A COMPARISON OF CAUDAL BLOCK ALONE AND CAUDAL BLOCK WITH INTRAVENOUS DEXAMETHASONE IN PAEDIATRIC UROLOGICAL PROCEDURE FOR POSTOPERATIVE ANALGESIA
Main Article Content
Keywords
Caudal block; Dexamethasone; Paediatric urology; Postoperative analgesia; FLACC; VAS.
Abstract
Background: Caudal epidural block has been extensively employed as postoperative analgesia in lower infra-umbilical surgery in children, but has a shorter duration, which causes early breakthrough pain and increased rescue analgesic needs. Dexamethasone intravenously provides the effect of anti-inflammatory and central analgesia and could do more to strengthen caudal analgesia without causing more complications. This trial involved a comparison between caudal block and caudal block and intravenous dexamethasone in children who had elective paediatric urological surgeries.
Material & Methods: The study was a prospective comparative cohort study carried out at the Department of Anaesthesia, Sindh Institute of Urology and Transplantation (SIUT) between 11 November 2025 and January 2026 after approval by the Ethical Review Committee (ERC No. 596; Approval No. SIUT-ERC-2025/A-596). The participants were children aged 2-10 years of age, ASA I, who were going to undergo elective paediatric urological surgery under general anaesthesia (n=97). Group A involved caudal block using local anaesthetic only (n=48), whereas Group B involved caudal regimen and intravenous dexamethasone (n=49). Age-specific VAS/FLACC was used to measure pain at 0, 1, 2, 4, 6, 12 and 24 hours. The main outcome was time to first rescue analgesia and secondary outcomes were rescue doses, total analgesic consumption, pain scores, adverse events and length of stay.
Results: Baseline characteristics were comparable between groups (p>0.05). Group B had a significantly longer time to first rescue analgesia (9.42±1.54 vs 5.22±1.23 hours; p<0.001), fewer rescue doses (1.47±0.50 vs 3.08±0.79; p<0.001), and lower total analgesic consumption (21.36±4.79 vs 39.49±5.53 mg/kg; p<0.001). Pain scores from 1–24 hours were significantly lower in Group B (p<0.001). Postoperative adverse events and hospital stay were similar (p>0.05).
Conclusion; Adding intravenous dexamethasone to caudal block significantly improves postoperative analgesia without increasing adverse effects or prolonging hospital stay in paediatric urological surgery.
References
2. Anwar, M.H., et al., Comparison of Intravenous Dexamethasone along with Caudal Block versus Caudal Block Alone for Postoperative Analgesia in Pediatric Lower Abdominal Surgeries. Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University, 2023. 19(4): p. 514-518.
3. Mathew, A., et al. Back to the Future: Historic Insights and Recent Innovations in Pediatric Regional Anesthesia. Journal of Clinical Medicine, 2024. 13, 6704 DOI: 10.3390/jcm13226704.
4. Kaur, R., R. Gupta, and G. Kaur, Comparison of analgesic efficacy of dexamethasone as an adjuvant to bupivacaine using ultrasound-guided caudal block in children undergoing infraumbilical surgeries. The Indian Anaesthetists Forum, 2025. 26(1).
5. Cai, Y., et al., Effect of hydromorphone combined with ropivacaine caudal block on immune function after hypospadias surgery in children. BMC Anesthesiology, 2025. 25(1): p. 172 DOI: 10.1186/s12871-025-03053-7.
6. Oliver, J.-A., et al., Ambulatory Pain Management in the Pediatric Patient Population. Current Pain and Headache Reports, 2022. 26(1): p. 15-23 DOI: 10.1007/s11916-022-00999-y.
7. Rotem, S., et al., Is Ultrasound-Guided Single-Shot Quadratus Lumborum Block a Viable Alternative to a Caudal Block in Pediatric Urological Surgery? Eur J Pediatr Surg, 2021. 32(03): p. 263-267 DOI: 10.1055/s-0040-1722223.
8. Stangl-Kremser, J., et al., Spinal anesthesia with caudal catheter in pediatric urologic surgery: an alternative to general anesthesia. Frontiers in Pediatrics, 2025. Volume 13 - 2025 DOI: 10.3389/fped.2025.1614512.
9. Sridharan, H., N. Kesarkar, and R. Dias, Optimizing Paediatric Hypospadias Surgical Repair: Pudendal Nerve Block Versus Caudal Block for Superior Analgesia. Turk J Anaesthesiol Reanim, 2025. 53(3): p. 114-121 DOI: 10.4274/tjar.2025.241773.
10. Khare, A., et al., A comparative study of ropivacaine 0.25% versus levobupivacaine 0.25% with dexamethasone in caudal block for postoperative analgesia in pediatric patients. Journal of Dr. YSR University of Health Sciences, 2023. 12(1).
11. SHARIF, M., et al., Intravenous Dexamethasone as an Adjuvant to Caudal Analgesia for Post Herniotomy Pain. Pakistan Journal of Medical & Health Sciences, 2021. 15 DOI: https://doi.org/10.53350/pjmhs2115103491.
12. Singh, N.P., et al., The analgesic efficacy of intravenous dexamethasone for post-caesarean pain: A systematic review with meta-analysis and trial sequential analysis. European Journal of Anaesthesiology | EJA, 2022. 39(6).
13. Zhang, C.-J., et al., Optimizing adjuvant strategies for sevoflurane-related emergence delirium: a Bayesian network meta-analysis in pediatric surgery. Frontiers in Pharmacology, 2025. Volume 16 - 2025 DOI: 10.3389/fphar.2025.1573640.
14. Khalil, H.A., et al., Caudal Block Versus Penile Block for Postoperative Pain Relief in Pediatric Patients Undergoing Hypospadias Repair. Neuroquantology, 2022. 20 DOI: 10.48047/NQ.2022.20.6.NQ23016.
15. Reysner, T., et al. Revolutionizing Pediatric Surgery: The Transformative Role of Regional Anesthesia—A Narrative Review. Surgeries, 2025. 6, 9 DOI: 10.3390/surgeries6010009.
16. Tu, Q., et al., Perioperative administration of dexamethasone to prevent postoperative shivering: a systematic review and meta-analysis of randomized controlled trials. 2023. 51(8): p. 03000605231187805 DOI: 10.1177/03000605231187805.
17. Kurniyanta, I.P., T.G.A. Senapathi, and I. Katarina, Continuous caudal anesthesia in children undergoing surgery: A systematic review of retrospective interventional studies. Journal of Emergency Medicine, Trauma and Acute Care, 2024. 2024(7) DOI: https://doi.org/10. 5339/jemtac.2024.26.
18. Sakr, M.A., et al., Effect of intraoperative single dose of dexamethasone on posttonsillectomy pain in children: a systematic review and meta-analysis. Tanta Medical Journal, 2023. 51(1).
19. Singh, V.K., et al., Comparison of the Analgesic Efficacy of Ultrasound-Guided Transperineal Approach Using Pudendal Nerve Block Versus Caudal Block in Children Undergoing Urological Surgeries: A Randomized Controlled Trial. Cureus, 2024. 16(11): p. e74244 DOI: 10.7759/cureus.74244.
20. Omara, A.F., A.A. Elzohry, and A.F. Abdelrahman, Comparison of Caudal Block and Dexmedetomidine Infusion in Pediatric Patients Undergoing Hypospadias Repair Surgery: A Prospective, Randomized, Double-blinded Clinical Study. Anesth Pain Med, 2023. 13(1): p. e130623 DOI: 10.5812/aapm-130623.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Syed Saqib Ali
Senior lecturer, Department of Anesthesia, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
Syed Wahaj Uddin
Assistant Professor, Department of Anesthesia, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
Sagar Khurana
Assistant Professor, Department of Anesthesia, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
Shakil Malik
Assistant Professor, Department of Anesthesia, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
Vijai Kumar
Assistant Professor, Department of Anesthesia, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
Hiranand
Assistant Professor, Department of Anesthesia, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
Abdullah Abdul Ghani
Postgraduate Trainee, Department of Anesthesia, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
