Comparison between Dexmedetomidine or Magnesium Sulfate as Adjuvants to Bupivacaine for Caudal Anesthesia in Pediatric Patients Undergoing Infraumbilical Surgeries

Background: Caudal epidural anesthesia is a common technique providing intra and postoperative analgesia in pediatric infraumbilical surgical procedures. Objectives: The aim of this study was to compare the effect of adding Dexmedetomidine or Magnesium Sulfate as an adjuvant to Bupivacaine for caudal anesthesia in pediatric infraumbilical surgeries. Patients and Methods: This randomized controlled prospective study was done at Sohag University Hospital on sixty pediatric patients with American Society of Anesthesiologists (ASA) Classes I or II or III, weighted up to 20 kg scheduled for infraumbilical surgeries using caudal block in the period between January 2019 and January 2020. The included subjects were divided into three groups, twenty patients each: Group C (control), Group D (Dexmedetomidine group) and Group M (Magnesium group). Results: In our study, the caudal block mainly used to relieve pain after Sevoflurane anesthesia with less incidence of emergence agitation. On comparing (Group D) and (Group M), Face, Legs, Activity, Cry, Consolability scale (FLACC) score was lower in (Group D: 0,1,1,2) than (Group M: 1,1,2,2) without significant difference at postoperative set times (30 minutes,1,2,3 hours), respectively. At the 6th hour postoperatively, (Group M) patients achieved higher FLACC scores (3) compared with (Group D) patients (2.5) with statistically significant difference with P value of 0.05. During the first 3 hours post-operative, there were higher sedation scores in (Group D: 4,4,3,3) and (Group M: 4,4,3,2.5) more than (Control group: 3,2.5,2,2) with highly statistical significant difference with (P value < 0.001) at (30 minutes,1h, 2h, 3 hours), respectively. At the 6th hour postoperatively, there were higher sedation scores with (Group D) (3) more than (Group M) (2) with highly statistical significant difference with (P value < 0.001). Conclusion: Administration of Dexmedetomidine as adjuvant with Bupivacaine enhances caudal block, prolongs duration of postoperative analgesia, reduces postoperative EA and provides preferred postoperative sedation in pediatric patient undergoing infraumbilical surgeries with minimum adverse effects compared to Magnesium Sulfate as adjuvant.