Introduction: In pediatric urological surgeries, caudal anesthesia stands as a cornerstone for effective pain management. Extending the duration of the block and postoperative analgesia is crucial. This study aims to compare the efficacy of bupivacaine with either fentanyl or dexmedetomidine ultrasound-guided in achieving optimal intraoperative analgesia and prolonging postoperative pain relief.
Methods: This double-blind, randomized controlled trial involved 45 pediatric patients undergoing elective urological procedures. They were allocated into three groups: Group I received bupivacaine 0.25%, Group II received bupivacaine 0.25% with fentanyl, and Group III received bupivacaine 0.25% with dexmedetomidine. The duration of caudal analgesia and time to reach FLACC score ≥ 4 were recorded for comparison.
Results: Group III exhibited the longest duration of caudal analgesia (5.5 ± 0.7 hours), significantly longer than Group I (3.4 ± 0.5 hours) (P-value 0.000). Moreover, the time to achieve FLACC score ≥ 4 was significantly prolonged in Group III (8.2 ± 1.8 hours) compared to both Group I and II (P-value 0.002). Dexmedetomidine in Group III demonstrated superior efficacy in delaying the need for analgesia.
Conclusion: The addition of dexmedetomidine (1 µg/kg) to bupivacaine 0.25% in caudal block extends the duration of the block and postoperative analgesia. It reduces postoperative analgesic requirements without notable hemodynamic instability or complications. Dexmedetomidine emerges as a promising adjunct for pediatric caudal blocks in urological surgeries.