Background: Effective postoperative pain management in pediatric patients is essential to ensure optimal recovery and reduce complications. Caudal epidural block is widely used for lower abdominal surgeries in children, with ropivacaine, levobupivacaine, and bupivacaine being commonly employed local anesthetics. However, comparative data regarding their efficacy and safety remain limited. Aim: To compare the efficacy and safety of ropivacaine, levobupivacaine, and bupivacaine administered via caudal block in pediatric patients undergoing lower abdominal surgeries. Methods: This prospective randomized controlled trial was conducted at a tertiary care center from February 2025 to January 2026. Pediatric patients aged 1–12 years undergoing elective lower abdominal surgeries were randomized into three groups to receive caudal block with ropivacaine, levobupivacaine, or bupivacaine. Postoperative pain was assessed using age-appropriate pain scales. Primary outcome was duration of analgesia, while secondary outcomes included pain scores, time to first rescue analgesia, and incidence of adverse events. Results: All three groups demonstrated effective postoperative analgesia. The mean duration of analgesia was slightly higher with bupivacaine (13.2 ± 1.8 hours) compared to ropivacaine (12.5 ± 2.1 hours) and levobupivacaine (11.8 ± 2.5 hours). Pain scores were comparable, with ropivacaine showing marginally lower scores in the early postoperative period. The incidence of adverse events was low and similar across groups. Conclusion: Ropivacaine, levobupivacaine, and bupivacaine are effective and safe for pediatric caudal analgesia. While bupivacaine provides slightly prolonged analgesia, ropivacaine and levobupivacaine offer comparable efficacy with favorable safety profiles.

Caudal block, Pediatric anesthesia, Ropivacaine, Levobupivacaine, Bupivacaine, Postoperative analgesia