Evaluation of caudal dexamethasone with ropivacaine for post-operative analgesia in paediatric herniotomies: A randomised controlled study

Abstract

Background and Aims:Caudal analgesia is one of the most popular regional blocks in paediatric patients undergoing infra-umbilical surgeries but with the drawback of short duration of action after single shot local anaesthetic injection. We evaluated whether caudal dexamethasone 0.1 mg/kg as an adjuvant to the ropivacaine improved analgesic efficacy after paediatric herniotomies.Methods:Totally 128 patients of 1–5 years age group, American Society of Anaesthesiologists physical status I and II undergoing elective inguinal herniotomy were randomly allocated to two groups in double-blind manner. Group A received 1 ml/kg of 0.2% ropivacaine caudally and Group B received 1 ml/kg of 0.2% ropivacaine, in which 0.1 mg/kg dexamethasone was added for caudal analgesia. Post operative pain by faces, legs, activity, cry and consolability tool score, rescue analgesic requirement and adverse effects were noted for 24 h.Results:Results were statistically analysed using Student's t-test. Pain scores measured at 1, 2, 4, and 6 h post-operative, were lower in Group B as compared to Group A. Mean duration of analgesia in Group A was 248.4 ± 54.1 min and in Group B was 478.046 ± 104.57 min with P = 0.001. Rescue analgesic requirement was more in Group A as compared to Group B. Adverse effects after surgery were comparable between the two groups.Conclusion:Caudal dexamethasone added to ropivacaine is a good alternative to prolong post-operative analgesia with less pain score compared to caudal ropivacaine alone.

Caudal and intravenous dexamethasone as an adjuvant to pediatric caudal block: A systematic review and meta‐analysis

“…This analysis included 5 trials with a total of 376 participants, of whom 194 were assigned to THE experimental group (the group receiving caudal block and dexamethasone) and the other 182 to THE control group (the group receiving plain caudal block). With significant heterogeneity ( P < .00001, I2 = 93%), we calculated the overall effects using a random effects model.…”

“…Postoperative wound dehiscence was seen in 1 case from THE experimental group and THE control group, and the 2 patients recovered with conservative care within the 3‐month follow‐up period. Other side effects, such as bradycardia, pruritis, shivering, wound infection, delayed wound healing, and urinary retention, also presented no significant difference between these 2 methods. In our review, the postoperative complications regarding delayed wound healing, dehiscence, or infection were not clearly defined and there were no studies that followed patients long enough to make this determination.…”

“…Six trials (587 participants) reported pain scores after surgeries. There were significant differences between THE experimental group and THE control group in pain scores at different time after surgery as followings: immediately, 30 minutes after surgery; 1 and 2 hours after surgery; 3 hours after surgery; 4 hours after surgery; 6 hours after surgery; 8 hours after surgery; 12 hours after surgery; 16 and 24 hours after surgery; and 48 hours after surgery…”

“…There were 7 trials that reported a number of pediatric patients with various side effects after caudal anesthesia (Table ). Respiratory depression was also observed in 4 trials and nobody happened.…”

“…dexamethasone 0.5 mg/kg (30)0.25% bupivacaine 0.5 mL/kgcaudal dexamethasone 0.1 mg/kg (30)Hong 201080I1‐50.15% ropivacaine1.5 mL/kg (40)0.15% ropivacaine 1.5 mL/kgi.v. dexamethasone 0.5 mg/kg (40)OrchiopexyKim 201380I–II0.5‐50.15% ropivacaine1.5 mL/kg (40)0.15% ropivacaine 1.5 mL/kgcaudal dexamethasone 0.1 mg/kg (40)VunilateralorchiopexyEl‐Feky 2014120I–II3‐10equal mixture0.25% Bupivacaine1% lidocaine0.5 mL/kg (30)equal mixture 0.25% Bupivacaine 1% lidocaine 0.5 mL/kg caudal fentanyl 1 ug/kg (30)equal mixture 0.25% Bupivacaine 1% lidocaine 0.5 mL/kg caudal dexmedetomidine 1 μg/kg (30)equal mixture 0.25% Bupivacaine 1% lidocaine 0.5 mL/kg caudal dexamethasone 0.1 mg/kg (30)Lower abdominal surgeryChoudhary 2016128I–II1–50.2% ropivacaine 1 mL/kg (64)0.2% ropivacaine 1 mL/kg caudal dexamethasone 0.1 mg/kg (64)Infraumbilical surgeriesYousef 2014105I–II1‐60.15% ropivacaine1.5 mL/kg (35)0.15% ropivacaine 1.5 mL/kgcaudal magnesium 50 mg (35)0.15% ropivacaine 1.5 mL/kgcaudal dexamethasone 0.1 mg/kg (35)Inguinal hernia repairArbi 201560I–II3‐100.25% levobupivacaine0.75 mL/kgSuppositoryparacetamol30 mg/kg (30)0.25% levobupivacaine0.75 mL/kg.i.v. dexamethasone 0.5 mg/kgsuppository paracetamol30 mg/kg (30)UnilateralherniotomyASA, American Society of Anesthesiology; i.v., intravenous. Rating scales.…”