Comparison of caudal bupivacaine and bupivacaine-tramadol for postoperative analgesia in children undergoing hypospadias surgery.

OBJECTIVE To compare the effectiveness of caudal bupivacaine and bupivacaine-tramadol for postoperative analgesia in children undergoing hypospadias surgery. STUDY DESIGN Quasi experimental study. PLACE AND DURATION OF STUDY The Postgraduate Medical Institute, Hayatabad Medical Complex, Peshawar, from February 2006 to August 2007. METHODOLOGY The study was conducted on 60 male children undergoing elective hypospadias surgery at the study centre. Patients were divided into two groups of 30 each. Patients in group 'B' (bupivacaine) were given 0.5 ml/kg of 0.25% plain bupivacaine, while patients in group 'BT' (bupivacaine and tramadol) were given 0.5 ml/kg of 0.25% bupivacaine in combination with 1 mg/kg of tramadol in caudal epidural space just after induction of anaesthesia. ASA status, duration of anaesthesia,duration of surgery, type of anaesthesia and maintenance of anaesthesia were similar for both groups. In the recovery room, patients were compared for pain scores, sedation score, need for rescue analgesia and any unwanted side effects for 24 hours postoperatively. All patients were assessed haemodynamically at regular intervals intraoperatively in both groups. A t-test was used to compare the mean values of the group with significance at p < 0.05. RESULTS Mean age of the children was 4.2+/-2.35 and 5.5+/-1.51 years in group B and BT respectively. Their weight ranged from 10-30 kg. A lower pain score was observed in the bupivacaine-tramadol group during the first 24 hours in the recovery room, as well as in the postoperative ward. The mean duration of analgesia was significantly prolonged and the requirement for rescue analgesics were significantly less in the bupivacaine-tramadol group (p < 0.0001) postoperatively. Demographic data, haemodynamic variables, sedation score, and minor complications were not significantly different in the two groups. CONCLUSION Caudal tramadol with bupivacaine provides prolonged and good quality postoperative analgesia compared to plain bupivacaine in children undergoing hypospadias surgery.