International Journal of Scientific Reports | February 2024 | Vol 10 | Issue 2 Page 34 International Journal of Scientific Reports George AF et al. Int J Sci Rep. 2024 Feb;10(2):34-41 http://www.sci-rep.com pISSN 2454-2156 | eISSN 2454-2164 Original Research Article Analgesic effects of caudal versus intravenous dexamethasone on bupivacaine based caudal block for paediatric infraumbilical surgeries Abiye F. George, Alfred T. Aggo* INTRODUCTION Providing adequate postoperative analgesia safely to children through simple, cost effective techniques, without triggering systemic upheaval is a desirable goal for paediatric anesthesiologists. Caudal block, following its description for paediatric urological procedures by Campbell in 1933, has evolved to become one of the most common and effective regional blocks used in children undergoing infraumbilical srgeries. 1,2 It is perhaps the most easily learned and mastered of all regional anesthetic techniques. Jӧhr and co-workers have shown that only 32 blocks are needed for an anesthetist registrar to reach about the same level of skill as older and more experienced colleagues. 3 The reliability and simplicity of a single-shot caudal block technique notwithstanding, the associated relatively short postoperative analgesic duration poses gross limitation. 3 Edomwonyi and Egwakhide 4 in their study did not find single-shot caudal bupivacaine superior to local infiltration adjacent to the ilioinguinal and iliohypogastric nerves for postoperative pain management in children. Besides, the continuous catheter technique for prolonging analgesia raises concerns about infection due to its proximity to the anorectal area. 5 Therefore, to achieve prolonged postoperative analgesic ABSTRACT Background: Singleshot caudal block provides short lived postoperative analgesia necessitating continued exploration for adjuvants. Aim was to compare the analgesic efficacy between intravenous and caudal dexamethasone on bupivacaine based caudal block for paediatric infraumbilical surgeries. Methods: Following ethical clearance and parental consent, 69 children aged 1-6 years, of American society of anesthesiologists (ASA) physical status classification I and II were randomized into groups A, B and C, of 23 each. All subjects underwent laryngeal mask airway (LMA) general anaesthesia induced with propofol and maintained with isoflurane in 100% oxygen, and had caudal block with 1 ml/kg bupivacaine 0.25%. Additionally, groups B and C received caudal 0.1mg/kg and intravenous preinduction 0.25 mg/kg dexamethasone, respectively. Pain was assessed using FLACC scale. The time to first analgesic request (TTFAR) was defined as the interval from caudal injection until pain score was ≥4; at this point, analgesic was given. Results: All 69 children were completely studied. The mean TTFAR (in minutes) was longest in Group B (485.40±24.50) followed by C (459.60±36.40), and shortest in group A (253.63±71.55), p=0.001, 0.024 and 0.968 for A versus B, A versus C and B versus C respectively, with greatest 24 hours pethidine consumption in Group A relative to groups B and C, p=0.001 and 0.025. Conclusions: Caudal 0.1 mg/kg or intravenous 0.25 mg/kg dexamethasone combined with bupivacaine significantly prolonged postoperative analgesic duration, with comparable analgesic profile between the caudal and intravenous routes, and without adverse effects. Keywords: Caudal block, Dexamethasone, Infraumbilical surgeries Department of Anaesthesia, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria Received: 12 December 2023 Accepted: 06 January 2024 *Correspondence: Dr. Alfred T. Aggo, E-mail: alfred.aggo@uniport.edu.ng Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. DOI: https://dx.doi.org/10.18203/issn.2454-2156.IntJSciRep20240045