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Introduction: Perioperative pain is distressing and detrimental. Pre-emptive caudal epidural analgesia (CEA) with ropivacaine and adjuncts like dexamethasone are effective but under-utilised techniques in lumbosacral spine surgeries.

Objective: To evaluate role of pre-emptive caudal epidural analgesia with ropivacaine and dexamethasone for post-operative pain relief in lumbosacral surgeries.

Methodology: This analytical observational study was conducted among 60 patients included using convenience sampling from 2024 May to August at National Trauma Centre after ethical clearance. Patients were grouped I if received CEA and grouped II if not received. Post-operative visual analgoue scale (VAS) scores were compared at immediate, four hours (hrs), eight hours, 12 hrs, and 24 hrs post-operative. Time of rescue analgesia requirement in 24 hours was also compared.

Result: There was no significant difference in age, sex, weight, and American Society of Anaesthesiologists physical status (ASA-PS) grade, and duration of anaesthesia. Eighteen (60%) out of 30 patients in CEA group (I) and four (13.33%) out of 30 in no CEA group (II), did not require rescue analgesia. Among those who required rescue analgesia, duration of analgesia (minutes) was 545.66 ± 437.01 in CEA group (I) and 143.34 ± 155.06 in no CEA group (II) which was significantly high (p-value = 0.0001). There was significant difference in post-operative VAS scores at immediate (0.0001), four hours (0.012), and eight hours (0.032) post-operative.

Conclusion: The study provides strong evidence supporting efficacy of pre-emptive caudal epidural analgesia in lumbosacral spine surgery by enhancing post-operative pain control, reducing opioid requirements, and improving patient satisfaction.

Caudal; dexamethasone; ropivacaine.