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EFFECTS OF INTRAVENOUS DEXAMETHASONE COMBINED WITH CAUDAL ANALGESIA ON POST OPERATIVE PAIN CONTROL IN DAY CASE PAEDIATRIC INGUINAL HERNIOTOMY
ABSTRACT
Many surgical procedures in children are of short duration and are increasingly being
performed on day-case basis with consequent need for adequate post-operative pain relief.
Caudal analgesia for post-operative pain relief in paediatric day-case surgery has been
found to be of short duration, hence the need for addition of adjuncts to prolong the
analgesia.
This prospective, double-blind, randomized-controlled study compared the duration of
analgesia when intravenous dexamethasone was administered in addition to caudal block
versus caudal block alone in children.
Methodology
After institutional ethical approval was obtained, ninety-four male children, who were
American Society of Anesthesiologists’ (ASA) physical status I or II, aged between 1 and
7 years scheduled for day case herniotomy were recruited into the study, after due consent
from parent or guardian. The children were randomized into Group A (dexamethasone)
and Group B (normal saline) using simple balloting by sealed envelopes. All patients had
general anaesthesia and intravenous access was obtained. Pre-operative blood sugar
sample was also determined with a glucometer. Children in group A received intravenous
0.25 mg kg-1 dexamethasone presented in 5 ml solution, while those in group B received
intravenous 5 ml normal saline solution after induction of anaesthesia.
All patients had caudal block aseptically after induction of anaesthesia, with 1 ml kg-1
0.25% bupivacaine. Surgery commenced 15-20 minutes later, and halothane adjusted as
tolerated. Patients were monitored into the post-operative period. In the PACU, in addition
to the vital sign monitoring, pain intensity was assessed on arrival (baseline), at 30
minutes, then every hour until discharge, using the Objective Pain Scale (OPS).
Pentazocine 0.5 mg Kg-1 was given when OPS was ≥ 4. They were discharged home on
oral paracetamol 20 mg kg-1 when they satisfied the discharge criteria.
Result
The groups were comparable with respect to demographic characteristics, haemodynamic
variables and blood glucose levels. The time to first analgesic (TFA) request was
654.18±31.56 minutes in group A and 261.50±10.82 minutes in group B, p<0.0001.
In PACU, the mean baseline OPS in group A was 2.01 ± 0.11, compared to 3.10 ± 0.22 in
group B, p<0.0001. At 240 minutes post-operatively, the group A patients had a mean
OPS of 0.42 ± 0.20 and group B, had a value of 1.34 ± 0.20, p<0.0001. Four patients in
group B and none in group A, received rescue pentazocine in the PACU, p = 0.64. Time to
first micturition was 241.91 ± 86.24 minutes in group A and in group B was 326.00
±168.65 minutes p=0.003.
At home, the mean pain score, using the numeric rating scale (NRS) was 3.06 ± 1.15 in
group A and 4.15 ± 0.86 in group B, p< 0.0001. The mean total Paracetamol consumption
was 7.66 ± 3.59 ml in group A compared to 11.06 ± 4.03 ml in group B, p < 0.0001.
(Paracetamol 125mg/ 5ml by Emzor Pharmaceuticals).
Conclusion
There was statistically significant prolongation of duration of analgesia when intravenous
dexamethasone was combined with caudal epidural bupivacaine compared to caudal
bupivacaine alone in patients scheduled for day-case herniotomy. The OPS and the NRS
scores were lower in the dexamethasone group. There was also a significant difference in
the amount of oral paracetamol consumption between the two groups post-operatively.
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