Comparison of Dexmedetomidine and Fentanyl as an Adjuvant to Ropivacaine for Postoperative Epidural Analgesia in Pediatric Orthopedic Surgery
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Purpose: Opioids are commonly used as an epidural adjuvant to local anesthetics, but are associated with potentially serious side effects, such as respiratory depression. The aim of this study was to compare the efficacy and safety of dexmedetomidine with that of fentanyl as an adjuvant to epidural ropivacaine in pediatric orthopedic surgery. Materials and Methods: This study enrolled 60 children (3–12 years old) scheduled for orthopedic surgery of the lower extremitiesand lumbar epidural patient-controlled analgesia (PCA). Children received either dexmedetomidine (1 μg/kg) or fentanyl (1 μg/kg) along with 0.2% ropivacaine (0.2 mL/kg) via an epidural catheter at 30 minutes before the end of surgery. Postoperatively,the children were observed for ropivacaine consumption via epidural PCA, postoperative pain intensity, need for rescue analgesics, emergence agitation, and other adverse effects. Results: The mean dose of bolus epidural ropivacaine was significantly lower within the first 6 h after surgery in the dexmedetomidinegroup, compared with the fentanyl group (0.029±0.030 mg/kg/h vs. 0.053±0.039 mg/kg/h, p=0.012). The median pain score at postoperative 6 h was also lower in the dexmedetomidine group, compared to the fentanyl group [0 (0–1.0) vs. 1.0 (0–3.0), p=0.039]. However, there was no difference in the need for rescue analgesia throughout the study period between groups. Conclusion: The use of dexmedetomidine as an epidural adjuvant had a significantly greater analgesic and local anesthetic-sparing effect, compared to fentanyl, in the early postoperative period in children undergoing major orthopedic lower extremity surgery.
Abstract
Purpose: Opioids are commonly used as an epidural adjuvant to local anesthetics, but are associated with potentially serious side effects, such as respiratory depression. The aim of this study was to compare the efficacy and safety of dexmedetomidine with that of fentanyl as an adjuvant to epidural ropivacaine in pediatric orthopedic surgery. Materials and Methods: This study enrolled 60 children (3–12 years old) scheduled for orthopedic surgery of the lower extremitiesand lumbar epidural patient-controlled analgesia (PCA). Children received either dexmedetomidine (1 μg/kg) or fentanyl (1 μg/kg) along with 0.2% ropivacaine (0.2 mL/kg) via an epidural catheter at 30 minutes before the end of surgery. Postoperatively,the children were observed for ropivacaine consumption via epidural PCA, postoperative pain intensity, need for rescue analgesics, emergence agitation, and other adverse effects. Results: The mean dose of bolus epidural ropivacaine was significantly lower within the first 6 h after surgery in the dexmedetomidinegroup, compared with the fentanyl group (0.029±0.030 mg/kg/h vs. 0.053±0.039 mg/kg/h, p=0.012). The median pain score at postoperative 6 h was also lower in the dexmedetomidine group, compared to the fentanyl group [0 (0–1.0) vs. 1.0 (0–3.0), p=0.039]. However, there was no difference in the need for rescue analgesia throughout the study period between groups. Conclusion: The use of dexmedetomidine as an epidural adjuvant had a significantly greater analgesic and local anesthetic-sparing effect, compared to fentanyl, in the early postoperative period in children undergoing major orthopedic lower extremity surgery.
참고문헌 (27)
- Nowicki PD, "Perioperative pain control in pediatric patients undergoing orthopaedic surgery", J Am Acad Orthop Surg, 20, pp.755~765 (2012)
- Peters JW, "Does neonatal surgery lead to increased pain sensitivity in later childhood?", Pain, 114, pp.444~454 (2005)
- Nolan J, "Anaesthesia and pain management in cerebral palsy", Anaesthesia, 55, pp.32~41 (2000)
- Penner M, "Characteristics of pain in children and youth with cerebral palsy", Pediatrics, 132, pp.e407~e413 (2013)
- Nasr DA, "The efficacy of caudal dexmedetomidine on stress response and postoperative pain in pediatric cardiac surgery", Ann Card Anaesth, 16, pp.109~114 (2013)
- Tong Y, "Analgesic effect and adverse events of dexmedetomidine as additive for pediatric caudal anesthesia: a meta-analysis", Paediatr Anaesth, 24, pp.1224~1230 (2014)
- Mahmoud M, "Dexmedetomidine: review, update, and future considerations of paediatric perioperative and periprocedural applications and limitations", Br J Anaesth, 115, pp.171~182 (2015)
- Wu HH, "Does dexmedetomidine as a neuraxial adjuvant facilitate better anesthesia and analgesia? A systematic review and meta-analysis", PLoS One, 9, pp.e93114~ (2014)
- Zheng Chen, "Intranasally Administered Adjunctive Dexmedetomidine Reduces Perioperative Anesthetic Requirements in General Anesthesia", Yonsei Medical Journal, 57(4), pp.998~1005 (2016), 연세대학교의과대학[DOI]
- Mason KP, "Review article: dexmedetomidine in children:current knowledge and future applications", Anesth Analg, 113, pp.1129~1142 (2011)
- El-Hennawy AM, "Addition of clonidine or dexmedetomidine to bupivacaine prolongs caudal analgesia in children", Br J Anaesth, 103, pp.268~274 (2009)
- Bharti N, "A dose-response study of caudal dexmedetomidine with ropivacaine in pediatric day care patients undergoing lower abdominal and perineal surgeries: a randomized controlled trial", Paediatr Anaesth, 24, pp.1158~1163 (2014)
- Al-Zaben KR, "Comparison of caudal bupivacaine alone with bupivacaine plus two doses of dexmedetomidine for postoperative analgesia in pediatric patients undergoing infraumbilical surgery: a randomized controlled double-blinded study", Paediatr Anaesth, 25, pp.883~890 (2015)
- Malviya S, "The revised FLACC observational pain tool: improved reliability and validity for pain assessment in children with cognitive impairment", Paediatr Anaesth, 16, pp.258~265 (2006)
- Sikich N, "Development and psychometric evaluation of the pediatric anesthesia emergence delirium scale", Anesthesiology, 100, pp.1138~1145 (2004)
- Virtanen R, "Characterization of the selectivity, specificity and potency of medetomidine as an alpha 2-adrenoceptor agonist", Eur J Pharmacol, 150, pp.9~14 (1988)
- Yoshitomi T, "Dexmedetomidine enhances the local anesthetic action of lidocaine via an alpha-2A adrenoceptor", Anesth Analg, 107, pp.96~101 (2008)
- Yabuki A, "Locally injected dexmedetomidine induces vasoconstriction via peripheral α-2A adrenoceptor subtype in guinea pigs", Reg Anesth Pain Med, 39, pp.133~136 (2014)
- Duka I, "Role of the postsynaptic alpha(2)-adrenergic receptor subtypes in catecholamine-induced vasoconstriction", Gen Pharmacol, 34, pp.101~106 (2000)
- Degos V, "Neuroprotective effects of dexmedetomidine against glutamate agonist-induced neuronal cell death are related to increased astrocyte brain-derived neurotrophic factor expression", Anesthesiology, 118, pp.1123~1132 (2013)
- Liu L, "Inhibition by dexmedetomidine of the activation of spinal dorsal horn glias and the intracellular ERK signaling pathway induced by nerve injury", Brain Res, 1427, pp.1~9 (2012)
- Asano T, "Antinociception by epidural and systemic alpha(2)-adrenoceptor agonists and their binding affinity in rat spinal cord and brain", Anesth Analg, 90, pp.400~407 (2000)
- Voepel-Lewis T, "A comparison of the clinical utility of pain assessment tools for children with cognitive impairment", Anesth Analg, 106, pp.72~78 (2008)
- 최승호, "Comparison of Dexmedetomidine and Remifentanil on Airway Reflex and Hemodynamic Changes during Recovery after Craniotomy", Yonsei Medical Journal, 57(4), pp.980~986 (2016), 연세대학교의과대학[DOI]
- Løvstad RZ, "Postoperative epidural analgesia in children after major orthopaedic surgery. A randomised study of the effect on PONV of two anaesthetic techniques: low and high dose i.v. fentanyl and epidural infusions with and without fentanyl", Acta Anaesthesiol Scand, 45, pp.482~488 (2001)
- Chalkiadis GA, "Comparison of lumbar epidural bupivacaine with fentanyl or clonidine for postoperative analgesia in children with cerebral palsy after single-event multilevel surgery", Dev Med Child Neurol, 58, pp.402~408 (2016)
- Voepel-Lewis T, "The reliability and validity of the Face, Legs, Activity, Cry, Consolability observational tool as a measure of pain in children with cognitive impairment", Anesth Analg, 95, pp.1224~1229 (2002)