Comparision of Caudal Bupivacaine with Additives Fantanyl or Ketamine for Post-Operative Pain Relief in Children: A Randomized Controlled, Double Blinded Study

Background and Aims:Ensuring adequate analgesia in the post-operative period is an indispensable part of a balanced anesthesia technique with increasing scope of day care surgery and emphasis on early discharge. In children undergoing infraumbilical and lower limb surgeries, caudal block is a reliable and safe technique that can be used with general anesthesia for intra and post-operative analgesia. The present study was designed to compare the analgesic efficacy of ketamine and fentanyl as additives to bupivacaine given caudally in children undergoing lower abdominal and lower limb surgery. Materials and Methods:A total of 60 children aged 1-5 years undergoing lower abdominal and lower limb surgery were included in this randomized, controlled, double-blind study. Three groups of 20 each were assigned to receive caudal block with bupivacaine 0.25% 0.5 ml/kg alone (group A) or along with 1 ml/kg fentanyl (group B) or 0.5 mg/kg ketamine (group C). Assessment of post-operative pain was done using the Objective Pain Scale. Requirement of rescue analgesia and side effects were also noted. Results:Children who received ketamine with bupivacaine caudally (group C) had the longest duration of post-operative analgesia [Group A vs. Group C: 150 min (p=0.32) vs. 180 min (p=0.00)] and requirement of first dose of analgesia in groups A, B and C ranged from 183±16.5 min, 350±2.5 min and 594±148.12 min respectively. The mean number of doses of rescue analgesia that patients received in 24 hours in group A, B and C were 6.0, 1.63 and 1.40 respectively. Conclusion:Caudally administered Ketamine in the dose of 0.5 mg/kg with bupivacaine provides prolonged post-operative analgesia in comparison to fenatnyl 1 μg/kg with bupivacaine with minimal side effects.