Background: The incidence of postoperative agitation could be reduced using intravenous dexmedetomidine. At the same time, on the other side, it could cause a delay in discharge from the hospital and a higher incidence of hypotension. This study aimed to evaluate effect of caudal dexmedetomidine on emergence agitation in pediatrics after infra umbilical surgeries.

Methods: This Prospective randomized controlled clinical trial included 104 pediatric patients undergoing elective infra umbilical surgeries, categorized into two equal groups (52 each): Control group (C): patients who received caudal block using 2 mg /kg of 0.25% bupivacaine diluted in saline. Dexmedetomidine group (D): patients who received caudal block using 2 mg/kg of 0.25% bupivacaine and 0.5 µg/kg dexmedetomidine. Incidence and severity of emergence Agitation (EA), hemodynamics, sedation level, duration of the caudal block, and adverse events were evaluated.

Results: The control group had a higher incidence of agitation than the dexmedetomidine group (p<0.05), denoting that caudal dexmedetomidine effectively decreased the incidence of emergence agitation. The Dexmedetomidine group had a longer post-anesthesia care unit (PACU) stay duration than the Control group (P=<0.001). The control group had a significantly higher FLACC Pain Score than the dexmedetomidine group during the next 6-24 hours at the ward (p=<0.001).

Conclusion: The addition of 0.5 µg/kg dexmedetomidine 0.5 to the local anesthetic 2 mg/kg of 0.25% bupivacaine in single shot caudal block could decrease the incidence of emergence agitation, prolongation of the duration of the block, postoperative analgesia and also reduces postoperative analgesic requirements without significant hemodynamic instability or postoperative complications.