Background: Postoperative pain management plays a crucial role in patient recovery, with concerns persisting about early postoperative pain, especially in pediatric populations.

Objectives: This study explores the impact of dexmedetomidine infusion, without a bolus dose, on the Surgical Pleth Index (SPI) in children undergoing hypospadias repair.

Methods: Ninety pediatric patients (1-7 years, ASA I-II) scheduled for hypospadias surgery were assigned to receive either dexmedetomidine infusion (0.5 μg/kg/hr) or a control solution. SPI, hemodynamic parameters, analgesic requirements, sedation depth, and various perioperative variables were meticulously assessed.

Results: The dexmedetomidine group exhibited lower SPI, heart rate, and blood pressure, indicating improved nociception control and reduced stress response during surgery. Despite a higher incidence of hypotension and bradycardia, the dexmedetomidine group required less rescue analgesia, had lower FLACC scores, and demonstrated prolonged PACU analgesic duration. Comparable surgical and anesthesia times were noted between the groups.

Conclusions: Dexmedetomidine infusion without a bolus dose significantly impacted SPI, reflecting improved nociception control in pediatric hypospadias surgery. Despite associated side effects, the benefits include reduced rescue analgesia requirements and improved postoperative pain management. These findings contribute to optimizing pain management strategies in pediatric urologic surgery.