Role of adding dexmedetomidine, ketamine, and magnesium sulphate to caudal block as preemptive analgesia in hypospadias repair in pediatrics: A randomized double-blinded prospective trial | ||||
| Egyptian Journal of Anaesthesia | ||||
| Volume 39, Issue 1, December 2023, Page 862-868 PDF (1.27 MB) | ||||
| DOI: TEJA-2023-0237 | ||||
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| Authors | ||||
| Basma M. Ghoniem; Gamal Hendawy Shams; Wafaa Abdelsalam; Sherif Medhat; Mahmoud Fawzy Elsharkawy | ||||
| Abstract | ||||
| Background The caudal block (CB) is a quick, and safe approach for pediatric analgesia. Numerous adjuvants were added to extend the analgesia duration. Our trial aims to evaluate the significance of CB by adding dexmedetomidine, ketamine, and MgSO₄ to bupivacaine to provide postoperative analgesia in children undergoing hypospadias repair. Methods This randomized double-blinded study was performed on 75 male children undergoing hypospadias repair under CB. Patients were randomized into three equal groups. All received 0.5 ml/kg bupivacaine 0.25% caudally plus 1 ml volume containing either dexmedetomidine 1 μg/kg in Group D, 0.5 mg/kg ketamine in Group K or 50 mg of MgSO₄ in Group M. Results Time of first rescue analgesia was significantly delayed in group D (8.2 ± 3.45 h) than in group K (5.8 ± 2.85 h) and group M (3.7 ± 1.51 h) ( value = 0.007 vs. <0.001) and in group K than in group M ( value = 0.027). Heart rate and mean arterial blood pressure measurements after block and 60 min intraoperative reduced significantly in group D than in K and Group M. At 6 h and 12 h, FLACC scores were considerably lower with Group D compared to Group K, and Group M, and ketamine group compared to Group M at 4 h. The total amount of pethidine consumed 24 hours postoperatively was significantly lower in Group D than in Group K and Group M. Conclusions Dexmedetomidine as an additive to the CB significantly prolonged time to first analgesia required and decreased total rescue opioid consumption compared to ketamine and MgSO₄. | ||||
| Keywords | ||||
| Dexmedetomidine; Ketamine; MgSO₄; Hypospadias repair; Preemptive analgesia | ||||
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