Effect of dexamethasone in combination with caudal analgesia on postoperative pain control in day-case paediatric orchiopexy.

BACKGROUND Dexamethasone has a powerful anti-inflammatory action and has demonstrated reduced morbidity after surgery. The aim of this study was to examine the effects of a single i.v. dose of dexamethasone in combination with caudal block on postoperative analgesia in children. METHODS Seventy-seven children (aged 1-5 yr) undergoing day-case orchiopexy were included in this prospective, randomized, double-blinded study at a single university hospital. After inhalation induction of general anaesthesia, children received either dexamethasone 0.5 mg kg(-1) (maximum 10 mg) (n=39) or the same volume of saline (n=38) i.v. A caudal anaesthetic block was then performed using 1.5 ml kg(-1) of ropivacaine 0.15% in all patients. After surgery, rescue analgesic consumption, pain scores, and adverse effects were evaluated for 24 h. RESULTS Significantly, fewer patients in the dexamethasone group required fentanyl for rescue analgesia (7.9% vs 38.5%) in the post-anaesthetic care unit or acetaminophen (23.7% vs 64.1%) after discharge compared with the control group. The time to first administration of oral acetaminophen was significantly longer in the dexamethasone group (646 vs 430 min). Postoperative pain scores were lower in the dexamethasone group and the incidence of adverse effects was similar in both groups. CONCLUSIONS Intravenous dexamethasone 0.5 mg kg(-1) in combination with a caudal block augmented the intensity and duration of postoperative analgesia without adverse effects in children undergoing day-case paediatric orchiopexy. TRIAL REGISTRATION ClinicalTrials.gov. The number of registration: NCT01041378.