Background: Caudal analgesia has been prolonged by the addition of various adjuvants.
Dexmedetomidine is a highly selective α2agonist with sedative and analgesic properties.
Objective: To investigate the effect of addition of dexmedetomidine to 0.25% bupivacaine for
caudal analgesia in children undergoing major abdominal cancer surgery.
Study Design: A randomized double-blind trial.
Setting: Academic medical center.
Methods: Forty pediatric patients, aged 3 – 12 years, weighting 10 – 40 kg, and of American
Society of Anesthesiologists (ASA) physical status I and II scheduled for major abdominal cancer
surgeries under general anesthesia combined with caudal analgesia were enrolled. They were
randomly allocated into 2 groups: Group I (BD): (n = 20) received 1 mL/kg bupivacaine 0.25% with
dexmedetomidine 1 μg/kg and group II (B): (n = 20) received 1 mL/kg bupivacaine 0.25%. Heart rate
(HR), mean arterial pressure (MAP), and oxygen saturation (SPO2) were recorded for 120 minutes.
Pain was assessed immediately postoperative and at hours 2, 4, 6, 12, 18, and 24 of postoperative
period by Face, Legs, Activity, Cry and Consolability (FLACC) score. Time to first request for analgesia
and total analgesic consumption [Intravenous acetaminophen 15mg/kg (perfalgan, Squibb)] in the
first 24 hours were recorded. The level of sedation was recorded using Ramsay’s sedation scale.
Adverse effects were recorded and treated.
Results: There was significant reduction in FLACC score in group BD at 2, 4, 6, and 12 hours
postoperatively compared to group B. At the eighteenth and twenty-fourth hour there was no
significant difference. Time of the first rescue analgesic requirement was significantly prolonged in
group BD compared to group B. The mean total consumption of rescue analgesia in the 24 hours
of the postoperative period was significantly decreased in group BD (405.00 ± 215.03) mg when
compared with group B (810.35 ± 200.93) mg.
Limitations: This study is limited by its small sample size.
Conclusion: Addition of dexmedetomidine (1 μg/kg) to caudal bupivacaine 0.25% (1 mL/kg) in
pediatric major abdominal cancer surgeries achieved significant postoperative pain relief for up to
19 hours, with less use of postoperative analgesics, and prolonged duration of arousable sedation.
Hemodynamic changes were statistically significant, yet of no clinical significance.