الفهرس 
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Abstract
Caudal anesthesia is one of the most used-popular regional blocks in children. This technique is a useful adjuvant during general anesthesia and for providing postoperative analgesia after infra umbilical operations. The quality and level of the caudal block is dependent on the dose, volume, and concentration of the injected drug. Although it is a versatile block, one of the major limitations of the single-injection technique is the relatively short duration of postoperative analgesia.
Prolongation of caudal analgesia using a ‘single-shot’ technique has been achieved by the addition of various adjuvants, such as epinephrine, opioids, ketamine, and α2 agonists like clonidine and Dexmedetomidine.
We have done a comparative, randomized, double blind study to compare and evaluate the efficacy and adverse effect of Dexmedetomidine and ketamine as an adjuvant during bupivacaine caudal anesthesia in pediatric patient also the need of postoperative analgesia.
A total of 80 patients, ASA Ι, scheduled for elective subumblical surgery were enrolled in the study. They were divided into 2 groups with 40 patients in each; they received study solutions as follows:
• group D: caudal analgesia bupivacaine 0.25 %( 1ml /kg) + Dexmedetomidine (1µg/kg).
• group K: caudal analgesia bupivacaine 0.25 %( 1ml /kg) +ketamine (0.5mg/kg).
All subjects were received a conventional preoperative dose of oral midazolam (0.5 mg kg−1) 20–30 min before anesthetic induction, and then undergo a standard inhalation induction with sevoflurane in oxygen followed by insertion of an i.v canula, Induction was strictly inhalation and atropine was not be administered routinely. After endotracheal intubation, patients were be placed in the lateral decubitus position, and a single-dose caudal block was be performed according to the group under sterile conditions using a 23 G needle and standard loss of resistance technique.
After administration of the caudal block, heart rate and pulse oximetry were monitored continuously and arterial pressure was monitored every 5 min by an automatic non-invasive blood pressure. The anesthesia time and emergence time were also noted. Using the pediatric observational FLACC pain scale with its 0–10 score range, each study participant’s pain intensity was assessed upon arrival in and at the time of discharge from the PACU, and then every 3 h for the first 12 h after operation.
Postoperative recordings also included: the duration of PACU stay, time of first administration of paracetamol for each patient, occurrence and treatment of PONV and pruritis, time to first micturition after caudal injection, and the incidence of bladder catheterization.
The results revealed that patients who required analgesia for postoperative pain, as four patients in group K need analgesia after 9h of operation while no patients needed any analgesia within 12h of operation in group D. As regarding intraoperative hemodynamic effects, there was no significant difference between groups.
In conclusion adding Dexmedetomidine or ketamine to bupivacaine in pediatric caudal anesthesia increase the quality and duration of postoperative analgesia and decrease the need for postoperative analgesics however Dexmedetomidine was more effective than ketamine.