Circumcision; caudal epidural block with single dose bupivacaine compared with tramadol for post operative analgesia in children

ABSTRACT

To compare the quality of postoperative analgesia with single dose Bupivacaine and that of Tramadol in caudal epidural block for circumcision in children. Interventional experimental study. This study was carried out in the department of anaesthesia and pain management at Combined Military Hospital Peshawar. Jun 30, 2004 to Mar 2005 and then from Dec 2006 to Feb 2007. 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 arid mininium 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. 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 atter 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=0.012]. 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. 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