Postoperative analgesic efficacy of caudal dexamethasone added to bupivacaine vs bupivacaine alone for pediatric elective infra-umbilical surgery at (Tikur Anbesa Specialized Hospital), Ethiopia: Prospective cohort study

Abstract

Background: Caudal block is the most preferred technique of postoperative analgesia in pediatrics, despite its limited duration of action. Many additives are used to improve the efficacy of caudal blocks, such as opioids or α2 agonists. Recently, there has been increased use of caudal dexamethasone as postoperative analgesia. Objective: To assess the efficacy of adding caudal dexamethasone on bupivacaine for postoperative analgesia in pediatric infra-umbilical surgery. Method: A prospective cohort study design was employed for two equal groups of 30 children aged 1–14 years scheduled for infra-umbilical surgery under caudal bupivacaine; those exposed to dexamethasone (BD) were considered to be the exposed group and those exposed to bupivacaine alone (B) were the non-exposed group. Pain severity, first analgesia request time as well as analgesic consumption were assessed using Mann-Whitney U test for 24 h. Chi-square test was used to analyze the homogenous categorical independent variables between these two groups and a p-value less than 0.05 was considered to be statistically significant. Result: The dexamethasone with bupivacaine group had significant prolonged postoperative analgesia with a median of 915 (650–1,440) minutes compared with 433 (328–555) minutes in the bupivacaine-alone group (p < 0.001). Moreover, the total analgesic consumption was significantly lower in the dexamethasone group with a median total dose of 55 (0–250) mg compared with 402 (95–812) mg in the bupivacaine group with (p < 0.001). Pain score in the dexamethasone group was reduced, being statically significant at 4th, 8th and 12th hrs. Conclusion: Dexamethasone with bupivacaine decreases postoperative pain severity and total analgesic consumption and prolongs the duration of analgesia. Therefore, we recommend the use of caudal dexamethasone with bupivacaine as an effective option for postoperative analgesia. Highlights:

A Comparative Study on Caudal Bupivacaine with and without Tramadol for Analgesia Postoperatively in Paediatric Inguino Scrotal Surgeries

“…Prosser et al stated that the adding of 2 mg / kg tramadol to caudal bupivacaine resulted in an prolong duration of anesthesia. The tramadol addition did not significantly lengthen the effect of caudal bupivacaine [20][21] . Young age, administration of different concentrations of intravenous inhalations, and the use of different methods of pain assessment and sedation may explain differences in the total dose of analgesia prescribed in different studies.…”

Review of clinical evidence of caudal block for postoperative analgesia in children with ketamine added local anesthetics

“…Ketamine is a good alternative to be an adjuvant to caudal block in pediatric postoperative pain treatment, but fentanyl, neostigmine, and dexamethasone are being clinically practiced in Ethiopia and other resource-poor areas [ [27] , [28] , [29] ]. In many nations, the rationale for the underuse of ketamine for a caudal block concerns neurotoxicity, dose, and uncertainty associated with the child's age, among other factors.…”

Comparison of Intravenous Dexamethasone along with Caudal Block versus Caudal Block Alone for Postoperative Analgesia in Pediatric Lower Abdominal Surgeries

“…6 Similarly, other studies have revealed that the administration of dexamethasone in the epidural space effectively prolongs the duration of caudal block. [7][8][9][10] However, in a meta-analysis; IV dexamethasone was recommended over caudal dexamethasone for prolonging the analgesic duration of caudal epidural block as there was a risk of potential neurotoxicity from administering Dexamethasone in the epidural space. 11 On the other hand various other studies have shown intravenous (IV) Dexamethasone to effectively prolong the duration of caudal block.…”