Role of adding dexmedetomidine, ketamine, and magnesium sulphate to caudal block as preemptive analgesia in hypospadias repair in pediatrics: A randomized double-blinded prospective trial.

Background: The caudal block (CB) is a quick, and safe approach for pediatric analgesia. Numerous adjuvants were added to extend the analgesia duration. Our trial aims to evaluate the significance of CB by adding dexmedetomidine, ketamine, and MgSO4 to bupivacaine to provide postoperative analgesia in children undergoing hypospadias repair. Methods: This randomized double-blinded study was performed on 75 male children undergoing hypospadias repair under CB. Patients were randomized into three equal groups. All received 0.5 ml/kg bupivacaine 0.25% caudally plus 1 ml volume containing either dexmedetomidine 1 µg/kg in Group D, 0.5 mg/kg ketamine in Group K or 50 mg of MgSO4 in Group M. Results: Time of first rescue analgesia was significantly delayed in group D (8.2 ± 3.45 h) than in group K (5.8 ± 2.85 h) and group M (3.7 ± 1.51 h) (P value = 0.007 vs. <0.001) and in group K than in group M (P value = 0.027). Heart rate and mean arterial blood pressure measurements after block and 60 min intraoperative reduced significantly in group D than in K and Group M. At 6 h and 12 h, FLACC scores were considerably lower with Group D compared to Group K, and Group M, and ketamine group compared to Group M at 4 h. The total amount of pethidine consumed 24 hours postoperatively was significantly lower in Group D than in Group K and Group M. Conclusions: Dexmedetomidine as an additive to the CB significantly prolonged time to first analgesia required and decreased total rescue opioid consumption compared to ketamine and MgSO4. [ABSTRACT FROM AUTHOR]