Comparison of 0.125% levobupivacaine with dexmedetomidine and 0.25% levobupivacaine in ultrasonography-guided pediatric caudal block: A prospective, randomized, double-blinded study

Abstract

Background: Caudal anesthesia is a safe and reliable technique for infraumbilical surgeries in pediatric patients. Addition of dexmedetomidine to local anesthetic (LA) in caudal block prolongs the duration of block, but the effect on reducing the concentration of LA drug has not been extensively evaluated. This study was, therefore, designed to evaluate the efficacy of addition of dexmedetomidine to lower concentration of levobupivacaine required for ultrasonography (USG)-guided caudal block. Methods: A total number of 60 children with American Society of Anesthesiologists Grade I and II, aged 2–8 years from both sexes, and undergoing infraumbilical surgeries were recruited in a prospective, double-blinded, randomized controlled study over a duration of 1 year. The study children were allocated into groups A and B (n = 30 each) via computer-generated randomization. Group A children received caudal 0.25% levobupivacaine 0.75 ml/kg with 1 ml of normal saline and Group B children received 0.125% levobupivacaine 0.75 ml/kg with 1 μg/kg dexmedetomidine in 1 ml of normal saline after induction and the insertion of I-gel. Heart rates, blood pressure, and SpO2were monitored perioperatively. Postoperative hemodynamic monitoring; face, legs, activity, cry, and consolability (FLACC) pain score up to 24 h; time to first rescue analgesia; and emergence delirium using Watcha scale and Ramsay sedation score were recorded. Rescue analgesia was administered when FLACC pain score was >4. Any adverse events were noted and documented. Results: The study groups were comparable in terms of demographic characteristics and nature/duration of surgery. The mean FLACC pain scale in Group B was significantly lower compared to Group A. The mean duration of analgesia was statistically prolonged in Group B (P < 0.05) as compared to Group A (1299 ± 145 min in Group B vs. 348 ± 36 min in Group A). Emergence delirium as measured by Watcha scale was significantly lower in Group B (P < 0.05). Perioperative hemodynamic parameters were stable in the two groups, and no clinically significant adverse effects were noted. Conclusion: Addition of 1 μg/kg of dexmedetomidine decreases the effective concentration of levobupivacaine required for USG-guided caudal block, extends the duration of analgesia, and lowers the incidence of emergence delirium among pediatric patients undergoing infraumbilical surgery.