الفهرس 
AcknowledgementsOnly 14 pages are availabe for public view
 |  | from | 167 |  |  |
| | | from | 167 | | |
Abstract
Caudal epidural anesthesia is a common technique providing intra and postoperative analgesia in pediatric infra umbilical surgical procedures (Bailey B and Trottier E, 2016). Prolongation of caudal analgesia using a “single-shot” technique has been achieved by the addition of various adjuvant such as opioids, ketamine, clonidine (Kalappa S et al, 2016).
The use of adjuvants, such as opioids, such as fentanyl and morphine, which have traditionally been used as adjuvants to epidural local anesthetics, are associated with side effects of pruritus, urinary retention, nausea and vomiting, and respiratory depression.(Swain A et al, 2017)
There is an increasing interest to study magnesium and dexmedetomidine analgesic effects. Many studies suggested that epidurally administered magnesium as an adjuvant to local anesthetics could reduce the postoperative pain in adults. But few studies are available about its use as an adjuvant in caudal block for such purpose.(Yousef G.T et al, 2014)
Dexmedetomidine, which is a highly selective α-2 adrenergic agonist with sedative and analgesic properties, has recently been used as an adjuvant to general and regional anesthesia in both adults and children.( Tong Y et al, 2014)( Mahmoud M and Mason K.P, 2015)( Wu HH et al, 2014)( Wu X et al, 2016) As of yet, dexmedetomidine has not been approved for use in the pediatric population in any country.(Mason KP and Lerman J, 2011)
Aim of the work:
We designed this study to compare the safety and duration of postoperative pain relief using caudal Magnesium Sulfate and Dexmedetomidine as adjuvants with Bupivacaine 0.25% in pediatric patients undergoing infra-umbilical surgeries.
Patients and methods:
After approval of ethics research committee,a written consent was taken from the parents of all patients who were candidate for the scientific research. All patients were allowed to refuse or withdraw from the research at any time without any effect on medical service production.
This randomized controlled prospective study was done at Sohag University Hospital on sixty pediatric patients with (ASA) Classes I or II or III, weighted up to 20 kg scheduled for infra-umbilical surgeries using caudal block in the period between January 2019 and January 2020.
Study groups:
Patients were divided into 3 groups, twenty patients in each group:
group C (Control group): patients received caudal injection of a mixture of Bupivacaine (0.25%) + (0.9%) normal saline with a total volume of (1mg/kg).
group D (Dexmedetomidine group): patients received caudal injection of a mixture of Bupivacaine (0.25%) + Dexmedetomidine (1μg/kg) with a total volume of (1mg/kg).
group M (Magnesium group): patients received caudal injection of a mixture of Bupivacaine( 0.25%) + Magnesium Sulfate (50 mg) with a total volume of (1mg/kg).
Follow up and data collection:
• Monitoring of the heart rate, mean blood pressure, respiratory rate and oxygen saturation every 5 minutes till 30 minutes then every 15 minutes during the intraoperative period and 30 minutes, 1, 2, 3, 6, 12, 24 hours postoperative.
• Onset and duration of caudal block (time for first analgesic inquiry).
• Time and scoring of discharge from recovery room using Modified Aldrete score.
• Postoperative delirium using PAED score every 15 minutes till 1 hour postoperative.
• Postoperative intensity of pain using FLACC score for 30 minutes, 1 ,2 ,3 , 6, 12, 24 hours.
• Incidence of complications.
Statistical analysis:
Statistical analysis was carried out for numerical data using mean, SD, and minimum and maximum of the range, where as for categorical data number and percentage used. Analyses performed for quantitative variables using the one-way ANOVA test for parametric data between the two groups and using post-hoc analysis for two groups . Paired sample t-test used for parametric data between two variables in each group . The χ2-test used for qualitative data between groups. The level of significance at P value less than 0.05.
Results:
• Our study showed that onset of the caudal block was faster in (group D) than (group M) and (group C), also was faster in (group M) than (group C), but the difference wasn’t statistically significant.
• Also, duration of the caudal block was highly significant longer duration of the caudal block in (group D) and (group M) compared to (group C).On comparing the duration between (group M) and (group D), it was longer duration with (group D) than (group M), but with no significant difference .
• In our study, there was no significant difference in heart rate measurements on adding Dexmedetomidine or magnesium, but it was significantly lower in patients received Dexmedetomidine.
• Our study showed that there was control of agitation postoperative with patients received Dexmedetomidine or Magnesium.
• Also, there was significant difference between control group and the two study groups showing lower sedation score postoperatively in these two groups (D) and (M), respectively.
• Furthermore, adding two study adjuvants to Bupivacaine markedly lower the FLACC score, postoperatively. Pain score was significantly lower in (group D) and (group M) than (group C) till 12 hours postoperatively.
Conclusion
Administration of Dexmedetomidine as adjuvant with Bupivacaine enhances caudal block, prolongs duration of postoperative analgesia, reduces postoperative EA and provides preferred postoperative sedation in pediatric patient undergoing infraumbilical surgeries with minimum adverse effects compared to Magnesium Sulfate as adjuvant.