Efficacy of dexmedetomidine versus magnesium sulfate as an adjuvant to intraperitoneal bupivacaine in pediatric laparoscopic surgery: a randomized clinical trial
Eficácia da dexmedetomidina versus sulfato de magnésio como adjuvante da bupivacaína intraperitoneal em cirurgia laparoscópica pediátrica: um ensaio clínico randomizado
Seham Mohamed Moeen, Ola Mahmoud Wahba, Ahmed Mohamed Mandour, Noha Abdel Ghany, Mohamed AbdelKader Osman, Tarek Abdelazeem Sabra, Mohammed Hamada Takrouney, Ahmed Mohamed Moeen
Abstract
Background
We evaluated the efficacy of dexmedetomidine versus magnesium sulfate as an adjuvant to intraperitoneal (IP) bupivacaine in pediatric laparoscopic inguinal herniorrhaphy.
Methods
Ninety-seven male children, ASA I–II, 1–6 years old, undergoing laparoscopic inguinal herniorrhaphy, were randomized to receive before peritoneal insufflation, IP 2 mg.kg−1 bupivacaine 0.5% combined with either 1 μg.kg−1 of dexmedetomidine (Group D), 30 mg.kg−1 of magnesium sulfate (Group M), or normal saline (Group C). All tested drugs were diluted to the volume of 10 mL with normal saline. FLACC pain scores, need for rescue analgesics, time to flatus and first stool, emetic events, adverse effects, functional recovery, and parents’ satisfaction were recorded for the first 48 h postoperatively.
Results
FLACC scores were significantly higher in Group C than in the other two groups at 6, 8, 12, 18, 24, and 48 hours after surgery with no differences between Groups D and M. Rescue analgesia was significantly higher in Group C with none of the children in Groups D and M requiring rescue analgesia (p = 0.001). Times to first flatus and stool, emetic events, and adverse effects did not differ among groups. Times to return to normal functional activity were comparable in all groups. Parents’ satisfaction was greater in Groups D and M than in Group C (p = 0.026).
Conclusion
Dexmedetomidine and magnesium sulfate added to IP bupivacaine improved the analgesia afforded by bupivacaine in the first two postoperative days in children scheduled for laparoscopic herniorrhaphy.
Keywords
Resumo
Introdução
Avaliamos a eficácia da dexmedetomidina versus sulfato de magnésio como adjuvante da bupivacaína intraperitoneal (IP) em herniorrafia inguinal laparoscópica pediátrica.
Métodos
Noventa e sete crianças do sexo masculino, estado físico I–II, 1–6 anos de idade, submetidas a herniorrafia inguinal laparoscópica, foram randomizadas para receber, antes da insuflação peritoneal, 2 mg.kg−1 IP de bupivacaína 0,5% combinada com 1 μg.kg−1 de dexmedetomidina (Grupo D), 30 mg.kg−1 de sulfato de magnésio (Grupo M) ou solução salina normal (Grupo C). Todos os medicamentos testados foram diluídos até o volume de 10 mL com solução salina normal. Os escores de dor FLACC, necessidade de analgésicos de resgate, tempo para flatulência e primeira evacuação, eventos eméticos, efeitos adversos, recuperação funcional e satisfação dos pais foram registrados nas primeiras 48 horas de pós-operatório.
Resultados
As pontuações FLACC foram significativamente maiores no Grupo C do que nos outros dois grupos às 6, 8, 12, 18, 24 e 48 horas após a cirurgia, sem diferenças entre os Grupos D e M. A analgesia de resgate foi significativamente maior no Grupo C sem que nenhuma das crianças dos Grupos D e M necessitaram de analgesia de resgate (p = 0,001). Os tempos até os primeiros flatos e fezes, eventos eméticos e efeitos adversos não diferiram entre os grupos. Os tempos para retornar à atividade funcional normal foram comparáveis em todos os grupos. A satisfação dos pais foi maior nos Grupos D e M do que no Grupo C (p = 0,026).
Conclusão
A adição de dexmedetomidina e sulfato de magnésio à bupivacaína IP melhorou a analgesia proporcionada pela bupivacaína nos primeiros dois dias de pós-operatório em crianças programadas para herniorrafia laparoscópica.
Palavras-chave
References
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Submitted date:
04/16/2021
Accepted date:
05/14/2022
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