Dexmedetomidine versus nalbuphine in prevention of emergence agitation following adenotonsillectomy in pediatrics

Abstract

Background: Adenotonsillectomy is considered one of the most common surgical procedures in preschool age children. Postoperative emergence agitation (EA) is a major problem that faces anesthesiologist and can be managed by different drugs as opioids, sedatives and propofol. The present prospective, randomized double blinded study was designed to evaluate the effect of intraoperative 0.5 µg/kg dexmedetomidine infusion versus 0.1 mg/kg nalbuphine IV for prevention of postoperative emergence agitation. Methods: After ethical committee’s approval and written informed consent, 160 patients were enrolled in the study, 80 in each group. Patients enrolled in the study were randomized into dexmedetomidine 0.5 µg/kg infusion (DEX group) or nalbuphine 0.1 mg/kg IV (NAL group). Both groups were under standard anesthetic regimen with sevoflurane anesthesia. Postoperative measurements included pediatric anesthesia emergence delirium (PAED) score, Ramsay sedation score, hemodynamic changes at arrival to post anesthesia care unit (PACU) 5, 10 minutes then every 10 minutes till discharge from PACU. Results: After ethical committee approval and written informed consent, 160 patients were enrolled in the study, 80 in each group. PAED score was significantly higher in NAL group than DEX group (13(12–16) vs. 12(11–13), respectively (p value <0.001). Number of patients needed rescue sedation was statistically higher in NAL than DEX group (12 vs. 3), respectively (p value 0.027). Ramsay sedation score was statistically higher in DEX group than NAL group at 10 and 20 minutes at PACU (p value <0.001). Both groups had similar length of stay in PACU. Conclusion: Dexmedetomidine is better than nalbuphine in prevention of postoperative EA in preschool children, with more postoperative sedation and similar stay in PACU.