Comparison of Caudal block with bupivacaine alone Versus Caudal block with Bupivacaine and intravenous Dexamethasone for Postoperative Analgesia of pediatrics Patient undergoing infra Umbilical surgery under general anesthesia at Tikur Anbessa Specialized Hospital, Addis Abeba ,Ethiopia,2019.
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Date
2019-06
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Addis Abeba University
Abstract
Background Caudal block is a common regional technique used to provide intra and
postoperative analgesia of infra-umbilical procedures in pediatric patients. However, the
relatively short duration of single shot caudal injection with local anesthetic is amongst the
limitations of the procedure. Addition of various adjuvants has been challenged by unacceptable
adverse effects & safety not being fully established, especially in preservative containing agents.
Objective The aim of this study was to compare effectiveness of caudal block with bupivacaine
alone versus caudal block with bupivacaine and IV dexamethasone for postoperative analgesia of
pediatrics patient undergoing infra-umbilical surgery under General anesthesia at Tikur Anbessa
specialized Hospital.
Method: In this institutional based prospective cohort study total of 60 ASA I and ASA II age of
1-7 years pediatrics patient undergo infra-umbilical surgery that fulfill inclusion criteria was
included. Systematic random sampling technique was applied & they grouped based on their
exposure status. Severity of postoperative pain was measured by FLACC score, duration of
analgesia and total analgesic consumption was assessed up to 24 hours after operation.
Postoperative pain severity & total analgesic consumption was analyzed by Mann-Whitney U
test. Independent sample t test was used for analgesia duration as well as Chi-square test was
used to analyze categorical variables and p value less than 0.05 was considered as statistically
significant.
Result data of 60 patients were analyzed and the result shows postoperative pain severity
presented in median in CB with bupivacaine & IV dexamethasone group was 1.5, 3,6 & 3, 6, 6
in CB with bupivacaine alone group at 4
th
, 6
th
& 12
th
hours with p value of (<0.001, <0.001&
0.003) respectively. Duration of analgesia was also significantly prolonged in CB with IV
dexamethasone group with mean of 699.3 minutes & 347 minutes in CB alone group with p <
0.001. Amount of analgesia given in 24 hours was also significantly reduced in CB with IV
dexamethasone group with p <0.001.
Conclusion and recommendation administration of 0.5mg/kg of intravenous dexamethasone in
combination with caudal block is good alternative to prolong postoperative analgesia in children
undergoing infra-umbilical surgery.
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Keywords
Caudal block, infra-umbilical surgery, IV dexamethasone, pediatrics, postoperative analgesia