Comparison of caudal bupivacaine plus ketamine and caudal bupivacine plus I.V. ketamine for post operative analgesia in children

The aim of this study was to compare the effect of single dose caudal bupivacaine, caudal bupivacaine plus ketamine and caudal bupivacaine plus I. V. ketamine in children for post operative pain management. Following ethics committee approval and informed parental consent 96 ASA I or II children between 1 and 10 years of age scheduled for elective inguinal hernia repair with general anaesthesia were recruited. After induction of anaesthesia and placement of a laryngeal mark air way [LMA], the patients were randomly divided into three groups to receive either caudal bupivacaine alone 0.25% 1ml.kg[-1] or caudal Bupivacaine 0.25% 1ml. kg[-1] plus ketamine 0.5mg/kg[-1] or caudal bupivacaine 0.25% ml.kg[-1] plus I.V Ketamine 0.5mg. Kg[-1]. Pain was evaluated by children's hospital of Eastern Ontario pain scale and sedation with a five point sedation test. No difference was found regarding age, weight, and duration of operation between the groups [p>0.05]. Duration of analgesia was longer in caudal ketamine group [1380.2+208.8min] than the other two groups. Pain scale was similar between groups in the first 2h-postoperative but lower in caudal ketamine group [4.6 +/- 1.1] than I.V ketamine group or bupivacaine group at 3h. The number of patients requiring supplementary doses of analgesia was significantly lower in caudal ketamine group 3 children compared with the IV ketamine group or bupivacaine group. Bupivacaine [0.25%] plus ketamine 0.5mg.Kg[-1] given caudally prolong postoperative analgesia and significantly reduce the need for subsequent post operative analgesia compared with caudal bupivacaine alone or I.V ketamine plus caudal bupivacaine

comparison of fentanyl, meperidine and lidocaine in preventing the withdrawal response associated with rocuronium injection

We compared the efficacy of IV fentanyl, IV meperidine and IV lidocaine as pretreatment for the prevention of withdrawal response after rocuronium injection. For this prospective, randomized, placebo-controlled, double-blinded study we recruited 120 patients aged between 18 and 65 years, ASA physical status I or II, who had undergone elective surgery requiring general anesthesia and positive pressure ventilation. Patients were randomly allocated to 1 of 4 groups; group F received 2ml IV fentanyl 50micro g/ml [100 micro g], group M received 0.5ml IV meperidine [25mg], group L received 2ml of preservative-free lidocaine 2% [40mg] and group P [placebo] received 2 ml of normal saline. The incidence of withdrawal response after rocuronium was 56%, 16%, 15% and 7% in the placebo, lidocaine, meperidine and fentanyl groups respectively. We found a significant reduction in incidence of withdrawal response in the fentanyl, meperidine and lidocaine groups when compared with the placebo group [p<0.05], with the fentanyl group being most effective [p<0.05]. In conclusion, it was found that fentanyl, meperidine and lidocaine are effective clinical treatments to alleviate the withdrawal response associated with rocuronium injection, with the fentanyl being the most effective of the three used drugs