A comparison of Ropivacaine alone and in combination with Fentanyl for caudal analgesia in pediatric patients

Caudal analgesia is a very popular route to provide intraoperative and postoperative analgesia in children because of its simple technique, predictable level of blockade, high success rate and smooth recovery. It can be used mainly for perineal and sub umbilical procedures. Ropivacaine, the S-enantiomer of the amide local anesthetic, produces differential neural blockade, with lesser motor blockade; less cardiovascular and neurological toxicity than bupivacaine, making it suitable for day-care surgery in children. The addition of an adjuvant prolongs and intensifies the sensory blockade caused by local anaesthetic and also reduces the dose of local anaesthetic required to provide desired analgesia. Fentanyl is one of the most commonly used adjuvant with local anesthetics in caudal blocks. The aim of our study was to compare the efficacy of ropivacaine alone and in combination with fentanyl via caudal route for postoperative analgesia in children. The primary end point was duration of sensory and motor blockade. Study Design: Double blind, prospective, randomized .The subjects were 40 children aged 1 – 10 years undergoing perineal and sub umbilical procedures. They were randomly divided in two groups of 20 each using chit in box method. Group R received inj ropivacaine 0.2%, 0.5 ml/kg and Group RF received inj ropivacaine 0.2%,0.5 ml/kg in combination with inj fentanyl 0.5mcg/kg via caudal route just after intubation. GA was induced in the standard manner using propofol. Our study showed that patients in group RF required rescue analgesic 16 – 20 hrs later than patients in group R and the pain scores of group RF were better in the postoperative period. There was no significant motor blockade in both the groups. There was also no significant hemodynamic variation and postoperative complications observed in either group. Thus, addition of fentanyl to ropivacaine as caudal analgesic provides prolonged and more intense postoperative analgesia in children.