Muhammad Akram, Manzoor Ahmed Faridi, Muhammad Boota, Riaz Ahmad Khan.
Circumcision; caudal epidural block with single dose bupivacaine compared with tramadol for post operative analgesia in children..
Professional Med J Jan ;14(3):504-11.

Objectives: To compare the quality of postoperative analgesia with single dose Bupivacaine and that of Tramadol in caudal epidural block for circumcision in children. Study design: Interventional experimental study. Settings: This study was carried out in the department of anaesthesia and pain management at Combined Military Hospital Peshawar. Duration: Jun 30, 2004 to Mar 2005 & then from Dec 2006 to Feb 2007. Subjects and Methods: Sixty (60) children between the ages of 2-6 year were included in study. They were divided into two groups by convenience non- probability technique and each group had 30 children. Group A (n=30) was given 1.25mg/kg Bupivacaine, 0.25% solution, whereas Group B (n=30) received 2mg/kg of Tramadol. The volume of drug in each group was 0.5ml/kg. Standard monitoring was done perioperatively. The analgesic effects were evaluated by using Hannallah pain score scale6, which had maximum score of 10 arid mininium of 0 (zero). The score of 3 or <3 was considered as adequate analgesia. Sedation was assessed by using 5-point sedation test. 0 - Awake, 1 - mild sedation, 2 - feeling sleepy, 3- sleepy but able to wake, 4 - Deep sleep difficult to wake. Results: Both the groups were comparable with respect to age, sex and duration of surgery. Insufficient pain control was observed in 4 patient`s in-group B (Tramadol group), 13% and 7 patient`s in-group A (Bupivacaine group), 23%, 30 minutes atter caudal administration of drug. Adequate postoperative analgesia was maintained in all other patients for 12 hrs. Only 6 patients in Tramadol group had light sedation (p=0.012). Weakness of lower limbs was found in 4 patient`s in-group A there was no difference in vital signs and there was no complication related to technique in both groups. Conclusion: Caudal administration of Tramadol in the dose of 2mg/kg when compared with 0.25% Bupivacaine in children under going circumcision provided similar quality of analgesia for 12 hours with out any requirement of rescue analgesic.

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