Efficacy of dexmedetomidine as an adjuvant to Quadratus lumborum block for pediatrics undergoing laparoscopic pyeloplasty. A prospective randomized double blinded study.

BACKGROUND: We designed this study to evaluate dexmedetomidine as an adjuvant to local anesthetics in Quadratus lumborum block (QLB) in pediatrics either interfascial versus intravenous on the quality of postoperative analgesia and incidence of side effects. METHODS: Fifty pediatric patients ASA I and II, from eight to thirteen years old posted for laparoscopic pyeloplasty were randomized either to: QLB dexmedetomidine intravenous (QD IV) group or QLB dexmedetomidine interfascial (QD IF) group. A 24-h postoperative morphine consumption (primary outcome), time to first analgesic request, postoperative pain and sedation scores were compared. The recovery time after anesthesia and the incidences of intraoperative and postoperative hypotension or bradycardia were recorded. RESULTS: The median [IQR] 24 h postoperative morphine consumption in QD IF group [0.05 (0.05-0.10) mg/kg] was lower compared with QD IV group [0.15 (0.10-0.20) mg/kg] (P<0.001). Longer time to first analgesic request was noted in QD IF group [505 (395-583) min] in comparison to QD IV group [306 (258-388) min] (P<0.001). Pain scores were lower in QD IF group at six and eight hours postoperatively. Sedation scores were lower in QD IF group on admission to PACU and two hours postoperatively. Intraoperative hypotension and bradycardia were lower in QD IF group. Longer recovery time in QD IV group. CONCLUSIONS: Interfascial dexmedetomidine adjuvant to QLB provided better postoperative analgesia in terms of less morphine consumption, better pain scores and longer time to first analgesic request when compared with the IV dexmedetomidine.

Does anaesthesia in mothers during delivery affect bilirubin levels in their neonates?

PURPOSE: This study aimed to assess whether different anesthetic techniques and oxytocin use applied during delivery affect transcutaneous bilirubin levels during the first 24 hours in neonates. METHODS: A total of 1,044 neonates delivered by either caesarian section (C/S) or normal vaginal delivery (NVD) were included in the study. They were classified into 5 groups as follows: group 1: born by C/S using general anesthesia, group 2: C/S using spinal anaesthesia, group 3: C/S using general anesthesia after failed spinal block, group 4: by NVD without anesthesia, and group 5: oxytocin-induced vaginal delivery without anesthesia. Transcutaneous total bilirubin levels (TBLs) were measured during the first 24 hours and on the fifth and eighth days of life and the levels in different groups were compared. RESULTS: The TBLs were significantly higher in neonates delivered by C/S using general anesthesia rather than spinal anesthesia (P<0.001), and both groups had higher levels than those born by NVD without anesthesia (P≤0.001). However, the group receiving general anesthesia after failed spinal block was found to have the highest bilirubin level. Moreover, TBLs were significantly higher with the use of oxytocin (P≤0.001). CONCLUSIONS: C/S and general anesthesia adversely affect the bilirubin levels in neonates, and the use of oxytocin during vaginal delivery also increases TBLs in neonates.