Saleem Sabbar, Rehan Abbas Khan, Munir Ahmed Siddiqui, Fawad Ahmed Khan.
Comparison of caudal bupivacaine with and without tramadol for postoperative analgesia in pediatric inguino scrotal surgeries.
Pak J Surg Jan ;26(2):155-9.

Objective: The aim of the study was to determine the postoperative analgesic effect of tramadol when given with caudally administered bupivacaine in children undergoing inguinoscrotal surgeries. Study Design: Quasi experimental Place and Duration: The study was conducted in Department of Anaesthesia, Sindh Govt Lyari General Hospital over a period of 6 months from January 2009 to July 2009. Materials & Methods: In this double blind comparative study we included total hundred children undergoing inguino-scrotal surgeries. Th ey were aged from 2 to 10 years. Our inclusion criteria were the children ASA I and II group. The patients were allocated into two equal groups. The patients in Group A (n=50) received 0.25% bupivacaine 0.75 ml/kg and the children in group B (n=50) were given 0.25 % bupivacaine 0.75 ml/kg and tramadol 2 mg/ kg through caudal route aft er induction of general anaesthesia. The postoperative pain was evaluated by using visual analogue pain scale in children over 6-7 years and observation of behavior in preverbal children. Sedation was assessed by 4 points sedation score, heart rate, mean arterial pressure, arterial oxygen saturation, respiratory rate. Pain and sedation scores were recorded immediately aft er awakening from anaesthesia till 24 hours postoperatively at periodic intervals. Acetaminophen was administered rectally (20 mg/kg) if the pain score was more than 4. Results: Addition of tramadol with caudally administered bupivacaine resulted in signifi - cantly longer postoperative analgesic period (10.4 ± 2.2 hours) in group B while in group A in which only bupivacaine was used, mean duration of analgesia was (2.85 ± 0.84 hours). Th ere were no signifi cant changes in heart rate, arterial pressure and oxygen saturation between groups. Except nausea and vomiting, no other side effects like respiratory depression, pruritis, urinary retention were found. Conclusion: Caudal tramadol with bupivacaine provides prolonged and good quality postoperative analgesia compared to plain bupivacaine in children undergoing inguino-scrotal surgeries.

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