Efficacy of dexmedetomidine in managing post-embolization pain in children undergoing doxycycline sclerotherapy of lymphatic malformations

Abstract

AbstractPurpose:Anesthetic care for children undergoing sclerotherapy for macrocystic lymphatic malformations with doxycycline is challenging, as they experience significant pain that peaks 1-3 hours after the injection. The aim of the study was to determine if dexmedetomidine is a useful adjuvant for the late-peaking post-operative pain experienced by children undergoing image-guided doxycycline sclerotherapy of macrocystic lymphatic malformations.Methods:This study included retrospective analysis of prospectively collected data in 136 consecutive image-guided doxycycline sclerotherapies of macrocystic lymphatic malformations. All patients received general anesthesia and were grouped based on whether dexmedetomidine was administered intraoperatively or not, a decision based on individual anesthesiologists’ preference. In addition, patients received intra and postoperative opioids as needed along with a single dose of intravenous ketorolac. The primary outcome of post-operative pain scores along with secondary outcomes of opioid usage, sedation scores and length-of-stay in post anesthesia care unit were compared. Data was analyzed with "R" and outliers excluded based on Mann-Whitney-Wilcoxon test.Results:Of the 136 procedures, 45 patients received dexmedetomidine with a mean dose of 0.92mcg/kg. The median IQR pain scores for patients who received dexmedetomidine were significantly lower than pain scores for patients who did not received dexmedetomidine in post anesthesia care unit, at admission (0.00 vs. 4.00, p =<0.001), 1 hour post-admission (0.25 vs. 3.33, p=0.006) and 4 hours post-admission (0.00 vs. 0.033, p=0.033). There was no significant difference in median IQR between the groups for intraoperative or postoperative opioid usage. No adverse events attributable to dexmedetomidine were found after individual case review.Conclusion:We found that dexmedetomidine is a safe and effective adjuvant for the late-peaking pain in children undergoing doxycycline sclerotherapy of macrocystic lymphatic malformations.