Controlling postoperative pain and vomiting in children remains a great challenge.
Objective: Study the efficacy of adding dexamethasone to caudal bupivacaine on postoperative
analgesia and vomiting.
Study Design: Prospective, randomized double blind controlled clinical trial.
Setting: Assiut University Hospital.
Patients: Ninety children ASA I-II, undergoing lower orthopedic surgeries.
Methods: Patients were randomly allocated into 3 equal groups. All received caudal block after
induction of anesthesia with 0.5 mL/kg of 0.25% bupivacaine in addition to 5 mL intravenous (IV)
normal saline in the control group, IV 0.5 mg/kg dexamethasone in IV dexamethasone group and
lastly 0.1 mg/kg dexamethasone in the caudal dexamethasone group. Postoperative pain scores
and rescue analgesic consumption were recorded. Blood glucose, postoperative vomiting, and
other side effects were evaluated up to 24 hours after extubation.
Results: The time of first analgesia and the number of patients requiring rescue analgesics were
significantly decreased with intravenous or caudal dexamethasone. No significant increase in
postoperative blood glucose levels were observed. A significant increase in β- Endorphin level at 3
and 24 hours postoperative was found in both dexamethasone groups when compared with the
preoperative baseline value. The incidence of postoperative vomiting was significantly decreased
in both dexamethasone groups in comparison with the control group. No other side effects were
detected.
Limitations: Measurement of serum cortisol.
Conclusion: Analgesic and antiemetic effects of dexamethasone as an adjunct to caudal block
with bupivacaine (0.25%) 0.5 mL/kg is similar whether administered intravenously 0.5 mg/kg or
caudally 0.1 mg/kg.