Comparison of the Sedative, Recovery, and Analgesic Effects of Oral Dexmedetomidine, Ketamine, and Midazolam for Premedication in Children Undergoing Inguinal Hernia Surgery: A Randomized Double-Blind Study

Abstract

Background: Midazolam is widely used for its anxiolytic and amnestic effects, while dexmedetomidine provides sedation and analgesia, and ketamine induces sedation, analgesia, and amnesia. Oral administration is commonly accepted in children undergoing inguinal hernia surgeries. Objectives: This study aimed to examine oral dexmedetomidine, ketamine, and midazolam as premedication in children having inguinal hernia operations. Methods: This randomized, double-blind study included 60 children (ages 3 - 7, ASA I-II) who underwent inguinal hernia operations. Subjects were randomly assigned to 3 groups: Group K received oral ketamine at 6 mg/kg, group D received oral dexmedetomidine at 4 µg/kg, and group M received oral midazolam at 0.5 mg/kg. Results: No substantial differences were seen in the five-point sedation score (P = 0.2811) or the Parental Separation Anxiety Scale (PSAS; P = 0.1122). Group D had a markedly reduced recovery time in comparison to groups M and K (P < 0.001). Furthermore, group D exhibited markedly reduced face, legs, activity, cry, and consolability (FLACC) scores at 15 and 20 minutes compared with groups M and K (P = 0.001, 0.016, respectively). Conclusions: Oral dexmedetomidine, ketamine, and midazolam provided comparable sedation quality and parental separation ease in children undergoing inguinal hernia surgeries. However, dexmedetomidine showed significant advantages by reducing recovery time and improving postoperative pain scores, despite a higher incidence of bradycardia in some patients. Thus, oral dexmedetomidine appears to be an efficient and safe alternative for pediatric premedication, provided careful heart rate monitoring.