A COMPARATIVE EVALUATION OF ULTRASOUND GUIDED CAUDAL BLOCK WITH ROPIVACAINE VERSUS ROPIVACAINE WITH DEXAMETHASONE FOR POST OPERATIVE ANALGESIA IN ADULT PERINEAL SURGERY:A PROSPECTIVE RANDOMISED DOUBLE BLINDED STUDY

Caudal epidural block is a commonly used technique for surgical anaesthesia in children and chronic pain management in adults. Using conventional blind technique, the failure rate of caudal epidural block in adults is high even in experienced hands. This high failure rate could be attributed to anatomical variations that make

locating sacral hiatus difficult. With the advent of ultrasonography it has been demonstrated to be highly effective in accurately guiding the needle entering the caudal epidural space and resurgence of interest in caudal block in adult for chronic pain relief and postoperative analgesia.

While excellent pain relief, minimal side effects, and high patient satisfaction are the advantages; short duration after a single injection is the single main disadvantage even with long‑acting local anaesthetics such as bupivacaine.Therefore, various adjuvants like opioids, alpha 2 agonist and steroids have been added to prolong the duration of caudal block. Dexamethasone potentiates analgesia of the caudal block by regulating transcription factor nuclear factor-kB and inhibits central sensitization after surgery. This study is designed to compare the analgesic efficacy of plain 20ml of 0.25% ropivacaine versus dexamethasone 8mg added as an adjuvant to ropivacaine for caudal block in adult perineal surgeries, in terms of the duration of post-operative analgesia, patients satisfaction and any side effects.