Comparison between low-dose intravenous and caudal dexamethasone as adjuvants to caudal bupivacaine in children undergoing lower abdominal surgeries

Abstract

Background Caudal block is the most common regional anesthetic technique performed for analgesia for pediatric surgeries. The aim of this study was to evaluate dexamethasone through intravenous and caudal routes as adjuvants to caudal block for postoperative analgesia for pediatric patients who underwent lower abdominal surgeries. Patients and methods This prospective, randomized, double-blinded controlled study included 150 children who were divided into three equal groups. All patients received caudal analgesia with 0.125% hyperbaric bupivacaine 1 ml/kg. Group C received an intravenous injection of 10 ml normal saline, group D received 0.1 mg/kg dexamethasone added to the caudal analgesia, and 10 ml normal saline intravenous, while group IV received dexamethasone 0.1 mg/kg in 10 ml normal saline intravenous. The primary outcomes were the duration and severity of postoperative pain. The amount of rescue analgesic doses, residual motor block, and side effects such as nausea, vomiting, and hyperglycemia (secondary outcomes) were monitored. Results Dexamethasone groups (D, IV) showed a significantly prolonged duration of postoperative analgesia in comparison to the control group (C) and group D showed a longer duration of analgesia and delayed analgesic rescue when compared with the dexamethasone IV group. CHIPPS was the least in group D compared with group C and group IV at 3, 6, 12, and 24 h. Postoperative nausea and vomiting were significantly lower in group IV compared with the other two groups. Conclusions Dexamethasone either caudal or low-dose intravenous was effective for prolonging the duration of analgesia from caudal blockade with bupivacaine, while caudal dexamethasone was more effective. Intravenous dexamethasone had the upper hand in decreasing postoperative nausea and vomiting.