A Study Comparing Pediatric Caudal Epidural Analgesia Using Ropivacaine Alone and in Combination with Dexamethasone or Magnesium Sulfate in Infraumbilical Surgeries

Abstract

Background and Aims: Caudal block is a commonly used regional anesthesia technique providing perioperative analgesia for young children with the disadvantage of a short duration of action after a single shot. Dexamethasone and magnesium as adjuvants could offer significant analgesic benefits. We compared the analgesic effects of dexamethasone or magnesium added to caudal ropivacaine in pediatric patients undergoing infraumbilical surgery. Methods: A total of 75 children (aged 6 months–9 years) were randomly assigned to three groups in a double-blinded manner. Group DR received ropivacaine 0.2% 1.5 mL/kg combined with dexamethasone 0.1 mg/kg in 0.9% normal saline, Group MR received magnesium 50 mg in 0.9% normal saline with 0.2% ropivacaine 1.5 mL/kg, and Group R received 1.5 mL/kg of 0.2% ropivacaine. The primary objective was the duration of analgesia. The secondary objectives were the duration of motor blockade, hemodynamic changes such as heart rate, mean arterial pressure, and adverse effects. One-way analysis of variance, Kruskal–Wallis, and Chi-square tests were applied for statistical analysis. Results: The groups were comparable with respect to age, sex, and duration of surgery. The hemodynamic parameters were comparable among all groups intraoperatively and postoperatively. The mean duration of analgesia in Group DR was 1216.6 ± 153.5 min, Group MR was 542.3 ± 111.7 min, and Group R was 325.8 ± 37.1 min (P < 0.001). The duration of motor block and adverse effects was comparable among all groups. Conclusion: The addition of dexamethasone to caudal ropivacaine significantly prolonged the duration of postoperative analgesia compared to magnesium as an adjuvant.

Keywords

• caudal block
• dexamethasone
• infraumbilical surgery
• magnesium
• pediatric
• ropivacaine