Comparative evaluation of fentanyl and dexamethasone as an adjuvant to bupivacaine for caudal analgesia in children undergoing infra-umbilical surgery

Abstract

Background: Caudal analgesia is the most commonly used technique providing intra and postoperative analgesia for various infra-umbilical surgeries for paediatric patients. Main disadvantage of single dose caudal block with local anesthetic alone is its short duration of action. To overcome this limitation, several adjuvants have been added to local anaesthetic agent to prolong the duration of analgesia. Aims and Objectives: To compare the effectiveness of caudal Bupivacaine, Bupivacaine + Fentanyl and Bupivacaine + Dexamethasone for intraoperative hemodynamic stability, duration of analgesia, total analgesic requirement in first 24 hours, postoperative sedation and side-effects.Materials and Methods: The study was conducted on 150 children of ASA I and II physical status aged 1 to 6 years undergoing elective infra-umbilical surgeries. The patients were randomly allocated into 3 groups of 50 patients’ each and the following were given in the caudal epidural space after the induction of anesthesia. In Group B, patients received 0.25% Bupivacaine 1ml/kg in normal saline caudally. Group BF patients received 0.25% Bupivacaine 1ml/kg + inj Fentanyl 1μg/kg in normal saline caudally. Group BD patients received 0.25% Bupivacaine 1ml/kg + inj Dexamethasone 0.1mg/kg in normal saline caudally.Results: Group BD had prolonged mean duration of analgesia (10.80 ± 0.755) hr, reduced mean total analgesic requirement in first 24 hour (1.90 ± 0.404), minimum sedation and adverse effects. Conclusion: Group BD shows prolonged duration of analgesia, reduced total analgesic requirement in first 24 hour with minimum sedation and adverse effects as compared to Bupivacaine alone or Bupivacaine with Fentanyl.