Comparative Evaluation of Caudal Dexmedetomidine vs. Tramadol As Adjuvants to Bupivacaine for Intraoperative Hemodynamic Stability and Postoperative Analgesia in Pediatric Infraumbilical Surgeries.

Background Caudal epidural analgesia is a widely used and effective regional anesthetic technique for pediatric infraumbilical surgeries. Although bupivacaine provides reliable analgesia, its relatively short duration has prompted the use of adjuvants to prolong postoperative pain relief. Dexmedetomidine, a selective α2-adrenergic agonist, and tramadol, a centrally acting analgesic, are commonly employed caudal adjuvants; however, their comparative effects when combined with bupivacaine remain incompletely defined. Methods This prospective, randomized, double-blind study included 60 pediatric patients aged two to eight years undergoing elective infraumbilical surgeries under general anesthesia. All patients received a caudal block with 0.25% bupivacaine (1 mL/kg) and were randomized into two groups: Group D received dexmedetomidine 0.5 µg/kg (n = 30), and Group T received tramadol 1 mg/kg (n = 30). Hemodynamic parameters, including heart rate (HR) and mean arterial pressure (MAP), were recorded intraoperatively and at extubation. The primary outcome was time to first rescue analgesia, defined as the time from skin closure to a Face, Legs, Activity, Cry, Consolability (FLACC) score >4. Data were analyzed using appropriate parametric tests, with p < 0.05 considered statistically significant. Results Demographic characteristics and duration of surgery were comparable between the groups. Mean age was 4.19 ± 1.91 years in Group D and 4.55 ± 2.10 years in Group T (p = 0.49), while mean body weight was 14.15 ± 4.00 kg and 15.16 ± 4.24 kg, respectively (p = 0.35). The duration of postoperative analgesia was significantly longer in the dexmedetomidine group compared with the tramadol group (812.70 ± 46.15 minutes vs. 605.53 ± 45.12 minutes; p < 0.0001). HR and MAP decreased gradually in both groups following induction, with lower values observed in the dexmedetomidine group; however, differences in HR at all measured time points were not statistically significant. MAP after extubation was significantly lower in Group D compared with Group T (66.73 ± 5.96 mmHg vs. 70.17 ± 6.86 mmHg; p = 0.04). No episodes of bradycardia or hypotension requiring intervention occurred in either group. Conclusion Dexmedetomidine (0.5 µg/kg) as an adjuvant to caudal bupivacaine provided significantly prolonged postoperative analgesia compared with tramadol (1 mg/kg) in pediatric infraumbilical surgeries. Both agents maintained stable perioperative hemodynamics without clinically significant adverse effects; however, dexmedetomidine demonstrated better attenuation of hemodynamic responses, particularly after extubation. Low-dose dexmedetomidine appears to be an effective and safe caudal adjuvant in pediatric patients undergoing infraumbilical surgical procedures.