Refaee Hagar Hassanein, Elela Amel Hanafy Abo, Hanna Maha Gamil, Ali Mai Ahmed, Khateeb Amira Mohamed El
Anesthesia and Critical Care, Cairo University, Cairo, Egypt.
Open Access Maced J Med Sci. 2019 Jan 12;7(1):73-76. doi: 10.3889/oamjms.2019.024. eCollection 2019 Jan 15.
Caudal block remains fundamental in pediatric anaesthetic practice. It is very useful in a wide range of surgical procedures and has proved to have a remarkable safety record, But one of the major limitations of the single-injection technique is the relatively short duration of postoperative analgesia. Prolongation of caudal analgesia using single-shot technique has been achieved by the addition of various adjuvant.
This work aims to compare magnesium and dexmedetomidine as adjuvants to bupivacaine-induced caudal block in children undergoing lower limb orthopaedic surgery.
Randomized, double-blind trial.
Pediatric or of a tertiary care centre.
A double-blinded, randomised controlled trial included 36 children, aged between 1 and 7 years, scheduled for lower limb orthopaedic surgery. Patients received general anaesthesia in addition to the caudal block. Patients were divided into three groups: Dexmedetomidine group (n = 12): received 0.5 mL/Kg bupivacaine + 2 mcg/Kg dexmedetomidine, Magnesium group (n = 12): received 0.5 mL/Kg bupivacaine + 50 mg magnesium, and control group (n = 12): received 0.5 mL/Kg bupivacaine + normal saline. Patients were compared according to the duration of analgesia, pain scores, sedation scores, mean arterial pressure, and heart rate.
Both magnesium group and dexmedetomidine group showed better analgesic profile (duration of analgesia and pain scores) compared to the control group without significant difference between the two former groups. Dexmedetomidine group showed higher sedation score, lower mean arterial pressure and lower heart rate compared to other groups.
Both magnesium (50 mg) and dexmedetomidine (2 mcg/Kg) improved the analgesic profile of bupivacaine-induced caudal block in children. Dexmedetomidine administration was accompanied with higher sedation score and negative hemodynamic profile.
骶管阻滞在小儿麻醉实践中仍然是基础操作。它在广泛的外科手术中非常有用，并且已被证明具有出色的安全记录，但单次注射技术的主要局限性之一是术后镇痛时间相对较短。通过添加各种佐剂已实现使用单次注射技术延长骶管镇痛时间。
本研究旨在比较镁和右美托咪定作为佐剂用于接受下肢骨科手术儿童的布比卡因诱导的骶管阻滞。
随机双盲试验。
三级护理中心的儿科手术室。
一项双盲、随机对照试验纳入了36名年龄在1至7岁之间、计划进行下肢骨科手术的儿童。患者除接受骶管阻滞外还接受全身麻醉。患者分为三组：右美托咪定组（n = 12）：接受0.5 mL/Kg布比卡因 + 2 mcg/Kg右美托咪定；镁组（n = 12）：接受0.5 mL/Kg布比卡因 + 50 mg镁；对照组（n = 12）：接受0.5 mL/Kg布比卡因 + 生理盐水。根据镇痛持续时间、疼痛评分、镇静评分、平均动脉压和心率对患者进行比较。
与对照组相比，镁组和右美托咪定组均显示出更好的镇痛效果（镇痛持续时间和疼痛评分），前两组之间无显著差异。与其他组相比，右美托咪定组显示出更高的镇静评分、更低的平均动脉压和更低的心率。
镁（50 mg）和右美托咪定（2 mcg/Kg）均改善了布比卡因诱导的小儿骶管阻滞的镇痛效果。右美托咪定给药伴随着更高的镇静评分和负面的血流动力学表现。
