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Objectives This study aimed to clinically evaluate and compare the efficacy of caudal epidural bupivacaine in prolonging the postoperative analgesia, with adjuvants like fentanyl or dexmedetomidine among children of Indian genotype. Materials and Methods A prospective double-blind randomized comparative study. The study population of 68 patients of Indian phenotype were randomly taken from a random number table and divided into two groups with 34 patients in each group. They received single shot caudal epidural blocks, with group A receiving 0.75 mL/kg of 0.25% bupivacaine + 1 mcg/kg fentanyl, group B receiving 0.75 mL/kg of 0.25% bupivacaine + 1 mcg/kg dexmedetomidine. Global Assessment of anesthesia, defined as the time from caudal injection to the first administration of rescue analgesia, will be recorded for both the groups. Results The addition of either fentanyl or dexmedetomidine as adjuvants in caudal block provided excellent postoperative analgesia, and sedation was significantly longer duration with dexmedetomidine (18.0 hours) than fentanyl (13.1 hours). We observed good hemodynamic stability in both the groups. Conclusion Addition of dexmedetomidine over fentanyl to bupivacaine for caudal epidural analgesia in pediatric age group has multiple advantages like better control of intraoperative and postoperative hemodynamics, significantly longer duration of postoperative analgesia, lesser bleeding during surgery, and achieving good surgical satisfaction. As the children are pain-free, calm, quiet, and sedated but arousable, the parents’ satisfaction is rewarding. The caudal epidural dose of 0.25% bupivacaine 0.75 mL/kg with adjuvants like dexmedetomidine or fentanyl is effective for postoperative analgesia in lower abdominal surgeries and is without side effects among the Indian population.

Introduction: Agricultural polytrauma injuries in children are rare. Rotating blades of a tractor can cause devastating injuries. Case Report: An 11-year-old male child presented with severe facial avulsion injuries, degloving injury of left lower limb, grade IIIB compound left tibia shaft fracture with a large butterfly fragment, and closed right tibia shaft fracture. General anesthesia through tracheostomy intubation was given. Simultaneous surgical intervention for the face and limbs was performed by a team of experts. The facial injury was debrided and repaired. After thorough debridement, compound left tibia fracture fixation was performed with two interfragmentary screws and neutralizing ankle-spanning external fixator. The closed right tibia shaft fracture was treated with closed elastic intramedullary nailing. Simultaneous debridement of degloving injuries over both thighs was performed and wound closure was done. Subsequently, the patient underwent debridement of wounds and vacuum-assisted closure 3 times with split skin grafting for the left leg. All fractures healed well at 6 months and the child was able to do all activities without any functional limitations. Conclusion: Agricultural injuries in Children can be devastating and should be managed using a multidisciplinary approach at a tertiary care center. A tracheostomy is a viable option for securing the airway in severe facial avulsion injuries. In a hemodynamically stable child, definitive fixation can be performed in a polytrauma situation and an external fixator can be used as a definitive implant in an open long bone fracture. Keywords: Agricultural injury, compound fracture, external fixation, facial avulsion injury, orthoplastic approach, pediatric polytrauma.

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