Abstracts / Free Papers

Dexmedetomidine is not superior to adrenaline when used as an additive to lignocaine infiltration in children undergoing palatoplasty

Vinoth Natarajan

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 lignocaineadrenaline with lignocainedexmedetomidine 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.