Efficacy of Dexamethasone and Dexmedetomidine as an adjuvant to Bupivacaine 0.25% versus plain 0.25 % Bupivacaine in caudal block in paediatric patients undergoing infra umbilical surgery.

Background: To compare efficacy of Dexamethasone and Dexmedetomidine as an adjuvant to Bupivacaine 0.25% versus Plain 0.25 % Bupivacaine in caudal block in paediatric patients undergoing infra umbilical surgery. Methods: Seventy-five Pediatric patients selected for infraumbilical surgery of either gender was classified into 3 groups of 25 each. In group I, the patients received inj Bupivacaine 0.25%: 1 ml/kg + 1 ml 0.9% normal saline. In group II, the patients received inj. Bupivacaine 0.25%: 1 ml/kg + inj Dexamethasone (0.1 mg/kg) making volume to 1 ml. In group III, the patients received inj Bupivacaine 0.25%: 1 ml/kg + inj Dexmedetomidine (1 μg/kg) making volume to 1 ml. Parameters such as time of analgesia (min), Ramsay sedation score and the modified objective pain score (MOPS) and adverse effects were recorded. Results: The mean weight in group I was 22.5 kgs, in group II was 21.6 kgs and in group III patients was 20.2 kgs. The height was 90.1 cms, 84.5 cms and 85.6 cms in group I, II and group III respectively. The mean duration of analgesia was 321.4 minutes in group I, 485.2 minutes in group B and 464.2 minutes in group III. The difference was significant (P< 0.05). At 30 minutes, the mean MOPS was 3.2, 4.2 and 3.8 in group I, II and III respectively. At 1 hour, it was 4.1, 4.5 and 3.5, at 3 hours was 3.7, 3.2 and 3.1 and 6 hours was 3.3, 2.7 and 1.2 in group I, II and III respectively. The difference was significant (P< 0.05). The mean Ramsay sedation score was 3.9 in group I, 3 in group II and 3.4 in group III. The difference was significant (P< 0.05). Among adverse events, bradycardia was seen in 1 in group I, 1 in group II and 3 in group III. Hypotension was 1 in group I, 2 each in group II and III. Vomiting was seen in 2 in group I, 1 in group II and 2 in group III. The difference was significant (P< 0.05). Conclusion: Contrary to caudal local anaesthetic alone or in combination with dexamethasone, caudal dexmedetomidine is a superior adjuvant in extending postoperative analgesia. They both displayed similar adverse effect profiles, with the exception of bradycardia, which was somewhat more common with dexmedetomidine. [ABSTRACT FROM AUTHOR]