Effect of Dexamethasone as an Adjunct on Efficacy of Ropivacaine in Caudal Block for Postoperative Analgesia in Paediatric Infra-Umbilical Surgeries: A Randomised Double-blind Controlled Study

摘要

Caudal block is a routinely performed analgesic and anaesthetic technique in paediatric population undergoing various infra-umbilical surgeries.Various adjuvants have been used along with local anaesthetics like ropivacaine in singleshot caudal block for enhancing postoperative analgesia in paediatric infra-umbilical surgeries.Aim: To evaluate the efficacy of dexamethasone used as an adjuvant to 0.2% ropivacaine in caudal block for postoperative analgesia in paediatric patients.Materials and Methods: This was a randomised doubleblinded controlled study conducted on 80 paediatric patients (8 months-8 years), with American Society of Anesthesiologists (ASA) physical status I or II undergoing various infra-umbilical surgeries,at a tertiary care teaching institute from April 2019 to September 2019.These total subjects were randomly allocated into two groups.Group R (n=40) administered 0.2% ropivacaine (1 mL/kg) while Group RD (n=40) administered 0.2% ropivacaine (1 mL/kg) with dexamethasone (0.1 mg/kg) in caudal block.The duration of analgesia, postoperative pain scores (Face Legs Activity Cry Consolability (FLACC) score), rescue analgesic consumption in 24 hours, haemodynamic changes and sideeffects were noted.The rescue analgesic (paracetamol 15 mg/ kg oral) was given whenever FLACC ≥4.Standard qualitative and quantitative tests (unpaired student t-test, Chi-square test) were used to analyse and compare the results obtained.Results: The mean duration of analgesia was significantly longer in Group RD (745.21±146.91 min) as compared to Group R (440.38±76.44 min); (p-value <0.001).The significantly lower FLACC pain scores were noted in patients in Group RD compared to Group R; (p-value <0.05).The rescue analgesic consumption was significantly lesser in Group RD in terms of requirement of number of doses of rescue analgesic than in Group R; (p-value 0.05).Amongst postoperative complications noted, fever was observed in 1 patient (3.33%) and PONV in 2 patients (6.66%) in Group R.None complications were observed in the patients of RD group.Conclusion: Dexamethasone (0.1 mg/kg) was found to be safe and effective adjuvant to 0.2% ropivacaine for caudal block in children undergoing various infra-umbilical surgeries.