Dexmedetomidine and Ketamine as an Adjuvant to Levobupivacaine for Pediatric Caudal Analgesia: A Randomized, Controlled Study.

BACKGROUND: Ketamine and dexmedetomidine as an adjuvant to caudal block are used in the pediatric population. AIMS: We aimed to compare the analgesic and safety profile of dexmedetomidine with ketamine for single-shot caudal block. SETTINGS AND DESIGN: This was a randomized controlled study conducted in a tertiary care university hospital. MATERIALS AND METHODS: Ninety patients admitted for routine infraumbilical surgical procedures under general anesthesia were enrolled in this double-blind randomized study. Following caudal block under general anesthesia, patients were allocated to one of three groups; Group LS received 0.75 mL.kg - 1 levobupivacaine 0.25% diluted in saline 0.9%, Group LK received 0.75 mL.kg - 1 levobupivacaine 0.25% with ketamine 0.5 mg.kg - 1, and Group LD received 0.75 mL.kg - 1 levobupivacaine 0.25% with dexmedetomidine 1 µg.kg - 1. Postoperative pain was assessed by the Face, Legs, Activity, Cry, and Consolability (FLACC) score, and the duration of analgesia (time from caudal block to time at which FLACC score 4 or more) was recorded. Hemodynamic parameters and oxygen saturation were also monitored. STATISTICAL ANALYSIS USED: Categorical data were analyzed by Chi-squire test and numerical continuous data were analyzed by Student's t-test for comparison between two groups. Mann-Whitney test was used to compare score. One-way analysis of variance was used to compare the means between three groups. RESULTS: The addition of dexmedetomidine and ketamine to levobupivacaine resulted in significant prolongation of postoperative analgesia duration (467 min and 385 min, respectively) compared with 0.25% levobupivacaine alone (276 min). No significant side effects requiring intervention were observed in any group. CONCLUSIONS: Dexmedetomidine as an adjuvant to levobupivacaine provides a longer duration of analgesia as compared to ketamine without any significant side effect.