title: Comparison of caudal and intravenous dexamethasone as adjuvants for caudal epidural block: A double blinded randomised controlled trial.
abstract: OBJECTIVE
  Dexamethasone has a powerful anti-inflammatory action with significant analgesic benefits. The aim of this study was to compare the efficacy of dexamethasone administered through intravenous (IV) and caudal route on post-operative analgesia in paediatric inguinal herniotomy patients.
  
  
  METHODS
  One hundred and five paediatric patients undergoing inguinal herniotomy were included and divided into three groups. Each patient received a single caudal dose of ropivacaine 0.15%, 1.5 mL/kg combined with either corresponding volume of normal saline (Group 1) or caudal dexamethasone 0.1 mg/kg (Group 2) or IV dexamethasone 0.5 mg/kg (Group 3). Baseline, intra- and post-operative haemodynamic parameters, pain scores, time to rescue analgesia, total analgesic consumption and adverse effects were evaluated for 24 h after surgery. Unpaired Student'st-test and analysis of variance were applied for quantitative data and Chi-square test for qualitative data. Time to first analgesic administration was analysed by Kaplan-Meier survival analysis and log-rank test.
  
  
  RESULTS
  Duration of analgesia was significantly longer (P< 0.001), and total consumption of analgesics was significantly lower (P< 0.001) in Group II and III compared to Group I. The incidence of nausea and vomiting was higher in Group I (31.4%) compared to Group II and III (8.6%).
  
  
  CONCLUSIONS
  Addition of dexamethasone both caudally or intravenously as an adjuvant to caudal 0.15% ropivacaine significantly reduced the intensity of post-operative pain and prolonged the duration of post-operative analgesia with the significant advantage of caudal over IV route.
authors.affiliation: Department of Anaesthesiology and Critical Care, Dr. S N Medical College, Jodhpur, Rajasthan, India.
authors.forename: Bharath
authors.initials: B
authors.lastname: Srinivasan
authors.affiliation: Department of Anaesthesiology and Critical Care, Dr. S N Medical College, Jodhpur, Rajasthan, India.
authors.forename: Rakesh
authors.initials: R
authors.lastname: Karnawat
authors.affiliation: Department of Paediatric Surgery, Dr. S N Medical College, Jodhpur, Rajasthan, India.
authors.forename: Sadik
authors.initials: S
authors.lastname: Mohammed
authors.affiliation: Department of Anaesthesiology and Critical Care, Dr. S N Medical College, Jodhpur, Rajasthan, India.
authors.forename: Bharat
authors.initials: B
authors.lastname: Chaudhary
authors.affiliation: Department of Anaesthesiology and Critical Care, Dr. S N Medical College, Jodhpur, Rajasthan, India.
authors.forename: Anil
authors.initials: A
authors.lastname: Ratnawat
authors.affiliation: Department of Anaesthesiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
authors.forename: Sunil Kumar
authors.initials: SK
authors.lastname: Kothari
keywords: Caudal anaesthesia; dexamethasone; paediatric inguinal herniotomy; ropivacaine