Effect Of Intranasal Dexmedetomidine On Duration Of Anaesthesia And Post Operative Analgesia In Paediatric Patients Undergoing Infraumbilical Surgeries Under Single Shot Caudal Epidural Anaesthesia- A One Year Hospital Based Double Blind Randomised Control Trial

Abstract

Background and Introduction Pain is a complex perceptual entity. Pain management is the cornerstone of entire medicine and especially so for anaesthesia. Pain management in Paediatric patients is often overlooked and misunderstood. Caudal Epidural Anaesthesia is a safe and effective mode of anaesthesia in paediatric patients. However, the duration of anaesthesia and the post operative analgesia provided by lone Caudal epidural is short but it can be prolonged using additives. The aim of this study was to overcome this relative shortcoming of caudal epidural with intranasal Dexmedetomidine. The present study titled “Effect of Intranasal Dexmedetomidine on duration of anaesthesia and post operative analgesia in paediatric patients undergoing infraumbilical surgeries under single shot caudal epidural anaesthesia – A one year hospital based Randomised Control Trial” attempted to study the effects of dexmedetomidine on duration of the caudal block and the ensuing post-operative analgesia in paediatric patients. Methods After obtaining Institutional Ethical Committee Clearance, we included 60 ASA I and II patients in our study and divided them into two groups randomly. One group received intranasal dexmedetomidine 1µg/kg body weight and the other group received Normal saline immediately after receiving Caudal bupivacaine 0.25% 1ml/kg body weight. Time of induction, intra operative hemodynamics, duration of caudal anaesthesia measured as duration of motor block and time till first rescue analgesic were noted. All the data was collated and tabulated using Microsoft Excel and Students unpaired t test was used for statistical analysis. Results The demographic parameters were comparable in both the groups. We found that the duration of motor block which was assessed using Modified Bromage Scale was significantly prolonged in the group receiving Dexmedetomidine (215.83±16.19 minutes) compared to the Group receiving Normal Saline(137±15.52 minutes). This resulted in a highly significant ‘p’ value of <0.0001. Duration of post operative analgesia was measured as the time between the caudal block and the requirement of first rescue analgesic given at a FLACC score of 4. In Group A, mean duration of analgesia was 12.47±2.16 hours and in Group B, it was 3.55±1.18 hours. The ‘p’ value for duration of analgesia was <0.0001, making the inference highly significant. Hemodynamic parameters were comparable. Conclusion Our study showed that intranasal administration of Dexmedetomidine significantly increased the duration of motor block in paediatric patients undergoing infra umbilical surgeries under caudal epidural anaesthesia. Our Study also showed that intranasal dexmedetomidine significantly prolonged the duration of post operative analgesia, thus achieving the primary objectives of the study.