Posted in Volume 15 - Number 4 Suppl
SALEEM SABBAR, ZAMIR,ASMA KHALID, FAWAD AHMED KHAN
ABSTRACT | Full Text PDF
OBJECTIVE: The aim of the study was to determine the postoperative analgesic effect of Ketamine when given with caudally administered Bupivacaine in children undergoing inguino-scrotal surgeries.
STUDY DESIGN: The study design was prospective quasi experimental.
PLACE AND DURATION: The study was conducted in Department of Anaesthesia, Sindh Govt Lyari General Hospital from April 2008 to September 2008.
PATIENTS AND METHODS: In this double blind comparative study we included total sixty children undergoing inguino-scrotal surgeries. They were aged from 1 to 12 years, ASA I AND II, meeting the inclusion criteria .The patients were allocated into two equal groups. The patient in Bupivacaine group or group A received caudal Bupivacaine 0.25%, 0.75 milliliter/kilogram (ml/kg) and the children in group B were given caudal Bupivacaine 0.25 %, 0.75 ml/kg and Ketamine 0.25 milligram/kilogram (mg/kg) through caudal route after induction of general anaesthesia. No other analgesics were given intra operatively. The postoperative pain was evaluated by using visual analogue pain scale in children over 6-7 years and observation of behavior in preverbal child including those who were too young to use visual analogue pain scale. The rescue analgesia was administered when pain score reached a level of 4 in the form of Paracetamol suppositories and syrup Ibuprofen was given accordingly. Sedation was assessed by 4 points sedation score at immediate postoperative period 30 minutes2, 3, 4, 6,12 and 24 hours.
RESULTS: Addition of Ketamine with caudally administered Bupivacaine resulted in significantly longer postoperative analgesic period (11.4 +/- 2.8 hours) while in group A in which only Bupivacaine was used, mean duration of analgesia was (3.14 +/- 0.94 hours)(p <0.0005). No other side effects like respiratory depression, pruritis, urinary retention found in both the groups except for nausea and vomiting. The demand for supplemental analgesia was more in group A than group B. The sedation scores were similar in both the groups. No patient in group A had nausea and vomiting where as one patient had vomiting of group B. No patient experienced emergence delirium or hallucinations in both the groups.
CONCLUSION: The use of Ketamine as an adjunct to local anaesthetics can prolong the post-operative analgesia period when administered caudally and its use is safe in children
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