The efficacy of dexamethasone/bupivacaine combination versus plain bupivacaine only for caudal block in paediatric herniotomy:- a comparative study.

Abstract

Background : The duration of caudal anaesthesia in pediatrics surgery have been prolonged with different adjunct, however, they were associated with untoward adverse effects.
Objective: We compared the efficacy of caudal dexamethasone/bupivacaine combination with caudal bupivacaine only for postoperative herniotomy pain.
Method : This was a randomized controlled trial in 84 children, aged 1-5 years with American Society of Anesthesiologists physical status (ASA) 1-11
scheduled for elective unilateral herniotomy under general anaesthesia. They were assigned to received either 0.25% bupivacaine 1ml/kg, (group B) or a mixture of dexamethasone (0.1mg/kg) with 0.25% bupivacaine 1ml/kg, (group BD). Postoperative pain was assessed using a Modified
Objective :  Pain Scale (MOPS) score. Rescue analgesia (oral ibuprofen 5 mg/kg) was administered when MOPS was ≥4.
Results : The mean MOPS was significantly higher in group B than group BD at 2, 6, and 8 hours after surgery; 4.10 ±1.1 versus 2.88 ±0.5, (p =0.001), 3.2 ±1.3 versus 2.60 ±0.9, (p = 0.002), and3.74 ±0.8 versus 2.1 ±1.1, (p =0.004) respectively. The mean time to first analgesic requirement was significantly longer in group BD than group B 478.17 ±27.64 versus 183.67 ±28.43 minutes, (p =0.001). The mean dose of total ibuprofen consumed was significantly higher in group B, 228.82 ±26.26 mg than group BD, 151.90 ±14.91mg, p =0.001.
Conclusion: It's concluded that the addition of 0.1mg/kg dexamethasone to 1ml/kg bupivacaine 0.25% during caudal block significantly prolonged the duration of analgesia, reduced the postoperative pain scores, and the total dose of ibuprofen consumed in the first 24 hours postsurgery.