• I Saadawy, A Boker, M A Elshahawy, A Almazrooa, S Melibary, A A Abdellatif, and W Afifi.
• Department of Anesthesia, Cairo University, Cairo, Egypt. ninaeg2001@yahoo.com
• Acta Anaesthesiol Scand. 2009 Feb 1;53(2):251-6.

BackgroundDexmedetomidine (DEX) is a highly selective alpha(2)-adrenoceptor agonist that has been used increasingly in children. However, the effect of caudal DEX has not been evaluated before in children. This prospective randomized double-blinded study was designed to evaluate the analgesic efficacy of caudal DEX with bupivacaine in providing pain relief over a 24-h period.MethodsSixty children (ASA status I) aged 1-6 years undergoing unilateral inguinal hernia repair/orchidopexy were allocated randomly to two groups (n = 30 each). Group B received a caudal injection of bupivacaine 2.5 mg/ml, 1 ml/kg; Group BD received the same dose of bupivacaine mixed with DEX 1 microg/kg during sevoflurane anesthesia. Processed electroencephalogram (bispectral index score), heart rate, blood pressure, pulse oximetry and end-tidal sevoflurane were recorded every 5 min. The characteristics of emergence, objective pain score, sedation score and quality of sleep were recorded post-operatively. Duration of analgesia and requirement for additional analgesics were noted.ResultsThe end-tidal sevoflurane concentration and the incidence of agitation were significantly lower in the BD group (P < 0.05). The duration of analgesia was significantly longer (P < 0.001) and the total consumption of rescue analgesic was significantly lower in Group BD compared with Group B (P < 0.01). There was no statistically significant difference in hemodynamics between both groups. However, group BD had better quality of sleep and a prolonged duration of sedation (P < 0.05).ConclusionCaudal DEX seems to be a promising adjunct to provide excellent analgesia without side effects over a 24-h period. It has the advantage of keeping the patients calm for a prolonged time. Implications statement: Caudally administered DEX (1 microg/kg), combined with bupivacaine, was associated with an extended duration of post-operative pain relief.

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