Background: Caudal block is considered a safe anesthetic technique in pediatrics. Various additives were studied to improve the quality of caudal block. This study was conducted to evaluate the effects of caudal dexmedetomidine versus clonidine on postoperative pain and stress response when used as adjuvant to bupivacaine.
Patients and methods: Randomized double blinded trial included fourty eight ASA physical status class I and II patients aged 1-6 years who were scheduled for unilateral inguinal hernia repair. After induction of propofol sedation, caudal block was established. Patients allocated randomly into three groups with 16 patients in each. Group A patients received 1ml/kg of 0.25%bupivacaine plus 1ml normal saline. Group D patients received 1ml/kg of 0.25%bupivacaine plus dexmedetomidine 1μg/kg that was mixed with normal saline up to 1ml. Group C patients received 1ml/kg of 0.25%bupivacaine plus clonidine 1μg/kg that was mixed with normal saline up to 1ml. Hemodynamic parameters and serum cortisol levels were recorded. Postoperative analgesia duration, total analgesic requirements and side effects were recorded.
Results: Postoperative duration of analgesia in dexmedetomidine and clonidine groups was significantly prolonged than in bupivacaine group only, while in dexmedetomidine group was more prolonged than in clonidine group. Serum cortisol level was significantly lower in dexmedetomidine and clonidine groups compared to bupivacaine group. There were neither significant hemodynamic changes nor side effects detected.
Conclusion: Addition of 1μg/kg of either dexmedetomidine or clonidine to bupivacaine in caudal anesthesia led to prolongation of the duration of postoperative analgesia and attenuation of the stress response without postoperative complications.