Abstract:

Postoperative pain management in paediatric infra-umbilical surgeries remains a challenge. Caudal epidural anaesthesia with Ropivacaine is widely used, but adjuvants such as Fentanyl and Dexamethasone may enhance its analgesic efficacy. This study aimed to compare the analgesic effects of Fentanyl and Dexamethasone as adjuvants to caudal Ropivacaine in paediatric patients undergoing infra-umbilical surgeries. A prospective, randomized, double-blind study was conducted with 54 paediatric patients aged 1-12 years, classified as ASA I or II, undergoing elective infraumbilical surgeries. Patients were randomly divided into two groups: Group F received Ropivacaine (0.25%, 1 ml/kg) with Fentanyl (1 mcg/kg), and Group D received Ropivacaine (0.25%, 1 ml/kg) with Dexamethasone (0.1 mg/kg). Postoperative pain was assessed using the FLACC scale at regular intervals, and the time to first rescue analgesic was recorded. The mean time to first rescue analgesic was significantly longer in Group D (10 hours) compared to Group F (6 hours, p < 0.001). FLACC scores were consistently lower in Group D at all measured time points (p < 0.001), indicating superior analgesia. Both groups maintained stable hemodynamic parameters, and adverse effects were minimal. Dexamethasone as an adjuvant to caudal Ropivacaine provides prolonged and superior analgesia compared to Fentanyl, making it a more effective option for postoperative pain management in paediatric infra-umbilical surgeries.

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