title: Dexmedetomidine as an adjuvant to bupivacaine in caudal analgesia in children.
abstract: BACKGROUND
  Postoperative pain management is becoming an integral part of anesthesia care. Various techniques of pediatric pain relief have been designed among which the most commonly practiced is caudal epidural block. Several adjuvants have been used to prolong the duration of caudal analgesia such as clonidine, neostigmine, ketamine, opioids, and ephedrine. We have designed the study using dexmedetomidine as an adjuvant to assess analgesic efficacy, duration of postoperative analgesia, hemodynamic stability, postoperative sedation, and any adverse effects in children.
  
  
  OBJECTIVE
  The aim is to study the effects of dexmedetomidine as an adjuvant to bupivacaine in caudal analgesia in pediatric patients posted for infraumbilical surgeries.
  
  
  METHODS
  This is a randomized, double-blind study in which effect of dexmedetomidine is studied when added to bupivacaine in the caudal epidural block. The observations are made intraoperatively for hemodynamic stability and postoperatively for the duration of analgesia.
  
  
  METHODS
  This study was conducted in 100 children of American Society of Anesthesiologists physical status I and II, aged 2-10 years, undergoing elective infraumbilical surgeries. They were divided into two groups as follows: Group A: (0.25%) bupivacaine 1 ml/kg + normal saline (NS) 1 ml. Group B: (0.25%) bupivacaine 1 ml/kg + 1 μg/kg dexmedetomidine in 1 ml NS. As this study was double-blind, patients were randomly assigned to receive either (bupivacaine + saline) or (bupivacaine + dexmedetomidine) in each group. The patients were observed for hemodynamic stability, respiratory depression, and postoperative pain using face, legs, activity, cry, consolability (FLACC) pain scale for 24 h postoperatively.
  
  
  METHODS
  Unpaired Student's t-test.
  
  
  RESULTS
  The mean duration of effective analgesia in Group A patients was 4.33 ± 0.98 h versus 9.88 ± 0.90 h in Group B patients. Likewise, the difference in mean FLACC score of both the groups was also statistically significant, 7.21 ± 0.76 and 6.49 ± 1.72 in Group A and Group B, respectively.
  
  
  CONCLUSIONS
  Dexmedetomidine as adjuvant to Bupivacaine increases duration of caudal analgesia and improves hemodynamic stability without an increase in adverse effects in children undergoing infraumbilical surgeries.
authors.affiliation: Department of Anaesthesiology and Critical Care, AIIMS, Bhopal, Madhya Pradesh, India.
authors.forename: Vigya
authors.initials: V
authors.lastname: Goyal
authors.affiliation: Department of Anaesthesiology and Critical Care, AIIMS, Bhopal, Madhya Pradesh, India.
authors.forename: Jyotsna
authors.initials: J
authors.lastname: Kubre
authors.affiliation: Department of Anaesthesiology, GMERS Medical College, Sola Civil Hospital, Ahmedabad, India.
authors.forename: Krishnaprabha
authors.initials: K
authors.lastname: Radhakrishnan
keywords: Caudal block; dexmedetomidine; pediatric patients; postoperative analgesia