CAUDAL ANALGESIA IN CHILDREN;

COMPARISON BETWEEN BUPIVACAINE AND BUPIVACAINE PLUS TRAMADOL

Abstract

Background: Caudal analgesia with bupivacaine is used commonly for pain relief in children and extradural administration of
tramadol seems to be a safe method of analgesia. The aim of the study was to compare the analgesic efficacy of caudal bupivacaine and
bupivacaine and tramadol mixture for postoperative analgesia and to observe for the side effects. Setting: Department of Anesthesia and
Intensive Care Unit, Bahawal Victoria Hospital, Bahawalpur. Period: 01-12-2010 to 30-11-2011. Methods: Eighty children, aged between 2 to
12 years of age undergoing infra umbilical surgeries were selected for this randomized, controlled trial. They were randomly divided into two
groups A and B. Group A (n = 40) received 0.5 ml/kg of 0.25 % bupivacaine and Group B (n = 40) received 0.5 ml/kg of 0.25 % bupivacaine with 1
mg/kg of tramadol as a single shot caudal block. In the postoperative period, duration of analgesia, pain score, nausea, vomiting and side
effects were noted and analyzed. Results: Patients in both groups were comparable for age and weight. It was observed that the mean
duration of analgesia in group A patients was 6.23+0.68 hours while in group B, it was 9.33+0.72 hours (p<0.05). Nausea and vomiting was
present in 20% (n=8) patients in group A, while in group B, 27.5% (n=11) had nausea and vomiting in the post operative period (p<0.05). None of
the patients in both the groups had complications like motor weakness, urinary retention in the postoperative period. Conclusions: The
addition of tramadol to bupivacaine in the caudal analgesic technique provides longer analgesia and lesser need for rescue analgesia in the
postoperative period compared to bupivacaine alone.