Dexmedetomidine vs hyaluronidase addition to fluoroscopy-guided caudal analgesia with steroid in lumbosacral spine surgery. A comparative double blinded study

Figures & data

Figure 1. (a) Caudal epidural injection of dye to confirm the position of the tip of needle (lateral view). (b) Antero-posterior view showing christmas tree appearance

Figure 2. Flow consort chart

Table 1. Demographic data of the patients and duration of surgery in the 3 groups

Variable		Group A	Group B	Group C	p value
		N = 20	N = 20	N = 20
Sex	Females	7 (35%)	8 (40%)	6 (30%)	0.803*
	Males	13 (65%)	12 (60%)	14 (70%)
Age (years)	Mean±SD	51.3 ± 10.74	52.8 ± 10.13	50.8 ± 10.13	0.817°
Weight (kg)	Mean±SD	81.65 ± 10.40	81.7 ± 10.21	84.05 ± 10.25	0.703°
Height (cm)	Mean±SD	170.3 ± 6.49	170.81 ± 7.28	170.55 ± 6.75	0.974°
ASA I ASAII	Number (%)	10 (50%) 10 (50%)	12 (60%) 8 (40%)	11 (55%) 9 (45%	0.810*
Duration of surgery (min)	Mean±SD	121.54 ± 33.17	121.94 ± 36.97	124.35 ± 30.48	0.966°

pvalue >0.05: Nonsignificant, pvalue <0.05: Significant t, °One-Way ANOVA test,*Chi-square test.

Table 2. Intraoperative haemodynamic parameters, need of intraoperative fentanyl and total dose of pethidine in 24 hours in the 3 groups

Variable		Group A	Group B	Group C	p- value
		= 20	N = 20	N = 20
Mean blood pressure baseline (mmHg)	Mean±SD	95.20 ± 8.68	95.45 ± 8.38	95.15 ± 9.28	0.993°
Mean blood pressure intraoperative (mmHg)	Mean±SD	79.75 ± 6.61	76.55 ± 8.31	81.15 ± 6.45	0.125°
Hear rate base line (beat/min)	Mean±SD	82.02 ± 5.08	80.10 ± 7.34	82.40 ± 6.10	0.466°
Heart rate intraoperative (beat/min)	Mean±SD	75.95 ± 6.49	73.81 ± 4.68	79.85 ± 7.86	0.017°
Need for intraoperative fentanyl (number of patients)	frequency	13 (65%)	5(25%)	10(50%)	0.038*
Total postoperative dose of pethidine in 24 hours (mg)	Mean±SD	64.25 ± 22	50.75 ± 10	55.25 ± 8.	0.021°

p value >0.05: Nonsignificant, p value <0.05: Significant, °One-Way ANOVA test, *Chi-square test.

Table 3. Post hoc analysis

Post hoc analysis
	Group A vs B	Group A vs C	Group B vs C
Heart rate (beat/min)	0.003	0.06	0.005
Number of patients who needed increments of Intraoperative fentanyl (no %)	0.025	0.523	0.191
Analgesic dose of pethidine in the first 24 hours (mg)	0.006	0.064	0.349
First rescue analgesic time (min)	0.011	0.06	0.547

A Bonferroni correction was made with statistical significance accepted at a p value<0.0167.

Table 4. Comparison between the 3 groups regarding the VAS score at the different times of assessment

		Group A	Group B	Group C	p value*
		N = 20	N = 20	N = 20
VAS score at 0	Median (range)	0 (0–2)	0 (0–0)	0 (0–1)	0.07
VAS score at 2	Median (range)	1 (0–2)	0 (0–1)	0 (0–2)	0.015
VAS score at 4	Median (range)	2 (1–4)	0 (0–2)	1 (0–3)	0.010
VAS score at 6	Median (range)	2 (1–4)	1 (1–2)	2 (1–6)	0.015
VAS score at 8	Median (range)	2 (1–5)	1 (1–3)	2 (1–6)	0.026
VAS score at 10	Median (range)	3 (1–6)	3 (1–5)	3 (2–6)	0.122
VAS score at 12	Median (range)	3 (2–6)	3 (2–5)	4 (2–5)	0.549
VAS score at 18	Median (range)	3 (1–6)	2 (1–4)	3 (2–6)	0.058
VAS score at 24	Median (range)	4 (2–7)	4 (2–7)	4 (1–7)	0.393

p value >0.05: Nonsignificant, p value <0.05: Significant, *Kruskal-Wallis test.

Table 5. The mean times in minutes for the first analgesic dose in the 3 groups and their confidence intervals

Intervention	Mean
	Estimate	Std. error	95% confidence interval
			Lower bound	Upper bound
Group A	492	24.06	444.8	539.2
Group B	589.5	27.96	534.7	644.3
Group C	565.5	31.48	503.8	627.2
Overall	549	16.78	516.1	581.8

Table 6. Log rank test of time to first analgesic dose in minutes

	Overall comparison		Pairwise comparisons
	Chi-Square	p value	Intervention	Group A		Group B		Group C
				Chi-square	p value	Chi-square	p value.	Chi-square	p value
Log Rank test	7.72	0.021	Group A			4.9	0.027	2.7	0.098
			Group B	4.9	0.027			0.114	0.736
			Group C	2.7	0.098	0.114	0.736

p value >0.05: Nonsignificant, p value <0.05: Significant.

Figure 3. Kaplan-Meier survival plot representing the time of first analgesic dose in the three groups

Availability of data and materials

Please contact corresponding author for data requests.