A comparison of bupivacaine with or without tramadol in caudal epidural block for postoperative caudal analgesia in children undergoing lower abdominal surgery under general anesthesia

Abstract

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 sedation score, FLACC pain score and adverse effects in both interventional groups. Data were analyzed using SPSS version 22. Student’s T-test was applied on data. P-value ≤ 0.05 was considered significant.
Results: Total 108 patients were included in the study (1:1 randomization). Mean age of patients was 6.41 ± 1.77 y. There were 92 (85.2%) male and 16 (14.8%) female children. Mean sedative scores (p = 0.00) and mean FLACC pain scores (p = 0.000) were significantly lower in bupivacaine tramadol group as compared to bupivacaine group. However, bupivacaine group had more adverse effects as compared to combination of bupivacaine and tramadol group.
Conclusion: Caudal epidural with a combination of 0.25% bupivacaine (0.5-1 ml/kg) with tramadol (1 mg/kg) has high postoperative analgesic efficacy and limited adverse effects as compared to 0.25% bupivacaine alone in children undergone general anesthesia for lower abdominal surgery.