of 30 patients. Group A, received 5cc bupivacaine 0.25%, and group B received 5cc bupivacaine 0.25% with dexmedetomidine 0.3 μg/ kg. Statistical analysis was performed using SPSS. The t-student and Mann-Whitney tests were used to compare the variables between groups. The values were considered significant if P < 0.05.Results: There was no significant difference in blood pressure (systolic or diastolic) and heart rate between the two groups (P=0.624, P=0.784 and P=0.167, respectively).  Analgesia duration was significantly longer in bupivacaine with dexmedetomidine group in comparison to bupivacaine alone group (P=0.008). However, there were no significant difference in frequency of analgesic consumption (P = 0.175) and total dose of analgesic consumption (P = 0.634) in the first 24 h between the two groups. One patient in group B developed bradycardia.Conclusion: The use of dexmedetomidine, as an adjuvant to bupivacaine prolongs the length and the analgesic efficacy of the ilioinguinal nerve block after inguinal herniorrhaphy in pediatric age group.

Keywords


Dexmedetomidine; Bupivacaine; Herniorrhaphy; ilioinguinal nerve block

Full Text:

PDF

9

References


Jenkins JT, O'Dwyer PJ: Inguinal hernias. BMJ 2008;336(7638):269-72.

Aasvang EK, Gmaehle E, Hansen JB, et al: Predictive risk factors for persistent postherniotomy pain. Anesthesiology: The Journal of the American Society of Anesthesiologists 2010;112(4):957-69.

Kehlet H, White PF: Optimizinganesthesia for inguinal herniorrhaphy: general, regional, or local anesthesia. Anesthesia Analg 2001;93:367-69.

Sharma NR, Pandit U, Sapkota PR: Postoperative pain management with combined local filtration and oral analgesia in herniotomy wound in children. JIOM 2011;33:24-9.

Eichenberger U, Greher M, Kirchmair L, et al: Ultrasound-guided blocks of the ilioinguinal and iliohypogastric nerve; accuracy of a selective new technique confirmed by anatomical dissection. Br J Anaesth 2006;97(2):238-43.

Miller RD, Eriksson LI, Fleisher LA, et al: Miller's Anesthesia E-Book: Elsevier Health Sciences; 2014.

Davis PJ, Cladis FP: Smith's Anesthesia for Infants and Children E-Book: Elsevier Health Sciences; 2016.

Ecoffy C: Regional anesthesia in children, inRaj P, editor. Textbook of Regional Anesthesia. Philadelphia: Churchill Livingstone; 2002.p.379-93.

Markham SJ, Tomlinson J, Hain WR: Ilioinguinal nerve block in children. A comparison with caudal block for intra and postoperative analgesia. Anesthesia 1986;41(11):1098-103.

Goyal V, Kubre J, Radhakrishnan K: Dexmedetomidine as an adjuvant to bupivacaine in caudal analgesia in children. Anesthesia, essays and researches 2016;10(2):227-32.

Kamal M, Mohammed S, Meena S, et al: Efficacy of dexmedetomidine as an adjuvant to ropivacaine in pediatric caudal epidural block. Saudi journal of anaesthesia 2016;10(4):384.

Jarineshin H, Fekrat F, Kermanshah AK: Treatment of Postoperative Pain in Pediatric Operations: Comparing the Efficiency of Bupivacaine, Bupivacaine-Dexmedetomidine and Bupivacaine-Fentanyl for Caudal Block. Anesthesiology and pain medicine 2016;6(5):e39495.

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. Journal of Clinical Anesthesia 2017;37:55-60.

El-Hennawy A, Abd-Elwahab A, Abd-Elmaksoud A, et al: Addition of clonidine or dexmedetomidine to bupivacaine prolongs caudal analgesia in children. British journal of anaesthesia 2009;103(2):268-74.

Asano T, Dohi S, Ohta S, et al: Antinociception by epidural and systemic ailpha(2)-adrenoceptor agonist and their binding affinity in rat spinal cord and brain. Anesth Analg 2000;90(2):400-7.

Lundblad M, Marhofer D, Eksborg S, et al: Dexmedetomidine as adjunct to ilioinguinal/iliohypogastric nerve blocks for pediatric inguinal herniarepair: an exploratory randomized controlled trial. Pediatric Anesthesia 2015;25(9):897-905.

Kang H: The effect of dexmedetomidine added to preemptive ropivacaine infiltration on post-operative pain after inguinal herniorrhaphy: a prospective, randomized, double-blind, placebo-controlled study. European Surgery 2012;44(4):274-80.

Merkel SI, Voepel-Lewis T, Shayevitz JR, et al: The FLACC: a behavioral scale for scoring postoperative pain in young children. Pediatr Nurs. 1997;23(3):293-7.

Xiang Q, Huang DY, Zhao YL, et al: Caudal dexmedetomidine combined with bupivacaine inhibit the response to hernial sac traction in children undergoing inguinal hernia repair. Br J Anaesth 2013;110(3):420-4.

El AE-AAA, Alla WA: Comparative study between caudal dexmedetomidine with bupivacaine versus ketamine with bupivacaine for postoperative analgesia after inguinoscrotal surgery in pediatric patients. Ain-Shams Journal of Anaesthesiology 2015;8(4):634-8.

Chatrath V, Attri JP, Kaur Get al: Comparative evaluation of bupivacaine alone versus bupivacaine and dexmedetomidine for spinal anesthesia in infraumbilical surgeries. Ain-Shams Journal of Anaesthesiology 2015;8(1):83-88.

Al-Zaben KR, Qudaisat IY, Abu-Halaweh SA, et al: Comparison of caudal bupivacaine alone with bupivacaine plus two doses of dexmedetomidine for postoperative analgesia in pediatric patients undergoing infra-umbilical surgery: a randomized controlled double-blinded study. Paediatr Anaesth 2015;25(9):883-90.

Shukla U, Prabhakar T, Malhotra K, et al: Intraperitoneal bupivacaine alone or with dexmedetomidine or tramadol for post-operative analgesia following laparoscopic cholecystectomy: A comparative evaluation. Indian J Anaesth 2015;59(4):234-9.

Shukla U, Prabhakar T, Malhotra K, et al: Intraperitoneal bupivacaine alone or with dexmedetomidine or tramadol for post-operative analgesia following laparoscopic cholecystectomy: A comparative evaluation. Indian J Anaesth 2015;59(4):234-9.




DOI: https://doi.org/10.22037/irjps.v5i2.25716

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.