Imani Farnad, Farahmand Rad Reza, Salehi Reza, Alimian Mahzad, Mirbolook Jalali Zahra, Mansouri Amir, Nader Nader D
Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran.
Department of Anesthesiology, University at Buffalo, Buffalo, USA.
Anesth Pain Med. 2021 Feb 28;11(1):e112880. doi: 10.5812/aapm.112880. eCollection 2021 Feb.
Caudal block is one of the methods of pain management performed following lower abdominal surgery, though having its own limitations.
In the present study, the effects and side effects of adding dexmedetomidine to ropivacaine in the caudal epidural block were investigated in children after lower abdominal surgery.
In this randomized, double-blinded clinical trial, 46 children aged three to six years were divided into two groups to perform a caudal block following lower abdominal surgery under general anesthesia. The injectable solution contained ropivacaine in the R group (1 mL/kg ropivacaine 0.2%), as the control group, and dexmedetomidine (2 µg/kg) and ropivacaine 0.2% (1 mL/kg) in the DR group. The pain score (modified CHEOPS score), duration of analgesia, amount of analgesia consumed (i.v. paracetamol), hemodynamic changes, and possible adverse effects were assessed at one, two, and six hours in both groups.
The pain score at one and two hours showed no significant difference between the two study groups (P > 0.05). In the DR group, however, the pain score at the sixth hour was significantly lower, and the duration of analgesia was longer (P = 0.001). The amount of analgesic consumption was also lower in the DR group (P = 0.001). However, there was no significant difference in systolic blood pressure and heart rate (P < 0.05), in the case of diastolic blood pressure, a significant difference (P < 0.05) was seen (DR group lower than the R group). There was no statistically significant difference between the study groups in the duration of surgery, recovery time, and side effects (P < 0.05).
In the present study, the addition of dexmedetomidine to ropivacaine in the caudal epidural blockade improved postoperative analgesia without significant adverse effects in pediatric patients.
骶管阻滞是下腹部手术后疼痛管理的方法之一，尽管有其自身局限性。
在本研究中，探讨在下腹部手术后儿童骶管硬膜外阻滞中，将右美托咪定添加到罗哌卡因中的效果和副作用。
在这项随机、双盲临床试验中，46名3至6岁儿童被分为两组，在全身麻醉下进行下腹部手术后行骶管阻滞。R组（对照组）的注射溶液含有罗哌卡因（1 mL/kg 0.2%罗哌卡因），DR组含有右美托咪定（2 µg/kg）和0.2%罗哌卡因（1 mL/kg）。在两组中分别于1小时、2小时和6小时评估疼痛评分（改良CHEOPS评分）、镇痛持续时间、镇痛药物消耗量（静脉注射对乙酰氨基酚）、血流动力学变化及可能的不良反应。
两个研究组在1小时和2小时时的疼痛评分无显著差异（P>0.05）。然而，DR组在第6小时的疼痛评分显著更低，镇痛持续时间更长（P = 0.001）。DR组的镇痛药物消耗量也更低（P = 0.001）。然而，收缩压和心率无显著差异（P<0.05），舒张压有显著差异（P<0.05）（DR组低于R组）。研究组之间在手术持续时间、恢复时间和副作用方面无统计学显著差异（P<0.05）。
在本研究中，在下腹部手术后儿童骶管硬膜外阻滞中，将右美托咪定添加到罗哌卡因中可改善术后镇痛，且无显著不良反应。
