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Analgesic effects of caudal and intramuscular S(+)-ketamine in children
H Koinig1, P Marhofer, C G Krenn
1Departments of Anesthesiology and Intensive Care and Pharmacology, University of Vienna, Vienna, Austria. Herbert.Koinig@unvie.ac.at
Insights
Caudal S(+)-ketamine offers superior pain relief in children compared to intramuscular administration, suggesting a local analgesic effect. This method provides longer-lasting analgesia with lower plasma concentrations.
Area of Science:
- Pediatric Anesthesiology
- Pain Management
- Pharmacology
Background:
- Previous research indicates caudal ketamine provides effective analgesia.
- Understanding the route of administration is crucial for distinguishing local vs. systemic effects.
Purpose of the Study:
- To compare the clinical effectiveness and plasma concentrations of S(+)-ketamine administered via caudal versus intramuscular routes in pediatric patients.
- To elucidate whether caudal ketamine provides local or systemic analgesia.
Main Methods:
- 42 pediatric patients (1-7 years) undergoing inguinal hernia repair received either caudal or intramuscular S(+)-ketamine (1 mg/kg).
- Intraoperative monitoring included heart rate, mean arterial pressure, and oxygen saturation.
- Postoperative assessments covered analgesia duration, sedation, hemodynamics, respiratory status, and plasma ketamine concentrations for 180 minutes.
Main Results:
- Caudal S(+)-ketamine resulted in significantly longer analgesia duration (528 min) compared to intramuscular administration (108 min).
- Plasma ketamine concentrations were significantly lower from 10 to 45 minutes post-caudal administration versus intramuscular.
Conclusions:
- Caudal S(+)-ketamine provides effective intraoperative and postoperative analgesia in children.
- The superior analgesia from caudal administration, despite similar plasma levels, indicates a local analgesic effect.
Background:
Previous studies suggest that caudal administration of ketamine cause effective analgesia. The purpose of the current study was to compare the clinical effectiveness and plasma concentrations of S(+)-ketamine after caudal or intramuscular administration in children to distinguish between local and systemic analgesia.
Methods:
After induction of general anesthesia, 42 patients, aged 1 to 7 yr, scheduled to undergo inguinal hernia repair randomly received a caudal (caudal group) or intramuscular (intramuscular group) injection of 1 mg/kg S(+)-ketamine. Intraoperatively, heart rate (HR), mean arterial pressure (MAP) and arterial oxygen saturation were measured. Postoperative measurements included duration of analgesia, a four-point sedation score, and hemodynamic and respiratory monitoring for 6 h in the recovery room. Analgesic requirements in the recovery room were assessed by an independent blinded observer using an observational pain/discomfort scale (OPS). Plasma samples for determination of ketamine concentrations were obtained before and 10, 20, 30, 45, 60, 90, 120, and 180 min after injection of S(+)-ketamine.
Results:
A significantly longer duration of analgesia (P < 0.001) was observed after caudal administration (528 min [220-1,440 min]; median [range]) when compared with intramuscular administration (108 min [62-1,440 min]) of S(+)-ketamine. Plasma levels of ketamine were significantly lower from 10 to 45 min after caudal administration than after intramuscular injection.
Conclusion:
Caudal S(+)-ketamine provides good intra- and postoperative analgesia in children. Despite similar plasma concentrations during most of the postoperative observation period, caudal S(+)-ketamine provided more effective analgesia than did intramuscular S(+)-ketamine, indicating a local analgesic effect.