Adeel Riaz¹, Shahid Nishtar², Ahmad Riaz², Muhammad Umair Amjad², Mariam Arif³, Nouman Arif⁴

Introduction:

Caudal anesthesia is safe and frequently used regional pediatricanesthesia for infraumbilical surgeries (1). Althoughbupivacaine provides effective analgesia, its duration is oftenlimited, prompting investigation into safe and effectiveadjuvants prolonging postoperative analgesia (2).Dexmedetomidine, a selective α2 adrenergic agonist, andtramadol, a centrally acting analgesic, are commonly studiedadjuvants (3,4). This study aims to compare the analgesicefficacy and safety of dexmedetomidine versus tramadol whenused with bupivacaine in pediatric infraumbilical surgeries.

Methods:

 

Sixty patients (ages 2–8 years) undergoing elective infraumbilicalsurgeries received a caudal block with 1 mL/kg of 0.25%bupivacaine under general anesthesia. Patients were randomlyallocated to receive either dexmedetomidine (group D) 0.5 µg/kg(n=30) or tramadol (group T) 1 mg/kg (n=30) as a caudal adjuvant.Institutional IRB approval was obtained before starting the study.

We recorded hemodynamic parameters, FLACC pain scores,sedation levels, time to first rescue analgesia, and adverse effects.Continuous variables were analyzed using independent t-tests,and categorical variables using Chi-square tests. A p-value < 0.05was considered statistically significant.

Results:

Both groups (n=30 each) were comparable indemographic and perioperative baselinecharacteristics. The primary end point of duration oftime to first rescue analgesia was significantlylonger in Group D (812.7 ± 46.1 min; ~13.5 hrs.)compared to Group T (605.5 ± 45.1 min; ~10 hrs.)(p=0.0001) with a mean difference of 3.4 hours.Group D also had significantly lower FLACC scoresand required fewer total rescue analgesic doses(mean 1.4 doses vs 2.5 doses) within 24 hours (p<0.001). Group D exhibited mild, transientbradycardia in 3 patients, responsive to atropine,and slightly higher sedation scores, though withinacceptable clinical limits. Group T experiencedhigher rates of postoperative nausea/vomiting (5 vs1 patients, p = 0.04). No episodes of respiratorydepression, urinary retention, pruritus, or block-related complications occurred.

Conclusions:

This study confirms that both dexmedetomidine and tramadoleffectively prolong bupivacaine's duration in pediatric caudal blockswith significant superiority for dexmedetomidine. It provided asubstantially longer time to first rescue analgesia (13.5 vs. 10 hours),resulted in lower overall pain scores and reduced analgesicrequirements within 24 hours. Hemodynamic changes and increasedsedation with dexmedetomidine were mild and clinically manageable.Critically, postoperative nausea and vomiting was significantly higherwith tramadol, highlighting safety advantage for dexmedetomidine.

References:

1. Dobereiner EF, Cox RG, Ewen A, Lardner DR. Evidence-based clinical update: Which local anesthetic drug for pediatric caudal block provides optimal efficacy with the fewest side effects?. Can J Anaesth. 2010;57(12):1102-1110. doi:10.1007/s12630-010-9386-1
2. Dr.P.Krishnaprasad, et. al. “Comparison of Analgesic Efficacy of Caudal Dexmedetomidine Versus Caudal Tramadol With Ropivacaine In Pediatric Urogenital Surgeries- A Prospective, Randomized, Comparative Study.” IOSR Journal of Dental and Medical Sciences (IOSR-JDMS), 19(12), 2020, pp. 19-25.
3. Kamal M, Mohammed S, Meena S, Singariya G, Kumar R, Chauhan DS. Efficacy of dexmedetomidine as an adjuvant to ropivacaine in pediatric caudal epidural block. Saudi J Anaesth. 2016;10(4):384-389. doi:10.4103/1658-354X.177325
4. Doda M, Mukherjee S. Postoperative Analgesia in Children- Comparative Study between Caudal Bupivacaine and Bupivacaine plus Tramadol. Indian J Anaesth. 2009;53(4):463-466.