Effect of Intravenous versus Intrathecal Dexmedetomidine on Potentiation of Spinal Anesthesia in Lower Abdominal Surgeries in Pediatric Patients

Abstract

Abstract Background regional anesthesia in children was first studied by August Bier in 1899. Since then, spinal anesthesia was practiced for years, and several cases were published in 1909- 1910. After some years, it fell into disuse owing to the introduction of various muscle relaxants and inhalational agents. Aim of the Work to compare the effectiveness and feasibility of dexmedetomidine intravenously and intra-thecally in potentiation and prolongation of spinal anesthesia in pediatric population undergoing lower abdominal surgeries. Patients and Methods this study is a prospective randomized single-blind Clinical trial. study setting pediatric surgery operating theatre, Ain Shams University Hospitals, Cairo, Egypt. Study Period 6 months. This study was carried out on children aging from 1year till 7 years of age who were undergo elective lower abdominal surgeries. Results the major obstacle for routine use of spinal anesthesia in pediatric patients is the short block duration provided with the plain SAB hence the use of adjuvants to overcome this defect were considered. The current clinical trial attempts to synthesize the evidence regarding the safety and efficacy of dexmedetomidine as an adjuvant with the most common spinal anesthetic, bupivacaine. The intrathecal route appear more effective in prolongation of duration of motor block and maintaining an adequate sensory level with slower two segment regression course which can be explained by the previously speculated anti-nociceptive effects of the intrathecal route of dexmedetomidine and its action at the level of spinal cord. Intravenous route seems to provide deeper level of sedation when compared to intrathecal route which can be explained by its higher level and bioavailability in the blood which provides a more satisfactory centrally inhibiting action. Conclusion dexmedetomidine as an adjunct to spinal anesthesia in pediatric lower abdominal surgeries either intravenous or intrathecal can potentiate the motor and sensory block and provide good postoperative analgesia without exerting hemodynamic compromise or significant adverse events. While intrathecal route provide better prolongation of the motor and sensory blockade and also provide longer postoperative analgesia than intravenous route.