Efficacy of Three Doses of Ketamine With Bupivacaine for Caudal Analgesia in Pediatric Inguinal Herniotomy (original) (raw)
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Saudi Journal of Anaesthesia, 2017
Background: Multiple studies claim that caudal administration of ketamine causes effective postoperative analgesia. The aim of this study was to assess the clinical effectiveness of ketamine after caudal or topical administration in pediatric patients undergoing inguinal herniotomy. Patients and Methods: This randomized, comparative, double-blind study included eighty children (aged 6 months to 6 years) received either 1 ml/kg of 0.25% bupivacaine/ketamine 0.5 mg/kg for caudal analgesia (caudal group) or 0.3 ml/kg of 0.25% bupivacaine/ketamine 0.5 mg/kg sprayed by the surgeon around the spermatic cord and upon the ilioinguinal nerve before wound closure for topical analgesia (topical group). The duration of postoperative analgesia, pain scores, rescue analgesic consumption, sedation score, hemodynamic monitoring, and side-effects were evaluated 48 h postoperative. Results: Kaplan-Meier survival analysis of analgesia free time demonstrated a significant advantage of topical ketamine (TK) group over caudal ketamine (CK) group. The duration of postoperative analgesia was longer in TK group than in CK group (28.74 ± 2.88 vs. 21.43 ± 5.01 h, P = 0.000). Fewer children asked for oral analgesics in the topical group (24 of 36, 66.7%) than in the caudal one (28 of 32, 87.5%; P < 0.01). Postoperative pain scores at the 6 th till 48 th h were lower in topical group with comparable analgesic consumption between two groups. In the caudal group, four subjects suffered from retention of urine: Two presented with a residual motor block and two had photophobia. Conclusion: Wound instillation of bupivacaine/ketamine is a simple, noninvasive, and effective technique that could be a safe alternative to CK for postoperative analgesia in children undergoing inguinal hernia repair.
Objective: Nowadays, conventional analgesic agents, which are widely used for pain relief after cesarean section, provide suboptimal analgesia with occasional serious side effects. We designed a randomized, double-blind, placebo-controlled study to evaluate the analgesic efficacy of intrathecal ketamine added to bupivacaine after cesarean section. Methods: Sixty patients scheduled for cesarean section under spinal anesthesia were randomly allocated to one of the two groups to receive either bupivacaine 10 mg combined with 0.1 mg/kg ketamine, or bupivacaine 10 mg combined with 0.5 mL distilled water intrathecally. The time to the first analgesic request, analgesic requirement in the first 24 hours after surgery, onset times of sensory and motor blockades, the durations of sensory and motor blockades, and the incidences of adverse effects such as hypotension, ephedrine requirement, bradycardia, and hypoxemia, were recorded. Results: Patients who received ketamine had a significantly prolonged duration of anesthesia compared with those who did not in the control group [95% confidence intervals (CI) 195e217; p ¼ 0.001]. The mean time to the first analgesic request was also significantly longer in ketamine group (95% CI 252.5e275; p < 0.001). The total analgesic consumption in the 24 hours following surgery significantly lessened in the ketamine group compared with that of the control group (95% CI 2e2.5; p < 0.001). The two groups did not differ significantly in intraoperative and postoperative side effects. Conclusion: Intrathecal ketamine 0.1 mg/kg co-administered with spinal bupivacaine elongated the time to the first analgesic request and lessened the total analgesic consumption in the first 24 postoperative hours in comparison with bupivacaine alone in the control group following elective cesarean delivery.
Biomedical Research and Therapy, 2018
Introduction: Adding ketamine to bupivacaine in caudal anaesthesia is likely to increase its analgesic effect. However, it is not clear which dose of ketamine will have the greatest impact and the lowest level of complications. Thus, the purpose of this study was to compare the effects of three different doses of caudal ketamine plus bupivacaine on pain control after pediatric surgery. Methodology: The present double-blinded clinical trial was conducted on 69 pediatric patients, of age ranging from 6 months to 10 years. Patients were assessed via the American Society of Anaesthesiologists (ASA) physical status classification system (ASA I-II), and had been also hospitalized for herniorrhaphy and orchidopexy. The patients were randomly divided into three groups. The first group received 0.75 mg/kg of 0.25% bupivacaine plus 0.25 mg/kg of ketamine, the second group received 0.75 mg/kg of 0.25% bupivacaine and 0.5 mg/kg of ketamine, and the third group received 0.75 mg/kg of 0.25% bupiv...
Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University
Objective: To compare the efficacy of intravenous paracetamol and rectal diclofenac combination with caudal block using 1ml/kg of 0.25% bupivacaine in the management of post-operative pain following paediatric inguinal herniotomy. Methodology: This quasi-experimental study was conducted at the Department of Anesthesia, Holy Family Hospital, Rawalpindi, from February 2020 to August 2020. A total of 342 children aged 2-12 years requiring inguinal herniotomy were enrolled after satisfying the inclusion and exclusion criteria. Computer-generated random numbers were used to split the patients into two groups. Group A received intravenous paracetamol (30 mg/kg) and rectal diclofenac (1mg/kg). Group B received a caudal block using 1ml/kg of 0.25% Bupivacaine. Pain was assessed postoperatively in the PACU by modified Objective Pain Scale (OPS) every 15 minutes for the 1st hour and hourly up till 8 hours. Effective analgesia was defined as a modified OPS score of ≤ 3 for upto 8 hours after...
Acta Anaesthesiologica Taiwanica, 2013
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Effect of Ketamine on the Quality of Anesthesia and Postoperative Analgesia in Epidural Anesthesia
Journal of Experimental & Clinical Medicine, 2014
To investigate the effects of adding ketamine to the epidural anesthesia over quality of intraoperative anesthesia and postoperative analgesia. Methods: Sixty adult patients, 20e70 yr with an American Society of Anesthesiologists physical status of I-III (ASA I-III) who were scheduled for total hip arthroplasty were enrolled. A 18-gauge epidural needle from the L4-5 space in addition to bupivacaine 75 mg; fentanyl 100 mcg was delivered in Group BF, ketamine 30 mg in Group BK, and fentanyl 100 mg plus ketamine 30 mg in Group BKF. Onset time of sensory block, start time of surgery, maximal sensory block level, time to two-segment regression, length of anesthesia, motor block level, quality of anesthesia, and patient satisfaction were determined. At the end of the operation, analgesia was achieved by patient-controlled analgesia method. Time to first analgesic requirement, morphine consumption at 24 hours, number of requests for additional analgesic, and the amount of delivered bolus solution, were noted. Results: There was no statistically significant difference between the groups with regard to onset time of sensory block and length of surgery. Start time of surgery was significantly shorter in Group BKF; and time to two-segment regression, length of anesthesia, and time to first analgesic requirement were significantly longer in Group BF. Morphine consumption at 24 hours, number of requests for additional analgesic, and the amount of delivered analgesic bolus were minimal in Group BKF. Conclusion: Epidural ketamine shortened the start time of surgery by reducing the onset time of block and elevating the maximal block level.
British Journal of Anaesthesia, 2006
Background. This study was designed to evaluate the analgesic efficacy of three doses of tramadol, administered caudally with bupivacaine, in providing postoperative pain relief in children. Methods. Eighty children, aged between 2 and 8 yr, undergoing inguinal herniotomy were randomly allocated to receive bupivacaine 0.25% 0.75 ml kg À1 (Group B; n=20), bupivacaine 0.25% 0.75 ml kg À1 with tramadol 1 mg kg À1 (Group BT1; n=20), bupivacaine 0.25% 0.75 ml kg À1 with tramadol 1.5 mg kg À1 (Group BT1.5; n=20), or bupivacaine 0.25% 0.75 ml kg À1 with tramadol 2 mg kg À1 (Group BT2; n=20) by the caudal route immediately after induction of general anaesthesia. Heart rate, arterial pressure and oxygen saturation were monitored. Postoperative pain was assessed at regular intervals for 24 h using All India Institute of Medical Sciences pain score. Analgesia was supplemented whenever pain score was >4. Duration of analgesia and requirement for additional analgesics was noted. Results. Duration of analgesia was longer in Group BT2 [(mean (SD) 12 (0.9) h] compared with Group B [4 (1) h], Group BT1 [8 (0.9) h], or Group BT1.5 [11 (1) h]; all P<0.001. Total consumption of rescue analgesic was significantly lower in group BT2 compared with other groups (P<0.001). There were no significant changes in heart rate, arterial pressure and oxygen saturation between groups. Adverse effects were not observed. Conclusions. Caudal tramadol 2 mg kg À1 , combined with bupivacaine 0.25% 0.75 ml kg À1 , provided longer duration of postoperative analgesia and reduced requirement for rescue analgesic compared with tramadol 1 mg kg À1 or 1.5 mg kg À1 in children undergoing inguinal herniotomy.
Analgesic effectiveness of caudal levobupivacaine and ketamine
BJA: British Journal of Anaesthesia, 2008
Background. Ketamine is used increasingly in paediatric anaesthetic practice to prolong the action of a caudal block. This study was designed to determine if adding S(þ)-ketamine 0.5 mg kg 21 allows a lower concentration of levobupivacaine to be used for caudal anaesthesia without loss of clinical effectiveness. Methods. One hundred and sixty-four children (ASA I or II) aged 3 months-6 yr were randomly allocated to receive 1 ml kg 21 of levobupivacaine 0.15% with 0.5 mg kg 21 S(þ)-ketamine (Group 1), levobupivacaine 0.175% with 0.5 mg kg 21 S(þ)-ketamine (Group 2), or levobupivacaine 0.2% (Group 3) by the caudal route. Pain, motor block, sedation, and requirement for postoperative analgesia were assessed up to 6 h after operation. Results. There was no significant difference between the groups in effectiveness at first surgical incision. Significantly lower analgesic requirements were reported in Group 2 compared with Group 3 at wakeup, 180 and 360 min after operation. Time to first rescue analgesia was longer in Group 2 compared with Group 1 or 3. Kaplan-Meier survival analysis of analgesia free time demonstrated a significant advantage of Group 2 over Groups 1 and 3 (log rank P¼0.05). The incidence of postoperative motor block was not significantly different between the groups. No excess sedation or dysphoric reactions were observed in the ketamine groups. Conclusions. The addition of 0.5 mg kg 21 S(þ)-ketamine to levobupivacaine 0.175% for caudal analgesia for lower abdominal and urological surgery is significantly more effective in providing postoperative analgesia than levobupivacaine 0.15% with 0.5 mg kg 21 S(þ)-ketamine or levobupivacaine 0.2%.
Anaesthesia, Pain & Intensive Care, 2019
Background and Objective: Millions of children receive sedative, anesthetic and analgesic drugs for surgery worldwide. Caudal epidural block with bupivacaine is widely used for perioperative analgesia in children undergoing surgeries under general anesthesia. Current study aims to determine postoperative pain relief and side effects due to caudally administered 0.25% bupivacaine (0.5-1 ml/kg) alone and a combination of 0.25% bupivacaine (0.5-1 ml/kg) with tramadol (1 mg/kg).Methodology: A randomized clinical trial was conducted at department of Anesthesiology, Shaikh Zayed Hospital, Lahore. Study duration was 1 year and 6 months (February 2015-August 2016). A sample size of 108 patients was calculated using WHO calculator. Non probability consecutive sampling was used. Patients were randomly divided into two groups; Group B was given inj. bupivacaine 0.25% while Group BT received a combination of 0.25% bupivacaine (0.5-1 ml/kg) with tramadol (1 mg/kg). Patients were observed for sed...