Dexmedetomidine as an adjunct to combined general and caudal anesthesia in children undergoing open reduction for congenital hip dislocation

ABSTRACT

We tested dexmedetomidine [DEX], and alpha 2 agonist for its ability to prolong the duration of analgesia after single shot caudal block, to provide stable haemodynamics and to optimize surgical field in pediatric patient undergoing open reduction for developmental dysplasia of the hip. In a randomized, placebo controlled study, 40 patients were randomly assigned to one of two equal groups. The Dex group received 0.5 micro g/kg/h dexmedetomidine and the control group received normal saline. Mean arterial pressure, heart rate, average category scale for quality of surgical field, intraoperative inspired sevoflurane concentartion and time to first rescue analgesia were measured. Relative to baseline and to the control group, mean arterial pressure and heart rate decreased significantly 15, 30, 45, 60, 75, 90, 105, 120, 135, 150, 180 minutes after start of dexmedetomidine infusion p<0.05. The average category scale for the quality of surgical field was significantly lower at 15, 30, 60, 90 and 120 minutes in the dexmedetomidine group compared to the control group p<0.05. The inspired sevoflurane concentration was significantly less in the dexmedelomidine group compared to the control group [1.46 +/- 0.7% Vs 2.07 +/- 0.18% respectively] p<0.05 and the time to the first rescue analgesia was significantly prolonged in the dexmedetomidine group compared to the control group [11.2 +/- 3.9h Vs 7.9 +/- 4.6h] respectively p<0.05. In conclusion, intraoperative dexmedetomidine infusion prolonded the duration of analgesia after single shot caudal ropivacaine, provided stable haemodynamics, better surgical field and decreased the intraoperative inspired sevoflurane concentration