A comparative study of ketamine and tramadol as additives to plain bupivacaine in caudal anaesthesia in children.

BACKGROUND: studies examining the benefits of additives to bupivacaine in caudal anaesthesia have produced mixed results. Although the mechanism of action of these analgesics remains unclear, ketamine and tramadol have been used successfully in caudal block for prolonged postoperative pain relief. We compared the onset, quality and duration of analgesia produced by bupivacaine, either alone or combined with tramadol and ketamine. MATERIAL AND METHODS: this study was conducted in 100 pediatric patients of asa grade I and II, aged between 1 to 7 years undergoing infra-umbilical surgery, during the study period. Cases were selected on the basis of simple random sampling method and were randomly allocated into three groups as follows: Group b: (n=34) who receives 0.75 ml/kg of 0.25% Bupivacaine caudally Group bk: (n=33) who receives combination of Ketamine 0.5 mg/kg + 0.75 ml/kg of 0.25% Bupivacaine caudally Group bt: (n=33) who receives combination of Tramadol 2 mg/kg + 0.75ml/kg of 0.25% Bupivacaine caudally RESULTS: the mean duration of action after addition of Ketamine and Tramadol to Bupivacaine by the caudal epidural route was 9.3 h(559.39 +/- 27.15 minutes) and 7.9 h (478.48 +/- 54.15 minutes) respectively as compared to caudal Bupivacaine 4.0 h (240.59 +/- 15.36 minutes). There were no significant differences between the groups in cardiac parameters, recovery characteristics and incidence of side effects. CONCLUSIONS: we conclude that Caudal Ketamine 0.5 mg/kg & Caudal Tramadol 2 mg/kg appear as satisfactory adjuncts to caudal Bupivacaine, which produced satisfactory intraoperative analgesia and also satisfactory postoperative analgesia without the use of any epidural catheter.