Caudal additives in pediatric: tramadol versus ketorolac

ABSTRACT

Lower abdominal and genitourtnary surgeries are often associated with appreciable postoperative pain in children. A single caudal injection provides analgesia only for the duration of action of local anaesthetic. Epidural tramadol has been used to provide analgesia in adult patients without any adverse effects. Also ketorolac has been used Intrathecally and caudally and produced postoperative analgesia. We conducted this study to determine the efficacy and safety of adding tramadol or ketorolac to bupivacaine in prolonging duration of caudal analgesia. This double blind study was conducted in 60 children, aged 2-10 years and undergoing lower abdominal or inguinal surgery. After administration of general anesthesia, patients in group B[bupivacaine] [n= 20] received caudal epidural injection of 0.25% bupivacaine 1 ml/kg, those in group BT [bupivacaine - tramadol] [n=20] received 0.25% bupivacaine 1 ml/kg and tramadol 2 mg/kg and group BK [bupivacaine - ketorolac] [n=20] received 0.25% bupivacaine 1 ml/kg and ketorolac 0.4 ml/kg. Total volume of caudal epidural injection in all patients was 0.5 ml/kg with maximum volume 20 ml. No premedication or intraoperative analgesic was given. Heart rate, blood pressure, respiratory rate. TPPPS pain score and side effects, were recorded for 24 hours postoperatively. Rescue analgesia was given in the form of paracetamol injection 10 mg/kg IM. and total number of doses of analgesic required in the first 24 hours was recorded. Median pain scores showed no significant difference among the three groups in the first 2 hours postoperative, but there were significantly lower scores in Group BT and Group BK after 4 hours compared with Group B [P<0.05] for the rest of monitoring period, duration of analgesia time to first rescue of analgesia were prolonged in the two additive groups compared to the group B. There were no significant side effects in the three studied groups - addition of both tramadol and ketorolac to caudal bupivacaine improve the quality and duration of analgesia with noadverse effects