Examining the Development of Perineal pruritus in paediatric Patients Following Minor Surgical Procedures: A Prospective Cohort Study
Authors: Voskanyan Ariana , Mirzoyan Ninel 
Published: December 2024

Abstract

Background:
Postoperative nausea and vomiting (PONV) is a common post-surgery complication in adults and children. Dexamethasone, which is widely used for antiemetic and pain control, offers the advantage of minimal long-term side effects, such as hemodynamic instability or adverse effects on the central nervous system, which are typical for other antiemetic drugs. This makes it a preferred choice for perioperative management, providing effective control of nausea and vomiting without compromising patient safety or long-term well-being. Previous studies have noted perineal pruritus, pain, and burning sensations after intravenous Dexamethasone in 25-100% of adults 1,2. Limited data exist on paediatric patients' side effects owing to challenges in expressing sensations. This study aimed to determine whether i.v. Dexamethasone induces perineal pruritus in paediatric patients and shows the distribution of study subjects based on sex.
Methods: A prospective cohort study was conducted in the Department of paediatric Surgery, Muratsan University Hospital Complex, Armenia, which included 158 paediatric patients from October 2023 to February 2024, 79 patients undergoing minor surgical procedures received intravenous dexamethasone at an antiemetic dose of 0.2 mg kg-1 diluted in 5 ml 0.9% saline 1 min before general anaesthesia or after induction with inhalation anaesthetic, relevant to their age. After the i.v. injection of dexamethasone, the anaesthesiologist asked the patients for any sensation they had and was assessed by recording answers (yes/no). In cases of little children up to 5 years of age, close monitoring of vital signs was performed to evaluate HR or RR changes during the procedure. The remaining 79 patients did not receive intravenous dexamethasone.
All recorded observations were analyzed using the exact binomial test, χ2 test, and G Power Version 3.1.9.7.
Results: The study included 158 paediatric patients (aged 1-17 years); 50% of patients received the drug, and 15% of patients complained about symptoms of perineal pruritus or burning sensation for 10-30 seconds, which vanished without any further treatment. In the case of using i.v. Dexamethasone during induction when patients were already asleep, the main signs of pain were 1.5 times increased in heart rate, frequent breathing in 20-30 duration, and movements of different parts of the body, excluding other options causing pain. The remaining 50% of the patients who had not received the drug did not have perineal symptoms.
Discussion:
The occurrence of Dexamethasone-induced perineal pruritus is a rare complication among paediatric patients compared with adults 2. Until an ideal antiemetic drug is discovered, it is imperative to acknowledge this potential side effects, and actively seek ways to minimise its incidence.
Conclusion:
This study established a relationship between the administration of intravenous dexamethasone and perineal pruritus in paediatric patients. years (p =0.035), respectively. In this study, no significant association with sex was observed (p-value=0.84). However, this conclusion requires further confirmation using more statistical data.