Study of Caudal Ropivacaine with or without Dexmedetomidine for Postoperative Analgesia in Paediatric Genitourinary Infraumbilical Surgery: A Double-Blinded Randomized Controlled Trial

Background: Postoperative pain management in pediatric patients is a critical component of surgical care, influencing recovery and morbidity. Ropivacaine, a local anesthetic, is commonly used for caudal epidural analgesia. Dexmedetomidine, an alpha-2 adrenergic agonist, has potential benefits in enhancing the analgesic effects of local anesthetics. Methods: This double-blinded, randomized controlled trial was conducted at the Department of Paediatric Anaesthesia, JK Lon Hospital attached to SMS Hospital Jaipur, from December 2019 to April 2020 until the desired sample size was achieved. Sixty pediatric patients undergoing genitourinary infraumbilical surgery were randomly assigned to two groups. Group R received ropivacaine 0.25% (1 ml/kg), while Group RD received ropivacaine 0.25% (1 ml/kg) mixed with dexmedetomidine (1 µg/kg). The primary outcome was the duration of postoperative analgesia. Secondary outcomes included pain scores, rescue analgesic requirements, and side effects. Results: The median duration of analgesia in Group RD was significantly longer compared to Group R (P < 0.05). Pain scores at 1, 2, and 4 hours post-operation were lower in Group RD. The incidence of rescue analgesic use was lower in Group RD, with minimal side effects. Conclusion: Caudal dexmedetomidine added to ropivacaine extends the duration of postoperative analgesia without significant side effects in pediatric genitourinary infraumbilical surgeries.