Pediatric Patients Undergoing Elective Surgeries Below the Umbilicus: Comparative Study of Caudal Bupivacaine (0.25%) and Caudal Bupivacaine (0.25%) with Ketamine

Abstract

Background: Caudal block has the potential advantage that, by adding other drugs to the local anaesthetic agent, the duration and effectiveness of the block may be extended. Peripheral nerve blocks and caudal anaesthesia are very benign, nonetheless inordinate attention is compulsory to evade side effects. Aim and objectives: We aimed at this study to compare total postoperative analgesic requirement, anaesthetic, analgesic and sedation qualities. Hemodynamic changes, motor block, adverse effect, and parents’ satisfaction in children who received caudal bupivacaine only versus caudal bupivacaine with ketamine in paediatric patients undergoing surgery below the level of the umbilicus. Methods: Prospective randomized double blind controlled clinical trial conduced at operation room in University Hospital in Faculty of Medicine, October 6 University. Sixty children scheduled for elective surgery below umbilicus were randomly allocated to either: Group A (30 patients) includes the children who take saline caudal bupivacaine with dose of 1 ml/kg, afterward initiation of overall anaesthesia or Group B (30 patients) who following the administration of general anaesthesia, receives caudal bupivacaine 0.25 % in a dose of 1 ml/kg and caudal ketamine preservative free in a dose of 0.5 mg/kg. Hemodynamic alterations, parent satisfaction, postoperative analgesia and sedation characteristics, and side effects were noted. Results: The studied groups showed no statically significant difference regarding demographic data. Motor block statistically was significantly lower in ketamine group. Anaesthesia quality statistically was significantly higher in ketamine group. Regarding hemodynamic state, mean arterial blood pressure (MPA) and heart rate showed a statistically significant difference during and up to 30 minute postoperative (P<0.001), and oxygen saturation showed no statistically significant difference during and after surgery (P>0.05). Sedation score was higher in ketamine group, were lower in ketamine group all were statistically significant. Side effects statistically were non-significantly but less frequent in ketamine group. Total 24-hours analgesia dose statistically was significantly lesser in ketamine group. Parent’s satisfaction statistically was suggestively better in ketamine group. Conclusion: Amalgamation therapy of ketamine with bupivacaine is enhanced decision for post-operative pain controller in children enduring surgery below the umbilical. It increased the duration of analgesia and abridged the necessity for post-operative analgesic supplementation as well.