الفهرس 
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Abstract
Caudal anesthesia is the one of most important pediatric regional anesthetic technique. The technique is relatively easy to learn (Schuepfer et al., 2000) has a remarkable safety record (Gunter, 1991), and can be used for a large variety of procedures.
It is thought that Campbell et al. (1933) was the first to perform caudal epidural in children where he reported a high success rate of 90%.
It allows rapid recovery from anesthesia by reducing the requirement of other systemic anesthetic agents with effective postoperative analgesia (Sethna et al., 2003).
One of the major disadvantages with caudal analgesia is the limited duration of analgesia following single injection. Various adjuvant like morphine, fentanyl, clonidine and ketamine have been used along with local anesthetic agents to prolong the duration of analgesia provided by the caudal epidural block ( Lonngvist, 2005).
Fentanyl has been widely used as analgesic adjuvant to epidural analgesia and it acts by blocking fibers carrying nociceptive impulses both pre- and postsynaptically. But it has undesirable side effects as respiratory depression, itching and vomiting (Cousins et al., 1984 and Shukla et al., 2011)
Dexmedetomidine is α2 adrenergic receptor agonist which has sedative and analgesic effects. When it is combined with local anesthetics caudally, it prolongs the postoperative analgesia (Hall et al., 2000 and Saadawy et al., 2009).
The current study compared caudal additives as fentanyl 1 µg/kg and dexmedetomidine 1 µg/kg to 0.25% bupivacaine (1mg/kg) in pediatrics underwent lower abdominal surgeries as regards hemodynamic, duration of analgesia, pain score, sedation score and adverse effects.
Sixty of children underwent lower abdominal surgery aged from 2 to 6 years were divided into two groups
Group D: 30 child received mixture of Dexmetedomedine (1µg/kg) and bupivacaine 0.25% (1mg/kg).
Group F: 30 child received mixture of fentanyl (1µg/kg) and bupivacaine 0.25% (1mg/kg)
Basal Heart rate (H.R.) and blood pressure (B.P.) were recorded and every 5 minutes until the end of surgery and every ½ h for 2 hours and then for 2 hours until 12 hours.
The FLACC pain score was used for assessment of pain in the children and Richmond Agitation Sedation Scale was used for assessment of sedation in the children and were recorded postoperative with the hemodynamics.
Conclusion
Adding dexmetedomidine to bupivacaine in caudal block is longer in duration of postoperative analgesia and shows more sedation time than that of fentanyl with more stability in heamodynamics.