Background: Caudal block is the most commonly used technique providing intra and postoperative analgesia for various pediatric Infraumblical surgical procedures, but with the disadvantage of short duration of action after single injection.

Objective: The objective of this study was to examine the effects of single dose i.v Dexamethasone in combination with caudal block for post operative analgesia in children undergoing Infraumblical surgeries.

Methods: This was a prospective randomized controlled study conducted in patients aged between 1- 6 years scheduled for Infraumblical surgeries. A total of   Sixty patients were randomized into two groups. Group A received i.v 0.25 mg/kg Dexamethasone in 5ml solution, where as Group B received an equivalent volume of i.v normal saline. All patients received caudal block with 1ml/kg of 0.2% ropivacaine. Postoperative pain was assessed and recorded in these patients using time to rescue analgesia, pain scores and adverse effects (if any), were documented for 24 hrs post operatively. Data were analyzed using SPSS IBM software version 21 (IBM SPSS Advanced Statistics; Chicago, IL, USA).   

Results: A total of sixty patients were analyzed with a mean age of (4.3±2.1) and (3.9±2.6) years in the groups A and B respectively. Time to rescue analgesia (TRA) was 635 min and 410 min in Group A and Group B respectively (p<0.05). Postoperatively there was statically significant difference in the pain scores between the two groups at the end of surgery (0 hrs) , 30min,  1 hr, 2hrs, 4hrs, 6hrs, 8hrs, 12hrs and 24hrs after surgery (p<0.05). Analgesic consumption within 24hrs post operatively was also low in Dexamethasone group as compared to control group with statically significant differences (p<0.05).  

Conclusions: The use of Intravenous Dexamethasone 0.25 mg/kg in combination with a caudal block prolonged the duration of analgesia, reduced pain score and analgesic consumption postoperatively in Children undergoing Infraumblical  surgeries in children.

Keywords:  caudal; analgesia, postoperative pain; Dexamethasone; paediatric surgeries, Infraumblical surgeries.

1. Motoyama EK, Davis PJ, editors. Special characteristics of paediatric anaesthesia. In: Smith’s Anaesthesia for Infants and Children. 7th ed. Philadelphia: Elsevier; 2005.
2. Bösenberg AT, Jöhr M, Wolf AR. Pro con debate: The use of regional vs systemic analgesia for neonatal surgery. Paediatr Anaesth 2011;21:1247‑58.
3. Constant I, Gall O, Gouyet L, Chauvin M, Murat I. Addition of clonidine or fentanyl to local anaesthetics prolongs the duration of surgical analgesia after single shot caudal block in children. Br J Anaesth 1998;80:294‑8.
4. Semple D, Findlow D, Aldridge LM, Doyle E. The optimal dose of ketamine for caudal epidural blockade in children. Anaesthesia 1996;51:1170‑
5. Cook B, Grubb DJ, Aldridge LA, Doyle E. Comparison of the effects of adrenaline, clonidine and ketamine on the duration of caudal analgesia produced by bupivacaine in children. Br J Anaesth 1995;75:698‑701.
6. El‑Hennawy AM, Abd‑Elwahab AM, Abd‑Elmaksoud AM, El‑Ozairy HS, Boulis SR. Addition of clonidine or dexmedetomidine to bupivacaine prolongs caudal analgesia in children. Br J Anaesth 2009;103:268‑
7. Mohamed SK, Ibraheem AS, Abdelraheem MG. Preoperative intravenous dexamethasone combined with glossopharyngeal nerve block: role in paediatric postoperative analgesia following tonsillectomy. Eur Arch  Otorhinolaryngol 2009; 266: 1815–9
8. Hanasono MM, Lalakea ML, Mikulec AA, Shepard KG, Wellis V, Messner AH. Perioperative steroids in tonsillectomy using electrocautery and sharp dissection techniques. Arch Otolaryngol Head Neck Surg 2004; 130: 917–21
9. Hargreaves KM, Costello A. Glucocorticoids suppress levels of immunoreactive bradykinin in inflamed tissue as evaluated by microdialysis probes. Clin Pharmacol Ther 1990;48:168‑78.
10. Hong D, Byers MR, Oswald RJ. Dexamethasone treatment reduces sensory neuropeptides and nerve sprouting reactions in injured teeth. Pain 1993;55:171‑81.
11. Ferreira SH, Cunha FQ, Lorenzetti BB, Michelin MA, Perretti M, Flower RJ, et al. Role of lipocortin‑1 in the anti‑hyperalgesic actions of dexamethasone. Br J Pharmacol 1997;121:883‑8.
12. Hong JY, Han SW, Kim WO, Kim EJ, Kil HK. Effect of dexamethasone in combination with caudal analgesia on postoperative pain control in day‑case paediatric orchiopexy.Br J Anaesth 2010;105:506‑
13. Yousef GT, Ibrahim TH, Khder A, Ibrahim M. Enhancement of ropivacaine caudal analgesia using dexamethasone or magnesium in children undergoing inguinal hernia repair.Anesth Essays Res 2014;8:13‑
14. Murni Sari Ahmad A, Azarinah I, Esa K, Khairulamir Z, Hamidah I, Norsidah Abdul M. Intravenous Dexamethasone in combination with caudal block prolongs postoperative analgesia in pediatric daycare surgery. Middle East J Anaesthesiol 2015;23:177‑83.
15. Desmet M, Braems H, Reynvoet M, Plasschaert S, Van Cauwelaert J, Pottel H, et al. V. and perineural dexamethasone are equivalent in increasing the analgesic duration of a single‑shot interscalene block with ropivacaine for shoulder surgery: A prospective, randomized, placebo‑controlled study. Br J Anaesth 2013;111:445‑52.
16. Cummings KC 3rd, Napierkowski DE, Parra‑Sanchez I, Kurz A, Dalton JE, Brems JJ, et al. Effect of dexamethasone on the duration of interscalene nerve blocks with ropivacaine orbupivacaine. Br J Anaesth 2011;107:446‑
17. Vosdoganis F, Baines DB. The effect of single dose intravenous dexamethasone in tonsillectomy in children. Anaesth Intensive Care 1999; 27: 489–92
18. Giannoni C, White S, Enneking FK. Does dexamethasone with preemptive analgesia improve paediatric tonsillectomy pain? Otolaryngol Head Neck Surg 2002; 126: 307–15
19. Bharath Srinivasan, Rakesh Karnawat, Sadik Mohammed1, Bharat Chaudhary, Anil Ratnawat, Sunil Kumar Kothari, Comparison of caudal and intravenous dexamethasone as adjuvants for caudal epidural block: A double blinded randomised controlled trial, Indian Journal of Anaesthesia, July 13, 2019 IP: 110.224.15.110.

Dr Fauzia Shifaat

Assistant Professor, Department of Anesthesiology & Critical Care, Govt. Medical College, Srinagar, India