The Efficacy of Single Dose Intravenous Dexamethasone vs Placebo Combined with Caudal Block on Postoperative Analgesia in Children Undergoing Outpatient Urologic Surgery: A Prospective, Double-Blind, Randomized Study

Janette   Pascual,; Marichu  D. Battad,; Sheila Bianca  M. Santy,

The Efficacy of Single Dose Intravenous Dexamethasone vs Placebo Combined with Caudal Block on Postoperative Analgesia in Children Undergoing Outpatient Urologic Surgery: A Prospective, Double-Blind, Randomized Study

Sheila Bianca M. Santy | Marichu D. Battad | Janette Pascual

Abstract:

BACKGROUND: Pain in the pediatric age is more difficult to assess and treat. Inadequate pain management may produce anxiety and trauma in children and affect not only the surgical outcome but the child‘s overall quality of life and recovery. Advances in various perioperative techniques to provide optimal analgesia continually grow especially in the outpatient setting where there are a significant number of pediatric patients. Caudal block is easy to perform and can be used in combination with general anesthesia. It provides excellent analgesia but is often short-lived. Dexamethasone is a potent synthetic glucocorticoid with anti-inflammatory and anti-emetic properties. The exact mechanism for its analgesic action is said to be related to its strong anti-inflammatory action. OBJECTIVES: The study aims to determine and compare the anxiety of children with acute lymphoblastic leukemia (ALL) and their well siblings based on Child drawing: Hospital manual and to identify factors associated with the level of anxiety. METHODOLOGY: This is a prospective, double-blind, randomized study that included sixty-four patients, aged 3 - 12 years old, ASA I and II, scheduled for outpatient urologic surgery under combined general and regional caudal anesthesia. Patients were randomized into two groups: Group D received 0.5mg/kg (maximum of 16mg) single dose intravenous dexamethasone in 5mL volume and Group P received the same volume of saline after the start of surgery when successful caudal block was determined. Postoperative pain scores using the Wong-Baker Faces Pain Rating Scale and vital signs were monitored at the PACU at hourly intervals until discharge. The time to first rescue analgesic and the total analgesic consumption given at home for forty-eight hours were recorded. RESULTS: Group D showed significantly longer block duration and time to rescue analgesic and lesser analgesic consumption. CONCLUSION: A single dose intravenous dexamethasone combined with caudal block effectively prolongs duration of caudal block and time to first rescue analgesic and lessens analgesic consumption in children undergoing outpatient urologic surgery.

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