Comparison of postoperative pain relief impact between caudal bupivacaine alone and caudal bupivacaine-dexamethasone mixture administration for pediatric local tube urethroplasty

Abstract EN

Objective : To compare the postoperative analgesic influence between caudal bupivacaine only and caudal bupivacaine-dexamethasone combination administration in children undergoing local tube urethroplasty.

Methods : This prospective, randomized and clinical trail investigation included 162 male pediatric patients, classed I by the American society of anesthesiologists, aged 11-14 years and assigned for local tube urethroplasty at Queen Rania Hospital, King Hussein Medical Center, Amman-Jordan, during the year of 2013.

General anesthesia was induced using inhalational sevoflurane / oxygen anesthesia, after which a laryngeal mask airway was inserted and an intravenous line was secured.

All subjects were repositioned to receive caudal sacral block using randomly either plain bupivacaine 0.25 % mixed with normal saline 0.9 % (Group I, n = 80) or plain bupivacaine 0.25 % mixed with dexamethasone 0.1 mg / kg (Group II, n = 82), not exceeding a total volume of 0.5 ml / kg and not exceeding a maximum dose of 2 mg / kg of bupivacaine in both groups, dividing the total volume in ¾ for bupivacaine and ¼ for dexamethasone, saline or both.

Postoperatively, in the recovery room, rectal paracetamol 10 mg / kg was administered if the numerical rating scale was more or equal to four.

Postoperative analgesia quality was assessed.

Statistical discrepancies between the two groups were evaluated using Students t and Chi-square tests.

Variance was used to assess inter-group differences in changes of pain scores.

A value of P < 0.05 was considered significant.

Results : Postoperative mean pain free period was significantly less in group I (186 min) than in group II (272 min) (P < 0.05).The mean time to first rectal paracetamol dose was 192 min.

in group II and 125 min.

in group I (P < 0.05).

Conclusions : The combination of caudal bupivacaine-dexamethasone significantly enhanced the postoperative analgesic profile compared to caudal bupivacaine-saline in children undergoing local tube urethroplasty under combined general-caudal anesthesia.