DOI: https://doi.org/10.53350/pjmhs2115103491 ORIGINAL ARTICLE P J M H S Vol. 15, No.10, OCT 2021 3491 Intravenous Dexamethasone as an Adjuvant to Caudal Analgesia for Post Herniotomy Pain MUHAMMAD SHARIF 1 , MUHAMMAD ARIF BALOCH 2 , NAZEER AHMED 3 , ZAFARULLAH 4 , YASIR REDA TOBLE 5 1 Registrar Anesthesia, Lateefa Hospital Dubai. 2 Specialist Anesthetist, Hamad Medical Corporation (HMC) Qatar. 3 Associate Consultant Anesthetist, Hamad Medical Corporation (HMC), Qatar. 4 FCPS 5 Senior consultant Anesthetist, HMC Qatar. Correspondence to: Arif Baloch, Email: marifbaloch@gmail.com ABSTRACT Objective: To compare the outcomes of caudal block with or without intravenous dexamethasone in controlling post-herniotomy pain in pediatric population Patients and Methods: A total of 90 patients who underwent inguinal herniotomy were included in this prospective comparative study. The study was conducted in a tertiary care setup in Qatar from Jan-2020 to May- 2021. Patients were randomly allocated to two groups. Group A (dexamethasone) patients received dexamethasone intravenous 0.25 mg/kg in 5 ml of distilled water, 10 minutes before surgery. Group B (control) received 5 ml of normal saline, 10 minutes before surgery. The patients were followed for up to 240 minutes after surgery to determine adequate pain relief. Results: Mean age of the children included in this study was 7.11±1.95 years. There were 46 (51.1%) female children and 44 (48.9%) male children. Adequate post-operative pain relief was achieved in 30 (33.33%) patients, while rescue analgesia was needed in remaining 60 (66.67%) patients. Adequate pain relief was achieved in 24 (53.3%) children in dexamethasone group and in only 06 (13.3%) children in control group (p-value 0.001). Conclusion: In children undergoing herniotomy, Intravenous 0.25 mg/Kg of dexamethasone when used as an adjunct to bupivacaine for caudal block significantly reduces post-operative pain. Keywords: Caudal Block, intravenous dexamethasone, Post-operative pain Relief. INTRODUCTION Pain after surgery adversely effects health outcomes. 1 Untreated pain may have long-term deleterious impacts on pain sensitivity, immunological function, neurophysiology, attitudes, and health-care behavior, according to evidence. 2 When compared to adults, postoperative pain in children was mostly disregarded or undertreated in the 1970s and 1980s. 3 This has been shown to have substantial consequences for children both in the immediate postoperative time and in the extended postoperative term. As a result, diagnosing, monitoring, and treating pain in children is critical. 4 According to reports, up to 40% of children who have surgery experience moderate to severe post-operative pain. 5 Almost all treatments involving the lower abdomen and lower limbs need caudal anesthesia for pre- and post- operative analgesia, particularly in newborns and young children. 6 In pediatric patients, a caudal epidural block is a typical regional approach for providing intra- and post- operative analgesia for surgical operations below the umbilicus. 7 It's often a one-shot approach. The procedure's shortcomings include the procedure's very brief duration of single-shot caudal injection with local anesthetic. 8 Clonidine, midazolam, ketamine, neostigmine, and tramadol are some of the adjuncts that have been added to local anesthetics to prolong analgesia of single-shot' caudal analgesia, but their use has been limited due to unacceptable side effects or safety concerns, especially in preservative-containing agents. 9 Dexamethasone is a corticosteroid that has powerful anti-inflammatory effects. 10 Dexamethasone has traditionally been used in anesthetic treatment to lower the occurrence of post-operative nausea and vomiting (PONV). When given intravenously, dexamethasone has been shown to offer sustained post- operative analgesia7. When paired with a caudal block, intravenous dexamethasone has been shown to improve postoperative analgesia. The aim of this study was to compare the outcomes of caudal block with or without intravenous dexamethasone in controlling post-herniotomy pain in pediatric population. MATERIAL AND METHODS A total of 90 patients who underwent herniotomy were included in this prospective comparative study. The study was conducted in a tertiary care setup in Qatar from Jan- 2020 to May-2021. Patients of age 4-10 years, with ASA status I-II, having inguinal hernia were included. Patients with coagulation disorders as deranged PT, APTT values, INR >1.5, pre-existing neurological disease like cerebral palsy (CP), and spine abnormalities or any infection at the local site were excluded. Approval from ethical committee of the hospital was taken. Patients were randomly allocated in to two groups by lottery method. We used 0.25% Bupivacaine (1ml/kg), 10 minutes before surgery as caudal analgesia in all patients of both groups. Group A (dexamethasone) patients received dexamethasone intravenous 0.25 mg/kg in 5 ml of distilled water, 10 minutes before surgery and note the response in terms of pain relief after the end of surgery up to 240 minutes. Group B (control) received 5 ml of normal saline, 10 minutes before surgery and note the response in terms of pain relief after the end of surgery up to 240 minutes. At the end of surgery post-operative pain was assessed by the resident anesthetist neither involved in study nor in the surgical procedure and recorded in both