Abstract
Background
Laparoscopic surgeries are associated with less postoperative pain and adverse events compared to open procedures. But, it still reduces quality of life in children. Transversus abdominis plane (TAP) block is used to reduce pain. We hypothesized that dexmedetomidine or clonidine could improve the analgesic profile of levobupivacaine to the same extent during TAP block in children.
Methods
Ninety children were randomly allocated in a randomized double‐blind trial to receive bilateral TAP block with levobupivacaine plus normal saline (Group‐B, n=30), or dexmedetomidine (Group‐D, n=30), or clonidine (Group‐C, n=30). Primary outcome was the modified CHEOPS score. Secondary outcomes included time to initial analgesic request, number of analgesic claims, total analgesic consumption, parents' satisfaction, sedation score, and complications.
Results
Children of group‐D showed reduced pain scores compared to other groups. They represented the longest period of analgesia (565.00 ± 71.5 minutes) with p‐value < 0.001, and fewer patients required two doses of analgesia during the first postoperative day. The cumulative amount of backup analgesia was significantly different between these groups (p‐value = 0.026). Higher parents’ satisfaction scores were recorded in groups D and C compared to group‐B. Sedation among the study groups revealed significant differences (p‐value = 0.035), but no severe complications were recorded.
Conclusions
Adding dexmedetomidine to levobupivacaine can extend the time of analgesia, reduce the use of postoperative backup analgesics with minimal sedation effects when used in TAP block in pediatrics undergoing laparoscopic orchiopexy. Clonidine can be used as an alternative adjuvant to local anesthetics with good postoperative analgesic profiles.
from Wiley: European Journal of Pain: Table of Contents https://ift.tt/3efESBF
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