Efficacy of dexmedetomidine versus magnesium sulfate as an adjuvant to intraperitoneal bupivacaine in pediatric laparoscopic surgery: a randomized clinical trial
Seham Mohamed Moeen, Ola Mahmoud Wahba, Ahmed Mohamed Mandour, Noha Abdel Ghany, Mohamed AbdelKader Osman, Tarek Abdelazeem Sabra, Mohammed Hamada Takrouney, Ahmed Mohamed Moeen
Abstract
Background
We evaluated the efficacy of dexmedetomidine versus magnesium sulfate as an adjuvant to intraperitoneal (IP) bupivacaine in pediatric laparoscopic inguinal herniorrhaphy.
Methods
Ninety-seven male children, ASA I–II, 1–6 years old, undergoing laparoscopic inguinal herniorrhaphy, were randomized to receive before peritoneal insufflation, IP 2 mg.kg−1 bupivacaine 0.5% combined with either 1 μg.kg−1 of dexmedetomidine (Group D), 30 mg.kg−1 of magnesium sulfate (Group M), or normal saline (Group C). All tested drugs were diluted to the volume of 10 mL with normal saline. FLACC pain scores, need for rescue analgesics, time to flatus and first stool, emetic events, adverse effects, functional recovery, and parents’ satisfaction were recorded for the first 48 h postoperatively.
Results
FLACC scores were significantly higher in Group C than in the other two groups at 6, 8, 12, 18, 24, and 48 hours after surgery with no differences between Groups D and M. Rescue analgesia was significantly higher in Group C with none of the children in Groups D and M requiring rescue analgesia (p = 0.001). Times to first flatus and stool, emetic events, and adverse effects did not differ among groups. Times to return to normal functional activity were comparable in all groups. Parents’ satisfaction was greater in Groups D and M than in Group C (p = 0.026).
Conclusion
Dexmedetomidine and magnesium sulfate added to IP bupivacaine improved the analgesia afforded by bupivacaine in the first two postoperative days in children scheduled for laparoscopic herniorrhaphy.
Keywords
References
1 R Gupta, S Singh Challenges in paediatric laparoscopic surgeries Indian JAnaesth, 53 (2009), pp. 560-566
2 M Pretorius, GE Rasmussen, GW Holcomb Hemodynamic and catecholamine responses to a laparoscopic adrenalectomy for pheochromocytoma in a pediatric patient Anesth Analg, 87 (1998), pp. 1268-1270
3 S El Basha, MG Hanna, SM Soaida, HH Refaee Intraperitoneal instillation of l-bupivacaine in laparoscopic pediatric procedures: a randomized-controlled study Ain-Shams J Anaesthesiol, 8 (2015), pp. 247-251
4 A Ahmed Laparoscopic surgery in children-anaesthetic considerations J Pak Med Assoc, 56 (2006), pp. 5-9
5 RA Raof, SA El Metainy, DA Alia, MA Wahab Dexmedetomidine decreases the required amount of bupivacaine for ultrasound-guided transversus abdominis plane block in pediatrics patients: a randomized study J Clin Anesth, 37 (2017), pp. 55-60
6 AM Elnabtity, M Ibrahim Intraperitoneal dexmedetomidine as an adjuvant to bupivacaine for postoperative pain management in children undergoing laparoscopic appendectomy: A prospective randomized trial Saudi J Anaesth, 12 (2018), pp. 399-405
7 RM Ali, AH Rabie, NA Elshalakany, TM El Gindy Effect of intraperitoneal magnesium sulfate on hemodynamic changes and its analgesic and antiemetic effect in laparoscopic cholecystectomy Ain-Shams J Anaesthesiol, 8 (2015), pp. 153-159
8 MH Willis, SI Merkel, T Voepel-Lewis FLACC Behavioral Pain Assessment Scale: a comparison with the child's self-report Pediatr Nurs, 29 (2003), pp. 195-198
9 X Tian, P Yang, T Su, et al. Intraperitoneal ropivacaine and early postoperative pain and postsurgical outcomes after laparoscopic herniorrhaphy in toddlers: a randomized clinical trial Paediatr Anaesth, 26 (2016), pp. 891-898
10 EM Kim, MS Kim, SJ Han, et al. Magnesium as an adjuvant for caudal analgesia in children Paediatr Anaesth, 24 (2014), pp. 1231-1238
11 DA Freilich, CS Houck, PM Meier, CC Passerotti, AB Retik, HT Nguyen The effectiveness of aerosolized intraperitoneal bupivacaine in reducing postoperative pain in children undergoing robotic‑assisted laparoscopic pyeloplasty J Pediatr Urol, 4 (2008), pp. 337-340
12 VC Zanetta, P Meier-Haran, CS Houck The use of intraperitoneal nebulization of bupivacaine reduces the need for postoperative opioids in young children undergoing robotic-assisted laparoscopic reconstructive surgery J Urol, 187 (2012), p. e298
13 B Ahmed, AE Ashraf, R Doaa Antinociceptive effect of adrenoceptor agonist dexmedetomidine vs meperidine, topically, after laparoscpic gynecologic surgery J Med Sci, 8 (2008), pp. 400-404
14 KM Fares, SA Mohamed, AM Abd El-Rahman, AA Mohamed, AT Amin Efficacy and safety of intraperitoneal dexmedetomidine with bupivacaine in laparoscopic colorectal cancer surgery, a randomized trial Pain Med, 16 (2015), pp. 1186-1194
15 Y-J She, Z-Y Zhang, X-R Song Caudal dexmedetomidine decreases the required concentration of levobupivacaine for caudal block in paediatric patients: a randomized trial Paediatr Anesth, 23 (2013), pp. 1205-1212
16 O Mentes, A Harlak, T Yigit, et al. Effect of intraoperative magnesium sulphate infusion on pain relief after laparoscopic cholecystectomy Acta Anaesthesiol Scand, 52 (2008), pp. 1353-1359
17 IM Saadawy, AM Kaki, AA Abd El Latif, AM Abd-Elmaksoud, OM Tolba Lidocaine vs. magnesium: effect on analgesia after a laparoscopic cholecystectomy Acta Anaesthesiol Scand, 54 (2010), pp. 549-556
18 S Kesavan Approapriate timing of administration of magnesium sulphate during spinal anesthesia to enhance postoperative analgesia Br J Anaesth, 104 (2010), pp. 89-93
19 SK Maharjan, S Shrestha Intraperitoneal magnesium sulphate plus bupivacaine for pain relief after laparoscopic cholecystectomy J Kathmandu Med Coll, 1 (2012), pp. 21-25
20 JH Ryu, MH Kang, KS Park, SH Do Effects of magnesium sulphate on intraoperative anesthetic requirements and postoperative analgesia in gynecology patients receiving total intravenous anesthesia Br J Anaesth, 1 (00) (2007), pp. 397-403
21 D Jee, D Lee, S Yun, C Lee Magnesium sulphate attenuates arterial pressure increase during laparoscopic cholecystectomy Br J Anaesth, 103 (2009), pp. 484-489
22 A Pasqualucci, V de Angelis, R Contardo, et al. Preemptive analgesia: Intraperitoneal local anesthetic in laparoscopic cholecystectomy. A randomized, double-blind, placebo-controlled study Anesthesiology, 85 (1996), pp. 11-20
23 AP Boddy, S Mehta, M Rhodes The effect of intraperitoneal local anesthesia in laparoscopic cholecystectomy: a systematic review and meta-analysis Anesth Analg, 103 (2006), pp. 682-688
24 SS Liu, CL Wu Effect of postoperative analgesia on major postoperative complications: a systematic update of the evidence Anesth Analg, 104 (2007), pp. 689-702
25 CD Gause, MG Casamassima, J Yang, G Hsiung, D Rhee Laparoscopic versus open inguinal hernia repair in children ≤ 3: a randomized controlled trial Pediatr Surg Int, 33 (2017), pp. 367-376
Facebook
Google+
Twitter
LinkedIn
Mendeley
StumbleUpon
CiteULike
Reddit
Email