Comparison of caudal clonidine versus caudal Dexmedetomidine with bupivacaine for prolongation of postoperative analgesia in children undergoing infra-umbilical surgeries (Caudal analgesia)

Introduction: Caudal analgesia is considered a safe, simple and common procedure in children. As bupivacaine alone has short duration of action, addition of clonidine and dexmedetomidine has been shown to increase the duration of caudal analgesia. We aimed to evaluate caudal clonidine and caudal dexmedetomidine with bupivacaine in terms of the analgesic efficacy and sedation in children scheduled for infra-umbilical surgeries. Methods: We conducted a prospective, randomized, and interventional study. We randomized sixty patients into two groups aging 1 to 8 years belonging to ASA grade I and II posted for infra-umbilical surgeries. Group C was administered 0.25% bupivacaine (1 ml/kg) + clonidine 1 µg/kg, maximum total volume of 12 ml for caudal block, while Group D was administered 0.25% bupivacaine (1 ml/kg) + dexmedetomidine 1 µg/kg, maximum total volume of 12 ml for caudal block. Hemodynamic variables were monitored. Postoperative analgesia was assessed using FLACC score, sedation using the Ramsay Sedation Scale, and total analgesic requirements and side effects were recorded during the first 24 hour. Results: A significant difference in duration of postoperative analgesia was observed between the two groups. In Group D, the mean duration was 742 min ± 247.38 min, whereas in Group C, it was 608.87 min ± 251.16 min (p value < 0.043). The mean sedation score in the immediate postoperative period was lower in Group D compared to Group C. The rescue analgesic requirement in the first 24 hours in Group D was also lower than in Group C. Hemodynamic changes and adverse effects were comparable between the two groups. Conclusions: Dexmedetomidine was a safe and more effective adjuvant to bupivacaine as compared to clonidine for prolonging caudal in children undergoing infraumbilical surgeries, without an increase in adverse effects.