Dexmedetomidine sedation in awake caudal block for lower abdominal surgeries in neonates

Abstract

The aim of this study is to effect of Dexmedetomidine sedation in awake caudal block for lower abdominal surgeries in neonates. Materials and Methods: This was a clinical trial study and the target population included term and preterm neonates, required awake caudal block for lower abdominal surgeries at the Tabriz Children's Educational and Medical Center in 2018-19. After obtaining informed consent from the parents of all patients and the approval of the Ethics Committee of Tabriz University of Medical Sciences, 100 neonates with ASA class 1 to 2 of the surgical candidate who were divided into two groups of 50 entered the study. The neonates were randomly divided into two groups, Normal saline (N) and Dexmedetomidine (D) and then, pre-meditation was performed in group N with 1µg/kg of Normal saline and in group D with 1µg/kg of Dexmedetomidine. 3 minutes after administration of the drug, neonates in the lateral position with a 22G needle and 0.2% bupivacaine (0.1 mg / kg) plus epinephrine 1-2 micrograms was under Codal block by an experienced anesthesiologist. 15 minutes after the block was tested the level and the quality of anesthesia in neonates using Pin prick and, if appropriate anesthesia, surgery began. Attempts to caudal block in each group were recorded. The number of attempts and time required for successful Caudal block was recorded in each group. In both groups, the patient's vital signs, including HR, SBP, DBP, MAP, SPO2 and sedation score were recorded from the beginning of the study to 15th minute of recovery. Results: In this study, the mean age (standard deviation) of the two groups of Dexmedetomidine and Normal saline was 19.10 (±10.3) and 14.80 (±12.6) days, respectively. Of all the variables related to the frequency and time required for successful intubation and side effects, non of the variables such as: number of Caudal block attempts, the length of stay in recovery, the apnea episode, the duration of apnea, the use of atropine during surgery and the analgesic drug during surgery did not show statistically difference in the two groups of neonates studied (P-value> 0.05). Regarding the results of HR, SBP, DBP, MAP, blood oxygen saturation levels and sedation score from the beginning of the study to the 15th minute of recovery, except for heart rate values in the 5-minute period (P-value = 0.048) After Caudal block, 5 minutes (P-value = 0.026), 10 minutes (P-value = 0.011), 15 minutes (P-value = 0.027) recovery and 5 minutes (P-value = 0.033) surgery, which was higher in the Normal saline group than in the Dexmedetomidine group, the difference in the values of these factors between the two groups of Dexmedetomidine and Normal saline was is insignificant at all time intervals (P-value> 0.05).