CIRCUMCISION

CAUDAL EPIDURAL BLOCK WITH SINGLE DOSE BUPIVACAINE COMPARED WITH TRAMADOL FOR POST OPERATIVE ANALGESIA IN CHILDREN.

Abstract

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 and minimum 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 after
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=0.0l2). 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.