Postoperative analgesia; comparison of caudal bupivacaine and bupivacaine - tramadol in children with inguinal hernia repair

To compare the effects after caudal bupivacaine alone and bupivacaine-tramadol in young children with inguinal hernia repair. Department of Paediatric Anaesthesia, Children Hospital Complex, Multan. August 2008 to May 2009. A total of 100 children aged between 2-5 years were included in the study. The duration of analgesia was significantly prolonged in group-A patients [P= 0.001]. A low frequency of postoperative vomiting was observed in both groups i.e. 10% in group-A and 6.7% in group-B [P=0.64]. No respiratory depression, flushing and pruritis were observed. Low dose combination of bypivacaine and tramadol, when administered caudally, had an additive effect and provided prolonged and effective postoperative analgesia with minimal side effects

Analgesic efficacy of single shot caudal block for circumcision

To assess the usefulness of caudal epidural block with bupivacaine for postoperative analgesia after circumcision in children at Children Hospital complex Multan. This study was earned out in Children Hospital Complex Multan from March 2008 to December 2008. One hundred boys, aged 2 to 10 years, ASA 1 status scheduled for elective circumcision. They received caudal epidural block with bupivacaine 0.25%, 0.5ml.kg-1, after induction of general anesthesia and studied for postoperative pain relief. Patients were excluded if they had local infection, preexisting neurological disease, bleeding diathesis or any analgesic ingestion in the preceding week.. Post-operative pain was assessed by Facial expression scale in small children. In older children pain assessment was done by clinical observation, by asking about pain and by dynamic pain score. Mean duration of analgesia was 10.43 +/- 3.4 hours. Time for micturition was 161.79 +/- 83.2 minutes while time to stand was 161.21 +/- 69.65 minutes. Hemodynamic and respiratory parameters remained stable during the observation period. Frequency of postoperative nausea and vomiting was 12% while urinary retention occurred in 2% patients. Caudal epidural block with bupivacaine 0.25% in a dose of 0.5 ml/kg-provides safe and effective postoperative pain relief in children undergoing circumcision and penile surgery, with very few complications

Effect of buprenorphine, pentazocine and tramadol on respiration

The purpose of this study was to evaluate the effects of Bupernorphine, Pentazocine and Tramadol on Respiration. Study design: This is a prospective study. Place and duration of study: This study was conducted at Intensive Care Unit of Nishtar Hospital, Multan from July to December 2001. Patients and method: Sixty patients belonging to age group ranging between 18-35 years, of ASA-I and II grades undergoing elective cesarean section were selected. All the patients suffering from severe systemic disease, not falling in ASA 1 or 2 and patients allergic to Opioids were excluded from the study. Patients were divided into three groups using the non-probability convenience sampling technique. Each group comprised of 20 patients. All the patients received endotracheal general anesthesia. In postoperative period Group-A received injection Bupernorphine 0.5mg IM. Group-B received injection Pentazocine 30mg IM and Group-C received Tramadol 100mg IM for pain relief. The effects on respiratory rate, tidal volume, minute volume and arterial blood gases were evaluated 30 minute, 1 hour, 2 hour and 4 hour after giving analgesia. Dosages were repeated 8 hourly. Bupernorphine led to a fall in respiratory rate and minute volume in 30 minute, whereas Pentazocine decreased the respiratory rate after 30 minute but minute volume was decreased in 5 minute, where as Tramadol had no effect on respiratory rate and minute volume. Pa02 was decreased within 30 minute with Bupernorphine and Pentazocine where as PaC02 raised after 60 minutes with Bupernorphine but within 5 minute with Pentazocine where as with Tramadol there was no significant alteration in arterial blood gas values. Opioids have a respiratory depressant effect which manifested within 30-60 minute of IM administration, where as Tramadol which is a non opioid, does not cause respiratory depression in equiv. potent doses