CLONIDINE AND DEXMEDETOMIDINE AS ADJUVANTS TO CAUDAL BUPIVACAINE FOR POSTOPERATIVE ANALGESIA IN CHILDREN UNDERGOING INFRAUMBILICAL SURGERY: A THREE-ARM RANDOMIZED CONTROLLED STUDY

Abstract

Background: Single-shot caudal bupivacaine provides effective analgesia for paediatric infraumbilical surgeries, but its duration is limited. α2-Adrenergic agonists may prolong duration of caudal analgesia when used as adjuvants. Objective: To compare the analgesic efficacy and safety of clonidine and dexmedetomidine added to caudal bupivacaine. Materials and Methods: This prospective, single blind, randomised controlled study included 90 children aged 1–10 years, with American Society of Anesthesiologists physical status I or II, undergoing elective infraumbilical, perineal, or lower-limb surgery. Participants were allocated equally in 3 groups to receive caudal 0.25% bupivacaine 1 mL/kg with either normal saline (Group B), or clonidine 1 μg/kg (Group BC), or dexmedetomidine 1 μg/kg (Group BD). The primary outcome was the duration of postoperative analgesia, secondary outcomes included postoperative pain score ( FLACC Face, Legs, Activity, Cry, and Consolability scores), rescue analgesic requirements during the first 24 hours, haemodynamic changes and adverse effects. Results: Baseline demographic and operative characteristics were comparable among the groups. The mean duration of postoperative analgesia was 329.0 ± 60.4 minutes in Group B, 606.7 ± 88.6 minutes in Group BC, and 834.3 ± 141.9 minutes in Group BD (p<0.001). All pairwise comparisons were significant (p<0.001). The mean number of rescue analgesic doses required during the first 24 hours was 3.10 ± 0.55, 2.17 ± 0.59, and 1.53 ± 0.63 in Groups B, BC, and BD, respectively (p<0.001), with significant differences between each pair of groups. Postoperative pain scores were generally lower with both adjuvants during the early postoperative period, with dexmedetomidine providing greater pain reduction at several assessment points. No significant between-group differences were observed in intraoperative or postoperative haemodynamic and respiratory variables. The incidence of nausea and vomiting was also comparable among the groups. Conclusion: Adding clonidine or dexmedetomidine at 1 mcg/kg to caudal 0.25% bupivacaine prolonged postoperative analgesia and reduced rescue analgesic requirements compared with bupivacaine alone. Dexmedetomidine provided longer analgesia and lower rescue analgesic requirements than clonidine without a significant changes in haemodynamic variables or observed adverse effects.