الفهرس 
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Abstract
Hypospadias repair surgery is an invasive procedure whose postoperative phase is very painful. Pain management can be counted as an important step in all surgeries, especially in pediatric and neonatal surgical procedures. It has been reported that up to 40% of the children undergoing surgeries suffer from moderate to severe post-operative pain.
Postoperative pain is one of the most untreated medical problems, and an annoying subjective sensation for patients, especially in children. A variety of methods have evolved for supposing postoperative pain relief in pediatric patients to provide a better quality of sleep and prolong the duration of sedation. Caudal epidural block is normally a safe technique performed in pediatric anesthesia. The main disadvantage of a caudal block is the shortest duration of analgesia after a single injection, it works for only for 4 to 8 hours.
The efficacy of the α-2 adrenoceptor agonists clonidine and dexmedetomidine in prolonging postoperative analgesia when administered as adjuvants to spinal anesthesia in children has been proven by multiple studies. This has been documented for intravenous route of administration of the both drugs.
The current study was conducted to evaluate the efficacy of intravenous ketorolac versus dexmedetomidine as analgesia after hypospadias repair surgery to determine the optimal procedure for pain control and postoperative reduction of analgesic use. A total of 60 children were scheduled for hypospadias repaired were enrolled in the study.
Those children were randomly subdivided into either group A (Ketorolac group) or group B (Dexmedetomidine group). We found that both groups had insignificant differences as regard baseline data and operative time. Another finding in the current was that we both groups had insignificant differences as regard changes in hemodynamics, respiratory rate, oxygen saturation with exception significantly lower intraoperative heart rate in dexmedetomidine group.
The main finding in the current study was that dexmedetomidine group had significantly longer duration till 1st analgesia request (5.56 ± 2.21 vs. 2.22 ± 0.79 (hour); p< 0.001) and less total analgesia consumption (248.11 ± 58.56 vs. 207.54 ± 23.87 (mg); p= 0.03) in comparison to the ketorolac group.
In the current study we found that dexmedetomidine group had significantly lower FLACC pain score at different postoperative times with exception at 4th and 12th hours. It was found that FLACC pain score was zero in magnesium sulphate group till the 6th hour postoperatively. Also, all patients in the studied groups had sedation scale was 3 starting from the 4th postoperative hour.
We found that only two patients in ketorolac group had emergency agitation. Meanwhile, none patient in dexmedetomidine group developed emergency agitation. We found that majority (90% vs. 86.7%) of both groups developed no adverse events. Bradycardia was reported in two patients of dexmedetomidine and one patient in ketorolac group. Three patients in ketorolac and only one patient in dexmedetomidine group suffered from nausea and vomiting.