Intravenous Dexamethasone in Combination with Caudal Block Prolongs Postoperative Analgesia in Pediatric Daycare Surgery.

BACKGROUND This study was conducted to determine if intravenous dexamethasone combined with caudal block was able to prolong post-operative analgesia in pediatric daycare surgeries. METHODS Sixty four ASA I or II children aged 3 to 10 year old scheduled for daycare open unilateral herniotomy received general anesthesia and caudal block using 0.25% levobupivacaine 0.75 mg.kg(-1) with suppository paracetamol 30 mg.kg(-1). After anesthesia induction, they were randomized to receive either intravenous dexamethasone 0.5 mg.kg(-1) (Group I) or same volume intravenous normal saline (Group II). Postoperatively, pain scores were assessed using Wong- Baker faces scale. At home, their parents assessed and recorded the pain scores, time to first oral paracetamol served and frequency of paracetamol given in two consecutive days post surgery. On the third postoperative day, these information were gathered from the parents via a phone call. RESULTS There were statistically significant differences between Group I and Group II in the median time to first paracetamol (800 vs 520 min, p = 0.01), mean pain scores postoperative day 1 (1.9 ± 2.0 vs 3.5 ± 2.2, p = 0.05), mean pain score-postoperative day 2 (0.8 ± 1.6 vs 2.3 ± 2.0, p = 0.03) and mean frequencies of paracetamol given on postoperative day 2 (0.3 ± 0.8 vs 1.1 ± 1.0, p = 0.02). CONCLUSION A single intravenous dexamethasone dose when combined with caudal block reduces postoperative pain, decreases paracetamol requirement and prolongs analgesic duration in children after open herniotomy.