Rukhsana Samad, Tahira Hakim Shah.
Comparison of Caudal TramadolBupivacaine and Ketamine-Bupivacaine For Postoperative Analgesia In Children.
J Surg Pak Jan ;18(2):54-8.

Objective: To compare the duration of postoperative analgesia and side effects of caudal tramadol – bupivacaine with ketamine – bupivacaine in children. Study design: Randomised controlled trial. Place & Duration of study: Department of Anesthesiology and Intensive Care, Kuwait Teaching Hospital Peshawar, from September 2010 to March 2011. Methodology: Thirty four children, American Society of Anesthesiologist (ASA) physical status Iand II, aged 3-8 year undergoing inguinoscrotal surgeries were randomly assigned to receive a caudal injection of either tramadol 2 mg/kg plus bupivacaine 0.5 mg/kg of 0.25% (groupA, n=17) or ketamine 1 mg/kg plus bupivacaine 0.5 mg/kg of 0.25 % (group- B, n=17) immediately after induction of general anesthesia. No analgesics were given intraoperatively. Postoperative analgesia was evaluated by modified objective pain scoring system (MOPS) and sedation was assessed by five point sedation score at predetermined time point. Postoperative analgesia was supplemented with syrup paracetamol or syrup ibuprofen when (MOPS) was = 4. Cardiorespiratory data, respiratory depression, nausea, vomiting, urinary retention, psychomotor effects and motor block were recorded in all patients. Results: Caudal tramadol with bupivacaine produced significantly increased postoperative analgesia. The duration of postoperative analgesia was 17.88± 1.96 hours in tramadol – bupivacaine group as compared to 12.05 ±1.63 hours in ketamine – bupivacaine group. The sedation score was high in tramadol – bupivacaine group only during 1st hour postoperatively. No other side effects like respiratory depression, urinary retention, pruritus were found in any group. The demand for rescue analgesia was high (n=2.41 ± 0.50) in ketamine - bupivacaine group as compared to tramdol-bupivacaine group (n=0.41 ± 0.6). Four children in ketamin - bupivacaine group experienced psychomotor effects. Conclusion: Caudal tramadol-bupivacaine provided longer time of postoperative analgesia without having significant side effects but with higher sedation score for one hour postoperatively.

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