Comparison of Caudal Block Versus Dexmedetomidine Infusion in Pediatric Patients Undergoing Hypospadias Repair Surgery
Status:
Recruiting
Trial end date:
2020-10-31
Target enrollment:
Participant gender:
Summary
Pain is one of the most misunderstood, underdiagnosed, and untreated medical problems,
particularly in children. New Joint Commission on Accreditation of Health Care Organization
regards pain as fifth vital sign and requires caregivers to regularly assess pain. Inadequate
pain relief during childhood may have long-term negative effects including harmful
neuroendocrine responses disrupted eating and sleep cycles and increased pain perception
during subsequent painful experiences. Also, postoperative pain can result in an
uncooperative and restless child. Hence, it is preferable to prevent the onset of pain rather
than to relieve its existence.
Various multimodal techniques have been designed for pediatric pain relief. These include
both systemic and regional analgesia. The most commonly used regional technique is caudal
epidural block. Advantages of the caudal block are smoother recovery with less distress
behavior, early ambulation, decreased the risk of chest infections, decreased postoperative
analgesic requirements, and early discharge.
In our culture; considerable number of parents still refuses caudal anesthesia fearing from
the rare neurological sequelae may occur. This the motive for searching for parenteral
surrogate gives clear headed recovery resembles regional analgesia.
Dexmedetomidine is an alpha 2 agonist which has sedative, analgesic, and opioid-sparing
effect. It prolongs the duration of analgesia by its local vasoconstrictive effect and by
increasing the potassium conductance in A-delta and C-fibers.
It also exerts its analgesic action centrally via systemic absorption or by diffusion into
the cerebrospinal fluid and reaches alpha 2 receptors in the superficial laminae of the
spinal cord and brainstem or indirectly activating spinal cholinergic neurons. The sedative
effects of dexmedetomidine are mostly due to stimulation of the alpha 2 adrenoceptor in the
locus coeruleus