Abstracts / Free Papers
Dexmedetomidine is not superior to adrenaline when used as an additive to lignocaine infiltration in children undergoing palatoplasty
JIPMER,Pondicherry
N Vinoth, Sandhya Yaddanapudi, Neerja Bhardwaj, RK Sharma.
Departments of Anaesthesia and Intensive Care, and Plastic Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh
Background: Surgical site infiltration with dexmedetomidine provides analgesia after dental and inguinal hernia surgery. Its local vasoconstrictive effect may also decrease the surgical bleeding. We compared lignocaineadrenaline with lignocainedexmedetomidine with respect to postoperative pain scores and surgical bleeding.
Methods: After institutional ethics committee approval and written informed parental consent, 30 ASA I-II children of 1-6 years, undergoing palatoplasty were enrolled in a prospective randomized double-blind study. A standardized technique of general anaesthesia was used. The surgical site was infiltrated with 1 ml/kg solution containing lignocaine (5 mg/kg) and either dexmedetomidine (1 μg/kg) or adrenaline (1.25 μg/kg). Surgical bleeding was graded by the blinded surgeon using Cohen’s surgical view grading scale (CSVG). Postoperative pain was assessed by a blinded investigator using FLACC scale for 24 hours. Fentanyl 0.5-1 μg/kg was given as rescue analgesia for FLACC score >4. Sedation was assessed by Modified Ramsay Hunt sedation score. Parental satisfaction was graded 24 hours after surgery.
Results: The incidence of intraoperative haemodynamic abnormalities was similar in both groups. The number of children with FLACC score >4 (8 in each) and the CSVG scores were statistically similar in both groups (2 test). Sedation and parental satisfaction scores were also similar in the two groups.
Discussion: 2-agonists prolong the duration of action of local anaesthetics by blocking the hyperpolarization-activated cation current. Dexmedetomidine also has anti-inflammatory effects. However it did not prolong the analgesia in the dosage used in this study.
Conclusions: Addition of dexmedetomidine to lignocaine for surgical site infiltration during cleft palate surgery is not superior to adrenaline.