A comparative study of analgesic effect of caudal bupivacaine with dexmedetomidine versus bupivacaine alone for infraumbilical surgeries in children in Windhoek Central Hospital
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Date
2025
Authors
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Publisher
University of Namibia
Abstract
Background: Paediatric pain is frequently underassessed and undertreated due to
challenges in pain expression among children, which can result in its under
recognition. Untreated pain can potentially lead to long-term consequences on
children's emotional and psychological welfare. The use of caudal blocks has evolved
to become the most common regional anaesthesia technique for providing
intraoperative and postoperative analgesia in children undergoing infraumbilical
surgeries. Existing literature has demonstrated that caudal administration with
bupivacaine alone typically has a short duration of action, and its analgesic effect can
be prolonged by incorporating adjuvants such as dexmedetomidine. The overall
objective of this study is to compare the difference in the duration of analgesic effect
between caudal bupivacaine alone and bupivacaine with dexmedetomidine by using
first time request of ibuprofen syrup based on the modified Hannallah pain score of ≥
4. Methodology: This was a prospective randomised double-blinded control study and
data were collected over a period of five months. The study included children
scheduled for elective infra-umbilical surgeries. A total of 50 children, aged 1 – 8 years
were recruited and divided into two groups (A and B) of 25 children each. Group A
received caudal block with 0.25% bupivacaine at a dose of 0.5 or 1 ml/kg. Group B
received 0.25% bupivacaine caudal bupivacaine at a dose of 0.5 or 1 ml/kg with
dexmedetomidine (1mcg/kg). Patients were monitored for 24 hours and data were
collected using a research questionnaire designed for the study. The data were analysed
using SPSS for Windows, version 26.0. (IBM Corporation, Armonk, NY, USA).
Results: For Group A patients, the mean time to first request for rescue ibuprofen was
471±230 minutes. In contrast, Group B patients had a mean of 1339±210 minutes.
These differences were statistically significant. Total consumption of ibuprofen syrup
was 298.00±150.665 milligrams in Group A and 53.20±82.952 milligrams in Group
B, the difference was statistically significant. No significant difference was observed
between the two groups in the incidence of pain scores, haemodynamic parameters
and side effects. Conclusion: The addition of dexmedetomidine significantly extended
the duration of analgesia provided by caudal bupivacaine in paediatric patients
undergoing infraumbilical surgeries without an increase in the incidence of
haemodynamic changes and side effects
Description
A thesis in partial fulfilment for the requirements for the Degree of Master of Medicine (Anesthesiology, Critical care and Pain management)
Keywords
Dexmedetomidine, Bupivacaine, Caudal blocks, Paediatric regional anaesthesia, Infraumbilical surgeries, Namibia, University of Namibia