Effects Of Adjuvants to Caudal Anesthesia on Hemodynamics Measured By Electrical Cardiometry In Children
Condition: Caudal Block
Study type: Interventional
Phase: Phase 4

Summary: 
      Caudal epidural anesthesia is one of the most common regional techniques used for
      post-operative pain management in pediatric patients. In this study we are going to compare
      the effects of caudal bupivacaine , caudal Dexamethasone with bubivacaine and Dexmedetomidine
      with bupivacaine on the systemic vascular resistance and the cardiac output, in pediatric
      patients undergoing lower abdominal surgeries, by using the electrical cardiometry (EC).
    

Detailed description: 
      Participants will be randomly allocated by a computer-generated table into one of the 3 study
      groups; the randomization sequence was concealed in sealed envelopes. The three study groups
      were as follows:

      Group A: Caudal Dexmedetomidine block group (DEXM) (n= 16) will receive caudal block using
      the bupivacaine 0.25% and Dexmedetomidine 1 μg/kg with the conventional general anesthesia,

      Group B: caudal Dexamethasone Block group (DEXA) (n =16) will receive caudal block using the
      bupivacaine 0.25% and Dexamethasone 0.1 mg/kg with the conventional general anesthesia,

      Group C: caudal with bubivacaine (CONTROL) group (n = 16) will receive caudal block using the
      bupivacaine 0.25% and general anesthesia.

      After induction of general anesthesia, the electrodes of the electrical cardiometry will be
      applied on the child neck and chest in the supine position and a measurement for the baseline
      cardiac output, systemic vascular resistance and stroke volume will be taken using the
      electrical cardiometry. Baseline blood pressure and heart rate will be also recorded.Then,
      another measurement for the systemic cardiac output, vascular resistance, stroke volume heart
      rate and blood pressure will be taken at 5minutes, 10 minutes, 20 minutes and 30 minutes
      after caudal block. The measurements will be stored and analyzed off-line.

      The Electrical Cardiometry device that will be used is the ICON™ monitor; (the Portable
      Noninvasive Hemodynamic Monitor manufactured by Osypka Medical Company). The measurements
      will be stored and analyzed off-line. The average values during three consecutive measures
      will be considered for the analysis.
    

Intervention name(s): Caudal block with dexmedetomedine; Caudal dexamethasone; Control (bupivacaine)
Intervention type(s): Drug; Drug; Drug
Intervention description(s): After induction, the electrical cardiometry is applied in supine position and a measurement for the baseline cardiac output, systemic vascular resistance and stroke volume is taken. In left lateral position, the back is sterilized. The block is done by introducing a 23-gauge needle perpendicular to the sacrococcygeal membrane. The needle is inserted until there is release of resistance as it pierces the sacro-coccygeal membrane. Then, it is directed upwards to make an angle of 20-30° with the skin about 2 mm. 1 ml/kg bupivacaine 0.25% along with dexmedetomidine 1 μg/kg (diluted with normal saline to 1ml) is injected over about 60s. Then, another measurement for the hemodynamics is taken at 5, 10, 20 and 30 minutes after caudal block.; After induction, the electrical cardiometry is applied in supine position and a measurement for the baseline cardiac output, systemic vascular resistance and stroke volume is taken. In left lateral position, the back is sterilized. The block is done by introducing a 23-gauge needle perpendicular to the sacrococcygeal membrane. The needle is inserted until there is release of resistance as it pierces the sacro-coccygeal membrane. Then, it is directed upwards to make an angle of 20-30° with the skin about 2 mm. 1 ml/kg bupivacaine 0.25% along with dexamethasone 0.1mg/kg (diluted with normal saline to 1ml) is injected over about 60s. Then, another measurement for the hemodynamics is taken at 5, 10, 20 and 30 minutes after caudal block.; After induction, the electrical cardiometry is applied in supine position and a measurement for the baseline cardiac output, systemic vascular resistance and stroke volume is taken. In left lateral position, the back is sterilized. The block is done by introducing a 23-gauge hypodermic needle perpendicular to the sacrococcygeal membrane. The needle is inserted until there is release of resistance as it pierces the sacro-coccygeal membrane. Then, it is directed upwards to make an angle of 20-30° with the skin about 2 mm. 1 ml/kg the control (bupivacaine) 0.25% is injected over about 60s. Then, another measurement for the hemodynamics is taken at 5, 10, 20 and 30 minutes after caudal block.
Other intervention name(s): Precedex; Decadrone; Marcaine
Intervention MeSH terms: Dexamethasone; Bupivacaine
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Supportive Care