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A Comparative Study between Caudal Bupivacaine (0.25%) and Caudal Bupivacaine (0.25%) with Dexmedetomidine in Children Undergoing Elective Infra-Umbilical Surgeries

Debarati Goswami, Avijit Hazra and Kanak Kanti Kundu

Background: 74 children, either sex, aged 2-7 years, ASA grade I, II, scheduled to undergo infra-umbilical surgeries included in a prospective, double blind, randomized, parallel group study. Aim was to compare duration of analgesia and level of sedation after single dose caudal bupivacaine versus caudal bupivacaine with dexmedetomidine.

Methods: The children were randomly allocated into Group B (n=37) and Group BD (n=37). Group B children received caudal bupivacaine (0.25%) 1 ml/Kg B/W in 1ml normal saline and Group BD children received same with dexmedetomidine 2 μg/kg B/W in 1ml normal saline after induction . Pulse rate, blood pressure, SPO2 were monitored and recorded at 0min (after administration of caudal anesthesia) and intra-operatively at 15 minutes interval till the end of operation. Postoperative hemodynamic monitoring, FLACC pain scoring and Ramsay sedation scoring was done at 2 hour interval after extubation upto 8 hrs., then 4 hrly upto 24 hrs. Rescue analgesia was administered when pain score was 4.

Results: The study groups were comparable in terms of demographic characteristics, body weight, duration and type of surgeries. Decrease in mean intraoperative heart rate, systolic blood pressure, diastolic blood pressure, postoperative pulse rate, systolic and diastolic blood pressure in Group-BD was statistically significant.

Mean FLACC pain scores were significantly low in group BD compared to group B at 0 mins, 120 mins, 240 mins and 360 mins after extubation (p<0.001). Mean duration of analgesia in group BD 648.9 ± 130.59 mins compared to 289.7 ± 78.21 mins in group B. Mean Ramsay sedation scores were significantly high in group BD compared to group B at 0 mins,120 mins and 240 mins after extubation (p<0.001).

Conclusion: The study demonstrated that addition of dexmedetomidine to caudal bupivacaine prolongs duration of analgesia, provides better quality of sleep, prolong duration of arousal sedation and better hemodynamic stability to the children compared to caudal bupivacaine.