Bangash L R, Afzal F, Hussain S, Ali K.
Comparison of caudal block alone with caudal block plus intravenous dexamethasone for postoperative analgesia in children undergoing orchidopexy under general anaesthesia.
Biomedica Jan ;30(4):267-71.

Background: Caudal block involves injection of local anaesthetic in the caudal epidural space and is commonly used for providing analgesia in children undergoing infra-umbilical surgeries like orchidpexy. The role of intravenous dexamethasone in prolonging the duration of caudal block is a new concept. Prolonged duration of analgesia not only keeps the patient pain free for an extended period of time but also reduces the cost of treatment when it comes to analgesic drugs and duration of hospital stay. Objective: To compare the efficacy of caudal block alone with caudal block plus intravenous dexamethasone for postoperative analgesia in children undergoing orchidopexy under general anaesthesia. Methodology: In this randomized controlled trial 100 children (ages 1 – 5 years) planned to undergo orchidopexy were randomly allocated to two groups A and B. In both groups after induction with halothane and succinylcholine 1.5 mg/kg, caudal block was performed by injecting 0.25% bupivacaine 0.5 ml/kg using a 22 gauge needle. Patients in group A were also given injection dexamethasone 1.5 mg/kg intravenously. Surgery was allowed to proceed 10 minutes after caudal block in both groups. Postoperative pain was assessed in both groups using FLACC score 5 minutes after extubation and then after every 30 minutes till a FLACC score of 5 was obtained at which point first dose of acetaminophen was given. Time to first analgesic dose was noted in both groups and compared using Independent sample t test. Results: Mean duration of analgesia turned out to be 621.60 ± 25.743 and 402.40 ± 34.792 in group A and group B respectively with a P value of < 0.0001. Conclusion: Dexamethasone, when given intravenously just after caudal block is administered, effectively prolongs the duration of caudal block in paediatric patients undergoing orchidopexy.

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