Elfawal S M, Abdelaal W A, Hosny M R
Department of Anesthesiology, Intensive Care and Pain Management, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Saudi J Anaesth. 2016 Oct-Dec;10(4):423-427. doi: 10.4103/1658-354X.179110.
Levobupivacaine is an effective local anesthetic agent with less systemic toxicity than racemic bupivacaine, but it has short postoperative analgesic duration. Dexmedetomidine and fentanyl are promising adjuncts to provide excellent and prolonged postoperative caudal analgesia. This study compared the effects of caudal levobupivacaine plus dexmedetomidine and levobupivacaine plus fentanyl for postoperative analgesia and sedation in children undergoing lower limb orthopedic surgery.
Ninety children, whose age ranged from 1 to 7 years, American Society of Anesthesiologists I-II, undergoing orthopedic lower limb surgery under general anesthesia received caudal block for postoperative analgesia. The children were randomly allocated into three groups: Group L (control) received 0.75 ml/kg levobupivacaine 0.25% diluted in saline; Group LD received 0.75 ml/kg levobupivacaine 0.25% with dexmedetomidine 1 μg/kg; and Group LF received 0.75 ml/kg levobupivacaine 0.25% with fentanyl 1 μg/kg. Following the administration of the drugs; hemodynamic variables, the total anesthesia time, sedation score, Face, Legs, Activity, Cry, Consolability score, duration of analgesia, and side effects were recorded.
Demographically, all the groups were comparable, both the baseline and the intraoperative hemodynamic profile were similar in all groups. The mean duration of analgesia and the mean sedation score in the Group LD were significantly greater as compared to both the other groups.
Dexmedetomidine may be a better additive to levobupivacaine than fentanyl for caudal postoperative analgesia, arousable sedation with comparable hemodynamic and side effect profile in children.
左旋布比卡因是一种有效的局部麻醉剂，其全身毒性低于消旋布比卡因，但术后镇痛持续时间较短。右美托咪定和芬太尼是有望提供出色且持久的术后骶管镇痛的辅助药物。本研究比较了骶管注射左旋布比卡因加右美托咪定和左旋布比卡因加芬太尼对接受下肢骨科手术儿童术后镇痛和镇静的效果。
90名年龄在1至7岁、美国麻醉医师协会分级为I-II级、在全身麻醉下接受下肢骨科手术的儿童接受骶管阻滞用于术后镇痛。这些儿童被随机分为三组：L组（对照组）接受0.75 ml/kg 0.25%的左旋布比卡因用生理盐水稀释；LD组接受0.75 ml/kg 0.25%的左旋布比卡因加1 μg/kg右美托咪定；LF组接受0.75 ml/kg 0.25%的左旋布比卡因加1 μg/kg芬太尼。给药后，记录血流动力学变量、总麻醉时间、镇静评分、面部、腿部、活动、哭闹、安慰评分、镇痛持续时间和副作用。
在人口统计学方面，所有组具有可比性，所有组的基线和术中血流动力学特征相似。与其他两组相比，LD组的平均镇痛持续时间和平均镇静评分显著更高。
对于儿童骶管术后镇痛，右美托咪定可能是比芬太尼更好的左旋布比卡因添加剂，可产生可唤醒的镇静作用，且血流动力学和副作用相当。
