Comparison of caudal bupivacaine and bupivacaine-tramadol for postoperative analgesia in children with hypospadias repair

ABSTRACT

To compare the effects after caudal bupivacaine alone and bupivacaine-tramadol in young children with hypospadias repair. Randomized controlled trial. The Department of Paediatric Anaesthesia, Children Hospital, Pakistan Institute of Medical Sciences, Islamabad, from April to September 2006. Sixty children aged between 13-53 months coming for hypospadias repair were divided randomly into two groups A and B. A caudal block was performed immediately after induction of general anaesthesia. The patients in group A received 0.125% bupivacaine 1 ml/kg with tramadol 1 mg/kg body weight caudally. Group B patients received 0.25% bupivacaine 1 ml/kg body weight caudally. Anaesthesia was discontinued after completion of surgery. In the recovery area, ventilatory frequency and pain scores were recorded at 1 hourly interval for first 6 hours and then every 2 hours for next 6 hours postoperatively. A modified TPPPS [Toddler-Preschool Postoperative Pain Scale] was used to assess the pain. Episodes of vomiting, facial flush and pruritus were noted, if present. The duration of analgesia was significantly prolonged in group A patients [p-value=0.001]. A low frequency of postoperative vomiting was observed in both groups i.e. 10% in group A and 6.66% in group B [p-value=0.64]. No respiratory depression, flushing and pruritus were observed. Low dose combination of bupivacaine and tramadol, when administered caudally, had an additive effect and provided prolonged and effective postoperative analgesia with minimal side effects. The risk of toxicity from bupivacaine decreased when combined with tramadol in low doses