Efficacy of dexmedetomidine versus magnesium sulfate as an adjuvant to intraperitoneal bupivacaine in pediatric laparoscopic surgery: a randomized clinical trial

Seham Mohamed Moeen; Ola Mahmoud Wahba; Ahmed Mohamed Mandour; Noha Abdel Ghany; Mohamed AbdelKader Osman; Tarek Abdelazeem Sabra; Mohammed Hamada Takrouney; Ahmed Mohamed Moeen

doi:10.1016/j.bjane.2022.05.003

Efficacy of dexmedetomidine versus magnesium sulfate as an adjuvant to intraperitoneal bupivacaine in pediatric laparoscopic surgery: a randomized clinical trial

Braz J Anesthesiol. 2022 May 23:S0104-0014(22)00067-7. doi: 10.1016/j.bjane.2022.05.003. Online ahead of print.

Authors

Seham Mohamed Moeen¹, Ola Mahmoud Wahba², Ahmed Mohamed Mandour², Noha Abdel Ghany², Mohamed AbdelKader Osman³, Tarek Abdelazeem Sabra³, Mohammed Hamada Takrouney³, Ahmed Mohamed Moeen⁴

Affiliations

¹ Assiut University, Faculty of Medicine, Department of Anesthesia, Intensive Care, and Pain Management, Assiut, Egypt. Electronic address: seham.moeen@aun.edu.eg.
² Assiut University, Faculty of Medicine, Department of Anesthesia, Intensive Care, and Pain Management, Assiut, Egypt.
³ Assiut University, Faculty of Medicine, General Surgery Pediatric Division, Assiut, Egypt.
⁴ Assiut University, Faculty of Medicine, Assiut Urology and Nephrology Hospital, Assiut, Egypt.

PMID: 35618084
DOI: 10.1016/j.bjane.2022.05.003

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: Dexmedetomidine; Intraperitoneal analgesia; Laparoscopic surgery; Magnesium sulfate; Pediatric.