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Background and Aims:Dexamethasone has a powerful anti-inflammatory action with significant analgesic benefits. The aim of this study was to compare the efficacy of dexamethasone administered through intravenous (IV) and caudal route on post-operative analgesia in paediatric inguinal herniotomy patients.Methods:One hundred and five paediatric patients undergoing inguinal herniotomy were included and divided into three groups. Each patient received a single caudal dose of ropivacaine 0.15%, 1.5 mL/kg combined with either corresponding volume of normal saline (Group 1) or caudal dexamethasone 0.1 mg/kg (Group 2) or IV dexamethasone 0.5 mg/kg (Group 3). Baseline, intra- and post-operative haemodynamic parameters, pain scores, time to rescue analgesia, total analgesic consumption and adverse effects were evaluated for 24 h after surgery. Unpaired Student's t-test and analysis of variance were applied for quantitative data and Chi-square test for qualitative data. Time to first analgesic administration was analysed by Kaplan–Meier survival analysis and log-rank test.Results:Duration of analgesia was significantly longer (P < 0.001), and total consumption of analgesics was significantly lower (P < 0.001) in Group II and III compared to Group I. The incidence of nausea and vomiting was higher in Group I (31.4%) compared to Group II and III (8.6%).Conclusions:Addition of dexamethasone both caudally or intravenously as an adjuvant to caudal 0.15% ropivacaine significantly reduced the intensity of post-operative pain and prolonged the duration of post-operative analgesia with the significant advantage of caudal over IV route.

Background: Foot surgery is associated with severe pain that can extend significantly up to 48 hours and often requires large amounts of parenteral opioids.. The benefit of adding clonidine to LAs for peripheral nerve blocks is less clear, although it is widely believed that clonidine improves quality and duration of a LA block. The aim of this study was to evaluate the effects of adding 1 mg/kg clonidine to 0.75% ropivacaine during combined sciatic-femoral nerve block for hallux valgus repair. Subjects and Methods: Thirty six ASA physical status I and II patients, scheduled for elective hallux valgus repair under combined sciatic-femoral nerve block, were enrolled in the study. By using a sealed envelope technique, patients were randomly allocated to receive sciatic-femoral nerve block with 30 mL of either 0.75% ropivacaine alone (group Ropivacaine, n 5 15) or 0.75% ropivacaine plus 1 mg/kg clonidine (group Ropivacaine-Clonidine, n 5 15). Standard monitoring was used throughout the study, including noninvasive arterial blood pressure, heart rate, and pulse oximetry. The time from the end of anesthetic injection to resolution of motor block at the ankle of the operated foot and first request for postoperative analgesic was recorded. At discharge from the orthopedic ward and 3 wk after hospital discharge, patients were also evaluated regarding the occurrence of neurological complications. Results: No differences in the time required to achieve surgical anesthesia were observed between patients receiving only 0.75% ropivacaine (10 [5-20] min) and those receiving the ropivacaine-clonidine mixture (10 [5-30] min). The mean time from block placement to first request for pain medication was shorter in group Ropivacaine than in group Ropivacaine-Clonidine (P = 0.03,. No differences in postoperative consumption of ketoprofen were observed between patients. Conclusion: Adding 1mg/kg clonidine to 0.75% ropivacaine provided a 3-h delay in first request for pain medication after hallux valgus repair, with no clinically relevant side effects.

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