Comparison of Extension of Analgesic Effect of Bupivacaine Alone and Bupivacaine with Dexmedetomidine in Caudal Anesthesia amongst Children

Abstract

Objective: To compare the duration and quality of postoperative analgesia between caudal bupivacaine alone and bupivacaine combined with dexmedetomidine in children.

Study Design: Prospective randomized comparative study
Place and Duration of Study: This study was conducted at the Department of Anesthesia KRL Hospital Islamabad from 20th April 2026 till 20th July 2026.

Methods: This study included 140 children undergoing elective infraumbilical surgery. Patients were divided equally into two groups.

Results: Mean duration of analgesia was significantly longer with bupivacaine plus dexmedetomidine than with bupivacaine alone (12.86±2.74 vs. 6.42±1.58 hours, p<0.001). Time to first rescue analgesia was also prolonged (12.51±2.68 vs. 6.18±1.51 hours, p<0.001), while rescue analgesia within 24 hours was required less frequently (48.6% vs. 87.1%, p<0.001). Mean rescue doses were lower in the dexmedetomidine group (0.69±0.66 vs. 1.74±0.72, p<0.001), with significantly lower FLACC scores up to 12 hours. Emergence agitation was reduced (8.6% vs. 21.4%, p=0.033), although early postoperative sedation was greater. Mean intraoperative heart rate and mean arterial pressure were modestly lower with dexmedetomidine.

Conclusion: Adding dexmedetomidine to caudal bupivacaine significantly prolonged postoperative analgesia, reduced pain scores and rescue analgesic requirements, and decreased emergence agitation in children without a significant increase in overall adverse effects.