Abstract
DEXAMETHASONE AS AN ADJUVANT TO CAUDAL ROPIVACAINE FOR POSTOPERATIVE ANALGESIA IN CHILDREN UNDERGOING INFRAUMBILICAL SURGERIES

Salma Maryam, Rohey Jan*, Azka Sunain, Khalid Sofi, Abdul Qayoom Dar, Waseem Raja, Zaheer

ABSTRACT

Introduction: 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. Aims & Objectives: We evaluated whether caudal Dexamethasone 0.1 mg/kg as an adjuvant to the Ropivacaine improved analgesic efficacy after paediatric infraumbilical surgeries. Material & Methods: This Prospective, randomized, double-blind study was conducted in the department of Anaesthesiology and Critical Care SKIMS Srinagar, J&K over a period of two years from june 2013 to june 2015 following approval from institutional ethical committee and written informed parental consent. The Sample size of 100 patients of 1–8 years age group, belonging to American Society of Anaesthesiologists (ASA) physical status I and II undergoing elective infraumbilical surgeries were randomly allocated into two groups in double-blind manner. Group A (control group, n =50) received 1 ml/kg of 0.2% ropivacaine caudally and Group B (study group, n = 50) received 1 ml/kg of 0.2% Ropivacaine, in which 0.1 mg/kg Dexamethasone was added for caudal analgesia. Post operative pain score, rescue analgesic requirement and adverse effects were noted for 24 hours. Results: Postoperative Pain scores by using Faces, Legs, Activity, Cry, and Consolability tool (FLACC & CHEOPS) measured at 0 minute, 30 minutes, 1, 2, and 3 hours post- surgery, were significantly lower in Group B (study group) as compared to Group A (control). Furthermore, the number of subjects who remained pain free up to 24 hours after operation was significantly greater in Group B (study group) than in Group A. Rescue analgesic requirement was less in Group B (Study group) as compared to Group A. The number of subjects who received oral analgesic was significantly lower in Group B (Study group), [12 out of 50 patients, than in Group A [26 of 50 patients], with significant P value = 0.004]. Mean time to first rescue analgesic administration after surgery was also significantly longer in Group B than in Group A, (10.17 ± 2.29 hours Vs 6.58 ± 1.63 hours with Significant P value of < 0.001. Adverse effects after surgery includes nausea and vomiting 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.

Keywords: Caudal block, Dexamethasone, infraumbilical surgeries, Ropivacaine.


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