Dexmedetomidine Vs Hyaluronidase Addition To Fluoroscopy-Guided Caudal Analgesia With Steroid In Lumbosacral Spine Surgery. A Comparative Double Blinded Study

Background:Caudal analgesia is a safe technique that can be performed under fluoroscopy in lumbosacral spine surgeries. Studies have raised evidence supporting the use of epidural dexamethasone in such surgeries. Adding second adjuvant like dexmedetomidine or hyaluronidase to dexamethazone has not been investigated before. Methods: Sixty patients scheduled for lumbosacral spine surgery were randomized and allocated in 3 groups. All patients received 30ml of caudal mixture after insertion of caudal catheter. Group A received 0.125% bupivacaine with 8 mg dexamethasone. Group B received 50 mu g dexmedetomidine in addition to the mixture given to group A. Group C received 1500 IU hyaluronidase in addition to the mixture given to group A. Results: Mean time to the first analgesic dose in group B was 589.5 min and in group C was 565.5 min, which is longer than mean time in group A (492 min), p = 0.021. Number of patients who needed intraoperative top-up doses of fentanyl was 5 (25%) in group B and 10 (50%) in group C versus 13 (65%) in group A, p = 0.038. Total pethidine dose in 24 hours was 50.75 +/- 10 mg in group B and 55.25 +/- 8 mg in group C versus 64.25 +/- 22 mg in group A, p = 0.021. Post hoc analysis and pairwise comparisons were conducted to determine which intervention groups had significant differences. Conclusion: Dexmedetomidine and hyaluronidase addition to caudal bupivacaine and dexamethasone increased duration of analgesia after lumbosacral spine surgery, but dexmedetomidine was superior to hyaluronidase.