Fentanyl, dexmedetomidine, dexamethasone as adjuvant to local anesthetics in caudal analgesia in pediatrics: A comparative study

Background
Caudal analgesia is a good, reliable and easy method to provide intraoperative and postoperative analgesia in the infraumbilical surgery in pediatrics. Many additives were used in combination with local anesthetics in caudal block to prolong the postoperative analgesia (fentanyl, dexmedetomidine and dexamethasone).
Aim of the study
This study aimed to compare the intraoperative hemodynamics, postoperative analgesia, postoperative sedation and postoperative side effects of fentanyl, dexmedetomidine and dexamethasone as adjuvant to bupivacaine in caudal analgesia in pediatrics.
Methods
120 pediatric patients (3–10 years old) scheduled for lower abdominal surgeries under general anesthesia allocated to 4 groups. Group I (control), in this group the patients received 0.5 ml of a equal mixture of bupivacaine 0.25% and lidocaine 1% diluted in saline (in a dose of 0.5 ml/kg) caudally. In Group II (fentanyl group), the patients received the same mixture of Group I + fentanyl (1 μg/kg) caudally. In Group III (dexmedetomidine group), the patients received the same mixture of Group I + dexmedetomidine (1 μg/kg) caudally. In Group IV (dexamethasone group), the patients received the same mixture of Group I + dexamethasone (0.1 mg/kg) caudally.
Results
The demographics and hemodynamics were comparable among the studied groups. The dexmedetomidine group and dexamethasone group were less in pain score, prolong the duration of analgesia and less in number of patients required analgesia compared to control and fentanyl groups. More sedation was present in the fentanyl and dexmedetomidine groups. The fentanyl group showed significant increase in the adverse effect incidence.
Conclusion
Both caudal dexmedetomidine and caudal dexamethasone added to local anesthetics are good alternatives in prolongation of postoperative analgesia compared to caudal local anesthetic alone or added to caudal fentanyl. Also they showed less side effects compared to caudal fentanyl.