Comparison of Effectiveness of Caudal Dexmedetomidine vs. Caudal Fentanyl with Bupivacaine during Pediatric Cardiac Surgery with regards to Hemodynamic Fluctuations and Postoperative Pain.

Abstract

Background: Optimum analgesia, reflecting into attenuation of stress response, is pertinent in pediatric cardiac surgery. Narcotics are still the mainstay in providing analgesia, and they are a common adjunct in caudal epidural analgesia. Unwanted effects of narcotics warrant a constant search for nonopioid analgesics.

Objective: To compare dexmedetomidine vs. fentanyl as an adjuvant in caudal anesthesia in pediatric cardiac surgery.

Materials and methods: Sixty patients, 1 to 8 years of age, with acyanotic congenital heart disease were divided into two groups randomly: group A received caudal dexmedetomidine 0.5 µg/kg with 2 mg/kg bupivacaine diluted to 1.6 ml/kg with normal saline. Group B received caudal fentanyl 1 µg/kg with 2 mg/kg bupivacaine diluted to 1.6 ml/kg with normal saline.

Results: Stress response assessed by surge in heart rate and blood pressure after induction was significantly lower in group A (Dexmedetomidine group). The mean time to successful discontinuation of mechanical ventilation was significantly lower in the dexmedetomidine group (1.2 ± 0.4 vs. 1.73 ± 0.58 h). Children in the dexmedetomidine group had lower FLACC pain scores at 4 hours postextubation (2.93 ± 1.04 vs. 3.83 ± 0.83), implying better pain control. The time to need for rescue analgesia was longer in the dexmedetomidine group (6.1 ± 1.21 vs. 3.96 ± 0.96 h).

Conclusion: Caudal dexmedetomidine gave better control of hemodynamic parameters when compared with fentanyl and was associated with earlier extubation postoperatively. It also has superior and prolonged analgesia compared to caudal fentanyl as an adjunct.