Comparison of Postoperative Analgesic Effect of Dexamethasone with Bupivacaine versus Tramadol with Bupivacaine in Caudal Anesthesia for Children Undergoing Lower Abdominal Surgeries at Tikur Anbesa Specialized Hospital Addis Ababa, Ethiopia 2022/2023. a prospective cohort study design
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Date
2023-10-16
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Addis Ababa University
Abstract
Pain is a stressful condition that is regarded as a global health issue, with children being the most vulnerable and underserved population. one of the most commonly used regional anesthesia techniques in children is Caudal analgesia despite its limitations.Many adjuvants are used to increase the effectiveness of this block. Currently, tramadol and dexamethasone are commonly used caudal adjuvants that increased the effectiveness postoperative analgesia.
Objectives: To compare the postoperative analgesic effect of tramadol with bupivacaine and dexamethasone with bupivacaine for caudal analgesia in elective pediatrics patients undergoing lower abdominal surgery at Tikur Anbessa specialized hospital in Addis Ababa Ethiopia.
Material and methods: from February 1 to April 30, 2023 an institutional-based prospective cohort study design was employed at Tikur Anbessa Specialized Hospital, Addis Ababa Ethiopia. Comparison of two mean with equal sample size formula for two indepndent cohort studies was used to get a sample size of 64 children age 1-8 years underwent elective lower abdominal surgery. Intraoperative information was gathered by trained anesthetists, whereas postoperative data were gathered by trained nurses. The data were analyzed by independent t-test, Mann-Whitney U test , chi-square & fisher exact test were used to analyzed outcome variable as needed.p-value < 0.05 was considered as statistically significant.
Results: Significant differences were observed in terms of time to first analgesic request time which was 15.63±2.22 and 14.14±2.12 in Bupivacaine-Tramadol and Bupivacaine-Dexamethasone group respectively (p=0.02).There also Significant differences in median total analgesia consumption(p=0.005).there was no difference in FLACC score between groups at the 3rd,6th, and 24th postoperative hours(p>0.05). However there was a significant difference in the FLACC score(p=0.002) at the 12th hour between groups. Base line vital sign, PACU hemodynamic parameters were comparable between groups.
Conclusion:The patients receiving the combination of Bupivacaine-Tramadol had the lowest dose of Acetamnphon and the longest time until their first analgesic request compared to the Bupivacaine-Dexamethasone groups. combination of bupivacaine-tramadol provides longer analgesia duration and decreases the severity of postoperative pain than bupivacaine-Dexamethasone in a pediatric patient.
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Keywords
Tramadol, Dexamethasone, Pediatric, postoperative analgesia, Caudal Anesthesia