Caudal bupivacaine plus ketamine compared with bupivacaine plus tramadol for postoperative analgesia in children

Abstract EN

Background Caudal epidural block has been used commonly in pediatric postoperative pain management.

However, the analgesic effect of caudal of bupivacaine lasts for 4–12 h.

Aim The aim of this study was to compare the analgesic effi cacy of the coadministration of tramadol (2 mg/kg) and ketamine (0.25 mg/kg) on the duration of caudal block produced by 0.25% bupivacaine 0.75 ml/kg on postoperative pain after an elective subumbilical surgery in children.

Settings and design This is a controlled, randomized, single-blinded study.

Patients and methods This study was carried out on 40 children between 2 and 12 years of age, ASA grade 1, of both sexes in Tanta University after obtaining the approval of the local hospital organization and parents’ consent.

The patients were divided into two equal groups.

The patients in the bupivacaine plus ketamine group (group 1) received caudal bupivacaine 0.25%, 0.75 ml/kg mixed with ketamine 0.25 mg/kg, diluted in a 0.9% NaCl solution to a total volume of 1 ml/ kg.

The patients in the bupivacaine plus tramadol group (group 2) were administered caudal bupivacaine 0.25%, 0.75 ml/kg mixed with tramadol 2 mg/kg, diluted in a 0.9% NaCl solution to a total volume of 1 ml/kg.

Statistical analysis Mean and SD were calculated as numerical data.

Continuous variables were compared using the unpaired Student’s t-test.

Nominal nonparametric data were analyzed using the χ2-test.

Results Patients were monitored over the fi rst 24 h postoperatively to assess analgesia using the All India Institute of Medical Science (AIIMS) objective pain discomfort scale and associated hemodynamic and respiratory changes.

Our results showed that the addition of tramadol in group 2 signifi cantly prolonged the analgesic effect of bupivacaine; also, there was hemodynamic stability and pain scores indicated minimal pain.

Conclusion Caudal epidural tramadol has been proven to be safe at the concentration used and to prolong bupivacaine’s analgesic duration postoperatively in children.