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

 Sang Jun Park  ;  Seokyung Shin  ;  Shin Hyung Kim  ;  Hyun Woo Kim  ;  Seung Hyun Kim  ;  Hae Yoon Do  ;  Yong Seon Choi 
 YONSEI MEDICAL JOURNAL, Vol.58(3) : 650-657, 2017 
Journal Title
Issue Date
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* ; Dexmedetomidine/therapeutic use ; Double-Blind Method ; Female ; Fentanyl/administration & dosage* ; Fentanyl/therapeutic use ; Humans ; Injections, Epidural ; Leg/surgery* ; Male ; Orthopedic Procedures* ; Pain, Postoperative/drug therapy* ; Postoperative Period ; Treatment Outcome
Dexmedetomidine ; epidural analgesia ; fentanyl
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.
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1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Orthopedic Surgery (정형외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Seung Hyun(김승현) ORCID logo https://orcid.org/0000-0003-2127-6324
Kim, Shin Hyung(김신형) ORCID logo https://orcid.org/0000-0003-4058-7697
Kim, Hyun Woo(김현우) ORCID logo https://orcid.org/0000-0001-8576-1877
Do, Hae Yoon(도해윤) ORCID logo https://orcid.org/0000-0003-3170-8207
Park, Sang Jun(박상준) ORCID logo https://orcid.org/0000-0002-2496-7764
Shin, Seokyung(신서경) ORCID logo https://orcid.org/0000-0002-2641-0070
Choi, Yong Seon(최용선) ORCID logo https://orcid.org/0000-0002-5348-864X
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