Comparison of Ropivacaine Alone versus Ropivacaine with Dexamethasone in Caudal Block for Pediatric Post-operative Analgesia

Background: Caudal block is a regional anesthesia technique most commonly used for post-operative analgesia in children undergoing infraumbilical surgeries. The local anesthetics used in caudal block have the shortcoming of less duration of action which can be increased by adding adjuncts. The aim of our study was to compare the duration of post-operative analgesia when 0.2% ropivacaine versus 0.2% ropivacaine with dexamethasone is administered caudally in pediatric patients undergoing infraumbilical surgeries. Materials and Methods: The study included 80 patients of 1-8 years age group of ASA Status I undergoing infraumbilical surgery allocated randomly into two groups of 40 each in double-blinded manner after ethical committee clearance and parent’s/ legal guardians consent. After securing airway with laryngeal mask airway under standardized general anesthesia Group R received 0.2% ropivacaine 1 ml/kg and Group RD received 0.2% ropivacaine 1 ml/kg with 0.1 mg/kg dexamethasone for caudal analgesia according to group allocated. Post-operative pain was assessed by objective pain scale and face, legs, activity, cry and consolability behavioral pain assessment scale for 24 h. Motor recovery and side effects were noted. The hemodynamics, duration of post-operative analgesia and number of rescue analgesia needed was noted and analyzed statistically. Results: Mean duration of analgesia in Group R was 324 ± 55.6 min and in Group RD was 1278 ± 304.4 min with P = 0.000. The number of subjects who remained pain-free up to 24 h postsurgery was significantly higher in Group RD than in Group R. Conclusion: Dexamethasone added to ropivacaine for caudal block has significantly improved analgesic efficacy and increased the duration of post-operative analgesia in children undergoing infraumbilical surgery.