Key result
Dexamethasone as an adjuvant to bupivacaine significantly increased the time to first request for analgesia compared to bupivacaine alone or with dexmedetomidine in 45 children.
Why the study?
Does dexamethasone or dexmedetomidine as an adjuvant to bupivacaine improve postoperative analgesia and hemodynamics in children undergoing subumbilical surgery?
RCT (n=45)
Double-blind
Randomized
No
Does dexamethasone or dexmedetomidine as an adjuvant to bupivacaine improve postoperative analgesia and hemodynamics in children undergoing subumbilical surgery?
Dexamethasone is superior to dexmedetomidine as an adjuvant to bupivacaine in prolonging the time to first analgesic request in pediatric subumbilical surgery.
Dexamethasone should be preferred over dexmedetomidine as bupivacaine adjuvant for longer postoperative analgesia in children; extends evidence for regional anesthesia adjuncts in pediatrics.
Aim: The purpose of this research was to compare the effectiveness and safety of dexmedetomidine against dexamethasone as an adjuvant to bupivacaine in paediatric patients having elective subumbilical surgery under general anaesthesia. Patients and methods: This randomised controlled trial included 45 children aged 2 to 12 years who underwent subumbilical surgery. The study was done at Beni-Suef University Hospital's department of anesthesiology, surgical intensive care, and pain management following ethical approval by the faculty of medicine's research ethics committee. Results: The three groups (Dexamethasone with Bupivacaine versus Dexmedetomidine with Bupivacaine versus Bupivacaine only) were matched regarding their baseline characteristics. The study revealed that there was no statistically significant difference between studied groups regarding heart rate and mean arterial blood pressure (MAP) but, there was statistically significant increase MAP 30 min in Bupivacaine only in comparison to Bupivacaine and dexamethasone and Bupivacaine and dexmedetomidine. There was no statistically significant difference between studied groups regarding fentanyl requirements, sevoflurane MAC and adverse events. There was statistically significant increase post operative heart rate (PO HR) 6 h in Bupivacaine and dexamethasone, increase PO HR 12 h and PO HR 24 h in Bupivacaine only. There was statistically significant increase post operative mean arterial blood pressure (PO MAP) in Bupivacaine only in comparison to Bupivacaine and dexamethasone and Bupivacaine and dexmedetomidine in addition to increased time of first request analgesia (hours) in Bupivacaine and dexamethasone in comparison to Bupivacaine only and Bupivacaine and dexmedetomidine.
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Khalil et al. (2023) conducted an RCT in Elective subumbilical surgery (n=45). Dexamethasone or Dexmedetomidine as an adjuvant to Bupivacaine vs. Bupivacaine only was evaluated on Effectiveness and safety (including hemodynamics and time to first request analgesia). Dexamethasone as an adjuvant to bupivacaine significantly increased the time to first request for analgesia compared to bupivacaine alone or with dexmedetomidine in 45 children.
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