Yonsei Med J.  2017 May;58(3):650-657. 10.3349/ymj.2017.58.3.650.

Comparison of Dexmedetomidine and Fentanyl as an Adjuvant to Ropivacaine for Postoperative Epidural Analgesia in Pediatric Orthopedic Surgery

• Park SJ
• Shin S
• Kim SH
• Kim HW
• Kim SH
• Do HY
• Choi YS

• KMID: 2419126
• DOI: http://doi.org/10.3349/ymj.2017.58.3.650

Abstract

PURPOSE
Opioids are commonly used as an epidural adjuvant to local anesthetics, but are associated with potentially serious side effects, such as respiratory depression. The aim of this study was to compare the efficacy and safety of dexmedetomidine with that of fentanyl as an adjuvant to epidural ropivacaine in pediatric orthopedic surgery.
MATERIALS AND METHODS
This study enrolled 60 children (3-12 years old) scheduled for orthopedic surgery of the lower extremities and lumbar epidural patient-controlled analgesia (PCA). Children received either dexmedetomidine (1 µg/kg) or fentanyl (1 µg/kg) along with 0.2% ropivacaine (0.2 mL/kg) via an epidural catheter at 30 minutes before the end of surgery. Postoperatively, the children were observed for ropivacaine consumption via epidural PCA, postoperative pain intensity, need for rescue analgesics, emergence agitation, and other adverse effects.
RESULTS
The mean dose of bolus epidural ropivacaine was significantly lower within the first 6 h after surgery in the dexmedetomidine group, compared with the fentanyl group (0.029±0.030 mg/kg/h vs. 0.053±0.039 mg/kg/h, p=0.012). The median pain score at postoperative 6 h was also lower in the dexmedetomidine group, compared to the fentanyl group [0 (0-1.0) vs. 1.0 (0-3.0), p=0.039]. However, there was no difference in the need for rescue analgesia throughout the study period between groups.
CONCLUSION
The use of dexmedetomidine as an epidural adjuvant had a significantly greater analgesic and local anesthetic-sparing effect, compared to fentanyl, in the early postoperative period in children undergoing major orthopedic lower extremity surgery.

Keyword

Dexmedetomidine; epidural analgesia; fentanyl

MeSH Terms

Amides/*administration & dosage
Analgesia, Epidural/*methods
Analgesia, Patient-Controlled/*methods
Analgesics/therapeutic use
Analgesics, Opioid/administration & dosage
Anesthesia, Epidural
Anesthetics, Local/*administration & dosage
Child
Child, Preschool
Dexmedetomidine/*administration & dosage/therapeutic use
Double-Blind Method
Female
Fentanyl/*administration & dosage/therapeutic use
Humans
Injections, Epidural
Leg/*surgery
Male
*Orthopedic Procedures
Pain, Postoperative/*drug therapy
Postoperative Period
Treatment Outcome
Amides
Analgesics
Analgesics, Opioid
Anesthetics, Local
Dexmedetomidine
Fentanyl

Figure

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  Fig. 1 CONSORT flow diagram.

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  Fig. 2 Hemodynamic changes after administration of the study drug. Baseline: before administration of the study drug, group F: fentanyl group, group D: dexmedetomidine group.

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