Dexmedetomidine and Ketamine as an Adjuvant to Levobupivacaine for Pediatric Caudal Analgesia: A Randomized,...

Ketamine and dexmedetomidine as an adjuvant to caudal block are used in the pediatric population.

We aimed to compare the analgesic and safety profile of dexmedetomidine with ketamine for single-shot caudal block.

This was a randomized controlled study conducted in a tertiary care university hospital.

Ninety patients admitted for routine infraumbilical surgical procedures under general anesthesia were enrolled in this double-blind randomized study. Following caudal block under general anesthesia, patients were allocated to one of three groups; Group LS received 0.75 mL.kg ^{- 1} levobupivacaine 0.25% diluted in saline 0.9%, Group LK received 0.75 mL.kg ^{- 1} levobupivacaine 0.25% with ketamine 0.5 mg.kg ^{- 1}, and Group LD received 0.75 mL.kg ^{- 1} levobupivacaine 0.25% with dexmedetomidine 1 μg.kg ^{- 1}. Postoperative pain was assessed by the Face, Legs, Activity, Cry, and Consolability (FLACC) score, and the duration of analgesia (time from caudal block to time at which FLACC score 4 or more) was recorded. Hemodynamic parameters and oxygen saturation were also monitored.

Categorical data were analyzed by Chi-squire test and numerical continuous data were analyzed by Student's t-test for comparison between two groups. Mann-Whitney test was used to compare score. One-way analysis of variance was used to compare the means between three groups.

The addition of dexmedetomidine and ketamine to levobupivacaine resulted in significant prolongation of postoperative analgesia duration (467 min and 385 min, respectively) compared with 0.25% levobupivacaine alone (276 min). No significant side effects requiring intervention were observed in any group.

Dexmedetomidine as an adjuvant to levobupivacaine provides a longer duration of analgesia as compared to ketamine without any significant side effect.