Postoperative analgesic efficacy of caudal dexamethasone added to bupivacaine for pediatric elective infra umbilical surgery at tikur anbesa specialized hospital, Addis Ababa, Ethiopia, prospective cohort study.
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Date
2018-06
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Addis Ababa Universty
Abstract
Background: - Caudal block is the most preferred techniques of postoperative analgesia in pediatrics, despite limited duration of action. Many additives are used to improve the efficacy of caudal blocks, such as opioids or α2 agonists. Recently, increased use of caudal dexamethasone as post-operative analgesia.
Objective: - To assess the efficacy of adding caudal dexamethasone to bupivacaine on postoperative analgesia in pediatric infra-umbilical surgery at Tikur Anbesa specialized hospital.
Method: - Cohort study design was employed from December,01,2017–February 30, 2018, G.C in two equal group of 30 children aged 1-14 years. Scheduled for Infraumbilical surgery under caudal bupivacaine with dexamethasone as exposed and bupivacaine only as a non-exposed group, based on the independent decision of anesthetist. Pain severity, first analgesia request time as well as analgesic consumption were assessed for 24hrs.Mann –Whitney U test was used to compare the pain severity, first analgesia request time as well as analgesic consumption between the groups in the postoperative time for 24 hours. 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 as statistically significant.
Result: - This study found that dexamethasone with bupivacaine has prolonged postoperative analgesia with a median duration of 15.25 hours compared to 7.2hours in bupivacaine alone. Moreover, total analgesic consumption was lower in dexamethasone group with a median total dose of 55mg compared with 402 mg in bupivacaine group with statistically significant difference within 24 hours (p<0.001). Also, reduced the pain score in dexamethasone group, Being statically significant at 4th, 8th and 12th hours.
Conclusion and Recommendation: -We found dexamethasone with bupivacaine decrease postoperative pain severity, total analgesic consumption and prolong the duration of analgesia. Based on our finding we recommend the use of caudal dexamethasone with bupivacine as effective postoperative analgesia in our setup.
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Keywords
Caudal Anesthesia, Infra Umbilical Surgery, Caudal Dexamethasone, analgesic efficacy.