Comparison of caudal dexmedetomidine and fentanyl combined with bupivacaine in pediatric patients undergoing urogenital surgery

Introduction: Caudal epidural block is one of the most popular, reliable, and safetechniques in pediatric patients that can provide analgesia for a variety of supra- andinfra-umblical surgical procedures. This study aimed to compare the efficacy ofdexmedetomidine–bupivacaine, fentanyl-bupivacaine mixture and bupivacaine alone onduration of postoperative analgesia, sedation, emergence agitation, duration of sensoryand motor block, hemodynamic stability and side effects.Methodology: After approval from ethical committee 90 pediatric patients of age 2-7 ywere enrolled. The children were randomly allocated to three equal groups of 30 eachusing a computer generated randomization list.Caudal block was given after induction of general anesthesia for urogenital surgery.General anesthesia was maintained with sevoflurane at a concentration adjusted tomaintain BIS between 40-60. Hemodynamic parameters, Pediatric AnaesthesiaEmergence Delirium (PAED) score, Richmond agitation sedation scale (RASS), andChildren's Hospital of Eastern Ontario Pain Scale (CHEOPS) were recorded immediatepostoperatively and then regularly every hour for the next 12 hours.Results: PAED score was less in group BD than group B and BF from baseline. RASS Scorewas less in Group BD than Group BF from base line to 12 h except at 240 min and Group BFis less than Group B from base line to 12 h. Group BD was less than B from base line to 12h. CHEOP score was less in Group BD than Group BF and Group B from base line to 12 h.Conclusion: Dexmedetomidine (1 μg/kg) added to bupivacaine in caudal block increasesthe duration of postoperative analgesia, provides arousable sedation, and decreasesemergence delirium with stable hemodynamics and minimal side effects in pediatricpatients.