Key result
IV dexamethasone added to caudal bupivacaine prolongs post-operative analgesia by ~1.5 hours versus bupivacaine alone.
Why the study?
Little is known about the analgesic efficacy of intravenous dexamethasone as an adjuvant to caudal block for post-operative pain relief in children undergoing infraumbilical surgeries.
Does intravenous dexamethasone prolong the duration of post-operative analgesia in children aged 1-5 years undergoing infraumbilical surgeries with caudal block?
RCT (n=110)
Double-blind
Sealed envelope technique
No
Does intravenous dexamethasone prolong the duration of post-operative analgesia in children aged 1-5 years undergoing infraumbilical surgeries with caudal block?
Intravenous dexamethasone 0.3 mg/kg significantly prolongs the duration of post-operative analgesia and reduces total analgesic consumption when used as an adjunct to caudal bupivacaine in children undergoing infraumbilical surgeries.
Supports adjunctive IV dexamethasone in pediatric caudal blocks; extends adult epidural evidence to infraumbilical surgery in young children.
Background: Post-operative pain is of great concern in pediatric age group. Intravenous dexamethasone has been found to be promising in reducing post-operative pain when administered as an adjuvant to epidural anaesthesia in abdominal and orthopedic surgeries. However, little is known about its efficacy in children receiving caudal block for post-operative pain relief. Aims and Objectives: This study aimed to evaluate the analgesic efficacy of intravenous dexamethasone as an adjuvant to caudal block in children posted for infraumbilical surgeries. Materials and Methods: This interventional, double-blinded, randomized controlled study included 110 children aged 1–5 years with American Society of Anesthesiologists Grade I and II undergoing elective infraumbilical surgeries. To test our hypothesis, the superiority of intravenous dexamethasone was compared with the control group. All children received caudal bupivacaine 0.25% (1 mL/kg). Children were randomly allocated to two groups to receive: normal saline 0.075 mL/kg (Group C) and IV dexamethasone 0.3 mg/kg (0.075 mL/kg) (Group D). Post-operative pain scores (Face, Legs, Activity, Cry, and Consolability [FLACC] score), duration of analgesia, post-operative analgesic consumption, and intraoperative hemodynamics were compared. Results: FLACC score was found to be higher in Group C than Group D at all times. The mean FLACC score was significantly less with the study drug compared to the control group (P<0.001). The time to request for first rescue analgesia was significantly less in Group C as compared to Group D (4.01±0.69 h vs. 5.51±0.50 h, P=0.019). The mean total analgesic consumed in the first 24 h was significantly higher in Group C than in Group D (666.09±174.69 mg vs. 384.55±125.04 mg, P=0.015). Hemodynamic parameters were comparable in both the groups. Conclusion: Intravenous administration of dexamethasone 0.3 mg/kg as an adjunct to caudal bupivacaine 0.25% provides significantly longer duration of post-operative analgesia and lesser total analgesic consumption compared to the use of caudal bupivacaine 0.25% alone.
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Gupta et al. (2023) conducted an RCT in Post-operative pain (n=110). Intravenous dexamethasone vs. Normal saline was evaluated on Duration of post-operative analgesia (time to first rescue analgesia) (p=0.019). Intravenous dexamethasone 0.3 mg/kg as an adjunct to caudal bupivacaine significantly prolonged the duration of post-operative analgesia compared to bupivacaine alone (5.51 vs 4.01 hours, P=0.019).
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