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Intravenous Dexamethasone Prolongs the Analgesic Effect of Caudal Bupivacaine after Hypospadias Repair Surgery

Background: Dexamethasone has a powerful anti-inflammatory action and has been demonstrated to reduce morbidity after surgery. Objective: The aim of this study was to examine the effects of a single i.v. dose of dexamethasone in combination with caudal block on postoperative analgesia in children. Patients and methods: Sixty pediatric patients (aged 2-10 years) undergoing hypospadias repair surgery were included in this prospective, randomized, double-blinded study at Sohag University Hospital. After induction of general anaesthesia, children received either dexamethasone 0.5 mg ∕ kg (maximum 10 mg) (n=30) or the same volume of saline (n=30) i.v. A caudal anaesthetic block was then performed using 1 ml ∕kg of bupivacaine 0.25% in all patients. Results: After surgery, rescue analgesic consumption, pain scores, and adverse effects were evaluated for 24 h. The time to first administration of acetaminophen (rescue analgesia) was significantly longer in the dexamethasone group (11.35 ± 2.36 hr vs 8.75 ± 1.33 hr) with a significant value of 0.01. Total amount of the analgesia required (paracetamol) was significantly lower in dexamethasone plus caudal block group than the caudal block alone (430 mg vs 680 mg) respectively. Conclusion: Postoperative pain scores were lower in the dexamethasone group and the incidence of adverse effects was similar in both groups. Intravenous dexamethasone 0.5 mg ∕ kg in combination with a caudal block augmented the intensity and duration of postoperative analgesia without adverse effects in children undergoing hypospadias repair surgery.