A comparative study between caudal bupivacaine and bupivacaine-tramadol combination for postoperative analgesia in paediatric infraumbilical surgeries

Abstract

Background & Objectives: Caudal epidural analgesia is one of the most commonly performed regional blocks in pediatric anaesthesia for intra and post-operative analgesia. However, the mean duration of analgesia provided by local and aesthetics alone is limited. Caudal opioids is associated with side effects like respiratory depression, urinary retention, pruritis, vomiting etc. Tramadol, an opioid agonist, is known for its analgesic effects with lesser side effects. Hence, this study was conducted to know the efficacy and safety of addition of tramadol to bupivacaine in a single shot caudal block in children.Methods: This study was conducted among 50 children in the age group of 1 – 13 years coming for various infraumbilical surgical procedures. They were divided into two groups of 30 each. Group B received caudal 0.25% bupivacaine (1ml/kg) and group BT received caudal 0.25% bupivacaine (1ml/kg) with tramadol (1mg/kg). The various parameters studied were hemodynamic changes, duration of analgesia and incidence of side effects. Pain assessment was done at the 1st, 2nd, 3rd, 4th, 8th, 12th and 24th hour after the surgery.Results: The groups were similar in age, sex and weight. The hemodynamic parameters like heart rate, blood pressure, respiratory rate were also similar between the two groups after administering caudal block. The mean duration of analgesia in group BT (425.3±33.4 min) was significantly longer (p< 0.05) than group B (219.3±19.1 min).The pain score in the two groups were similar up to 2 hours after surgery but was higher in group B at the end of 3rd and 4th hour compared with group BT. Sedation score was similar in both the groups. Incidence of vomiting was comparable in both the groups while there were no incidence of bradycardia, hypotension or respiratory depression in both the groups. Conclusion: This study showed that the addition of tramadol in the dose of 1mg/kg to 0.25% bupivacaine (1ml/kg) improved the analgesic duration and efficacy after a single shot caudal block with minimal side effects in children.