Low Dose IV Dexamethasone in Prolonging Caudal Anesthesia in Children Undergoing Genitourinary Surgery
Status:
Terminated
Trial end date:
2017-12-01
Target enrollment:
Participant gender:
Summary
Caudal injection of local anesthetic is a neuraxial technique routinely performed on young
children for postoperative analgesia after lower abdominal and lower extremity surgical
procedures. One of the major limitations of the use of single shot neuraxial injections for
this purpose is the limited duration of action of the injected local anesthetic. Adjuvant
medications, such as clonidine and epinephrine, have been added to the local anesthetic to
prolong the duration of the neuraxial block, with varying results. Dexamethasone is a
synthetic glucocorticoid steroid commonly used in the perioperative setting for a multitude
of indications, including the prolongation of local anesthetic based analgesia. It has been
shown that the administration of dexamethasone either intravenously or via perineural
injection can significantly increase the duration of analgesia derived from a local
anesthesia based peripheral nerve block. Literature also suggests that the effect of
dexamethasone is equivalent whether given intravenously or perineurally. Interest in
dexamethasone enhanced caudal analgesia exists and a previous study noted that caudal
anesthesia can be prolonged by intravenous dexamethasone. The study was criticized for using
a higher dose of dexamethasone (0.5 mg/kg) than is routinely used in the pediatric population
outside of airway procedures, which may expose patients to dose related side effects of
dexamethasone. A large meta-analysis has suggested that 0.1 mg/kg is effective for analgesic
prolongation, but no direct study of low dose intravenous dexamethasone in combination with
caudal anesthesia has been performed.