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

ABSTRACT

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