Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 0 0 2026 01 01 1363 1363 Mamta Sharma Department of Anaesthesiology, SMS Medical College, Jaipur, Rajasthan, India. Kirandeep Kaur Department of Anaesthesiology, SMS Medical College, Jaipur, Rajasthan, India. & Department of Anaesthesiology, Fortis Hospital, Kangra, Himachal Pradesh, India. Ajay Ajay Department of Anaesthesia and Pain Medicine, AIIMS Gorakhpur, Uttar Pradesh, India. 2025 08 03 2025 09 13 Background: Postoperative pain following lumbosacral spine surgery is often intense and may hinder early recovery and ambulation. Caudal epidural analgesia using local anesthetics, particularly when combined with adjuvants, has shown potential in enhancing pain control. Dexmedetomidine which has a high affinity for α2-adrenergic receptors, may augment the analgesic effects of ropivacaine and extend its duration. To evaluate the effectiveness and safety of caudal epidural administration of ropivacaine alone versus ropivacaine combined with dexmedetomidine in patients undergoing lumbosacral spine surgery under general anesthesia. Methods: A total of 60 adult patients (ASA I–II) scheduled for elective lumbosacral spine procedures were enrolled in this prospective, randomised, double-blind trial. Participants were assigned to two groups. One group received 20 mL of 0.2% ropivacaine, and another group received 18 mL of 0.2% ropivacaine with 2 mL of dexmedetomidine (1 µg/kg). Pain scores, time to first rescue analgesia, sedation levels, hemodynamic parameters, and adverse events were monitored. Statistical evaluation was carried out with SPSS version 21, with significance set at p < 0.05. Results: Patients who received dexmedetomidine showed lower pain scores at 4, 8, and 12 hours after surgery. Their average duration of postoperative analgesia was also longer (23.00 ± 4.33 hours) when compared with the control group (15.13 ± 1.74 hours). Sedation profiles and intraoperative hemodynamics were largely similar in both groups. No clinically important adverse effects, such as hypotension, bradycardia, or respiratory compromise, were observed. Conclusion: Incorporating dexmedetomidine into a caudal epidural block with ropivacaine provides more effective postoperative pain relief without significant side effects. https://aacc.tums.ac.ir/index.php/aacc/article/view/1363