Comparative Study between Caudal Bupivacaine and Bupivacaine/Tramadol for Postoperative Analgesia in Children for Lower Abdominal Surgery

Abstract

Summary ain is a highly unpleasant sensory and emotional experience. Various pharmacological agents and analgesic delivery systems have been employed to avoid under-treatment of pain. The goal of post-operative pain relief is to reduce or eliminate pain with minimum side-effects and in our setup as cheaply as possible. Effective pain relief means a smooth postoperative period, increased patient compliance and an early discharge from hospital. Caudal anesthesia is one of the commonly used regional blocks in children. This technique is a useful adjunct during general anesthesia and also for postoperative analgesia after lower abdominal operations. Bupivacaine is the most commonly used local anesthetic in caudal anesthesia in pediatric practice, and it provides reliable, long-lasting anesthesia and analgesia when given via the caudal route. However, the mean duration of surgical analgesia provided by local anesthetics is limited and thus single shot caudal anesthesia is indicated only for surgery expected to last less than 90 min. The administration of opioids into the epidural space prolongs the duration of caudal analgesia such as tramadol. In our study fifty pediatric patients scheduled for elective lower abdominal, pelvic or lower limb surgeries, aged 2-6 years of either sex, ASA (I -II) randomly allocated into two groups 25 in each group. One group received caudal block of 0.5ml/kg of 0.25% plain bupivacaine solution following the induction of general anesthesia while the other group received caudal block of 0.5 ml/kg of 0.25% bupivacaine in combination with 1 mg/kg of tramadol following the induction of general anesthesia. All patients in both groups were monitored for HR, MBP, SpO2, RR and ETCO2 intraoperatively and postoperatively. Postoperative analgesia was assessed using a toddler preschooler postoperative pain score (TPPPS). TPPPS pain score was recorded at admission to PACU (baseline), then hourly for first 2 hours, then every 2 hours for next 12 hours and at 24 hours postoperative. Results of our study were showing that addition of tramadol to bupivacine in caudal block as above mentioned dose leading to increase postoperative analgesia up to 14 hours approximately with no significant side effects.