Authors: Abbas N et al.
Cureus, June 11, 2026.
Summary
This prospective, randomized, double-blind study compared caudal dexmedetomidine with caudal tramadol as additives to bupivacaine in children undergoing infraumbilical surgery.
Caudal epidural anesthesia is commonly used in pediatric surgery because it provides effective intraoperative and postoperative analgesia. However, the duration of analgesia from bupivacaine alone may be limited. Adjuvant medications are therefore frequently added to extend pain relief.
The study included 60 children between two and eight years of age undergoing elective infraumbilical procedures under general anesthesia.
All patients received a caudal block containing 0.25% bupivacaine at 1 mL/kg. They were then randomly assigned to one of two groups:
• Dexmedetomidine group: dexmedetomidine 0.5 µg/kg
• Tramadol group: tramadol 1 mg/kg
Each group included 30 children.
The primary outcome was the time from skin closure until the child first required rescue analgesia. Rescue medication was provided when the Face, Legs, Activity, Cry, Consolability score exceeded 4.
The duration of postoperative analgesia was significantly longer with dexmedetomidine:
Dexmedetomidine group: 812.7 minutes
Tramadol group: 605.5 minutes
This represents approximately 13.5 hours of analgesia with dexmedetomidine compared with approximately 10.1 hours with tramadol, a difference of more than three hours.
The difference was highly statistically significant.
Heart rate and mean arterial pressure gradually decreased in both groups after induction of anesthesia. The dexmedetomidine group generally had lower hemodynamic measurements, although differences in heart rate were not statistically significant at the measured time points.
Mean arterial pressure after extubation was significantly lower in the dexmedetomidine group:
Dexmedetomidine group: 66.73 mmHg
Tramadol group: 70.17 mmHg
Despite this difference, neither group experienced clinically important bradycardia or hypotension requiring treatment.
What You Should Know
Adding dexmedetomidine to caudal bupivacaine produced significantly longer postoperative analgesia than adding tramadol.
Dexmedetomidine extended pain relief by more than three hours compared with tramadol.
Both adjuvants maintained acceptable intraoperative hemodynamic stability.
Low-dose caudal dexmedetomidine produced slightly greater attenuation of the hemodynamic response, particularly after extubation.
No child in either group developed bradycardia or hypotension requiring intervention.
The dexmedetomidine dose used was 0.5 µg/kg, while the tramadol dose was 1 mg/kg.
The study involved only 60 children, so uncommon adverse effects may not have been detected.
The findings apply to children between two and eight years old undergoing elective infraumbilical surgery and may not apply to neonates, infants, emergency procedures, or other surgical populations.
The study supports low-dose dexmedetomidine as an effective caudal adjuvant when prolonged postoperative analgesia is desired.
Thank you to Cureus for allowing us to summarize this article.