A COMPARATIVE STUDY OF LEVOBUPIVACAINE 0.

25% WITH OR WITHOUT

DEXAMETHASONE 0.1 MG/KG FOR CAUDAL BLOCK IN PEDIATRIC PATIENTS UNDERGOING
INFRAUMBILICAL SURGERIES

INTRODUCTION: Single shot caudal blocks are commonly used in paediatric pa?ents. The use of
adjuvants increases the dura?on of analgesia and decrease local anesthe?c dose requirement hence
decreasing the risk of toxicity.

AIM: The aim of this study is to assess the dura?on and effec?veness of caudal analgesia in children
undergoing infraumbilical surgeries using 0.25% levobupivacaine 1 mL/kg Vs 0.25% levobupivacaine 1
mL/kg+ dexamethasone 0.1mg/kg .

OBJECTIVES

Primary objec?ve -

1. Dura?on of analgesia by measuring pain intensity using face, legs, ac?vity, cry, consolability
(FLACC) scale in postopera?ve period
2. Total consump?on of rescue analgesia in 24 hours post surgery

The secondary objec?ves of the study are as follows:

• To study the intraopera?ve hemodynamics.

• To record the side effects if any.

MATERIALS AND METHODS

• Study Design : Prospec?ve, randomized and double-blind controlled study

• Sample size : 60

Inclusion criteria Exclusion criteria

Age between 1 and 6 years
ASA Grade I and II
Pa?ent of either sex
Scheduled for infraumbilical
surgeries
ASA Grade III and IV
Known hypersensi?vity to local
anesthe?c
Any anatomical abnormality
Ac?ve infec?on at local site.
Pre-exis?ng neurological disease
Bleeding disorders

• A total of 60 pa?ents were randomly divided into 2 groups A and B based on computer
generated randomised chart :
Group A – Levobupivacaine 0.25% 1 mL/kg+Saline 0.5 mL
Group B – Levobupivacaine 0.25% 1 mL/Kg+dexamethasone 0.1 mg/kg.
• Acer intuba?on, caudal block was performed. Surgery was started 10 mins acer caudal
placement of study drug. Pain score was assessed in post opera?ve period using face, legs,
ac?vity, cry, consolability (FLACC) scale (0=No pain, 1–3=Mild pain, 4–7=Moderate pain, and 8–
10=Severe pain) at interval of 0, 15, 30, 60, 90, 120, 150, and 180 min.
 • Time from caudal block to the ?me when FLACC score was >4 considered as dura?on of
analgesia and at that ?me rescue analgesia was given in form of IV paracetamol 15 mg/kg body
weight.

Sta?s?cal analysis

• To compare the two groups, either Chi-square test or unpaired t test were applied.
• Data were described as a frequency (percentage) distribu?on as well as in mean±standard
devia?on.
• P < 0.05 was considered sta?s?cally significant.

RESULTS:

There was a significant decrease in post-opera?ve systolic blood pressure and pulse rate in Group B
compared to Group A acer caudal block. Postopera?vely, FLACC score at 3 h, 4 h, 5 h, 6 h, 8 h, 14 h, 16 h,
20 h, 24 h was highly significantly lower in group B. The mean dura?on of analgesia in Group A was
420.77±16.71 min and in Group B was 840.00±36.71 min (p<0.005). The total consump?on of rescue
analgesia was more in Group A compared to B.

CONCLUSION: From this study, we can conclude that on adding Dexamethasone to levobupivacaine in
caudal block significantly prolonged dura?on of analgesia in post-opera?ve period. There were minimal
side effects noted and provided more hemodynamic stability during intraopera?ve and post-opera?ve
period.