Related Experiment Videos

Caudal bupivacaine and s(+)-ketamine for postoperative analgesia in children

Frank Weber1, Hinnerk Wulf

  • 1Department of Anaesthesia, University of Regensburg, Regensburg, Germany. frank.weber@klinik.uni-regensburg.de

Paediatric Anaesthesia
|March 19, 2003
PubMed

Insights

Adding s-ketamine to caudal bupivacaine significantly extends postoperative pain relief in children undergoing minor surgery. This combination offers prolonged analgesia without adverse side effects, improving patient recovery.

Area of Science:

  • Pediatric Anesthesiology
  • Pain Management
  • Pharmacology

Background:

  • Caudal anesthesia is common for pediatric surgery.
  • Prolonging the duration of analgesia is a key goal in pediatric pain management.
  • Evaluating adjuncts to local anesthetics can enhance anesthetic techniques.

Purpose of the Study:

  • To assess if caudal s-ketamine prolongs analgesia when combined with caudal bupivacaine in pediatric patients.
  • To determine the safety and efficacy of this combined anesthetic approach.

Main Methods:

  • A prospective, double-blind study randomized 30 pediatric patients (1 month-9 years) undergoing minor surgery.
  • Patients received caudal blockade with either bupivacaine alone or bupivacaine with preservative-free s-ketamine.
  • Postoperative pain was monitored using a 10-point scale, with analgesia administered for scores >3.

Main Results:

  • 67% of patients receiving s-ketamine combination did not require additional analgesia within 24 hours, compared to 20% in the bupivacaine-only group (P < 0.01).
  • No significant differences in hemodynamic changes were observed between groups.
  • No negative side effects were attributed to the caudal block or s-ketamine.

Conclusions:

  • Caudal s-ketamine, when added to bupivacaine, significantly prolongs postoperative analgesia in pediatric patients.
  • The combination is safe and does not increase adverse events.
  • This approach offers an effective strategy for extended pain relief after pediatric surgery.
Abstract

Related Concept Videos

Local Anesthetics: Clinical Application as Epidural Anesthesia01:29

Local Anesthetics: Clinical Application as Epidural Anesthesia

Epidural anesthetics are administered in the fat-filled epidural space, the outermost part of the spinal canal. This technique is commonly employed for pain management and anesthesia during lower abdomen and pelvis surgeries or labor and delivery.
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
Parenteral Anesthetics: Overview01:24

Parenteral Anesthetics: Overview

Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.
Local Anesthetics: Clinical Application as Spinal Anesthesia01:11

Local Anesthetics: Clinical Application as Spinal Anesthesia

Spinal anesthetics are given during lower abdomen and limb surgeries to block sensory and motor neurons. They are administered in the mid to low lumbar regions, primarily acting on the cauda equina's nerve roots. The blockade level depends on the local anesthetic (LA) concentration. Usually, low LA concentrations are sufficient to block sensory fibers, while only high LA concentrations block motor fibers. Other factors like injection volume and speed, the patient's posture, and the drug...
Local Anesthetics: Common Agents and Their Applications01:23

Local Anesthetics: Common Agents and Their Applications

Local anesthetics (LAs) are commonly used for various applications in medical and dental procedures. Some of the common agents used are cocaine, lidocaine, and bupivacaine.
Cocaine is an ester of benzoic acid and methylecgogine. It is used to anesthetize and vasoconstrict locally. Currently, it is used primarily for topical applications. It is beneficial for surgeries on the upper respiratory tract, providing anesthesia and shrinking the mucosa. Cocaine in the form of cocaine hydrochloride is...
Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia01:16

Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia

Intravenous regional anesthesia or the Bier block technique is used to anesthetize a specific limb or extremity. It uses exsanguinated or blood-drained vessels to transport local anesthetics or LAs to the peripheral nerve trunks. Lidocaine without vasoconstrictors like epinephrine is most commonly used for this technique. Other drugs used are prilocaine, ropivacaine, and chloroprocaine. Bupivacaine is not recommended for this technique due to its high cardiac toxicity.
One of the advantages of...
Local Anesthetics: Clinical Application as Surface, Infiltration, and Conduction Block Anesthesia01:30

Local Anesthetics: Clinical Application as Surface, Infiltration, and Conduction Block Anesthesia

Depending on the target organ, local anesthetics (LAs) can be administered via various routes. In surface anesthesia, LAs are applied directly to the surface of the skin or mucous membranes. It is widely used for topical skin numbing before venipuncture or minor surgical procedures. Commonly used surface local anesthetics are lidocaine or benzocaine sprays or creams. Surface anesthesia occurs within 5 minutes and lasts for about 60 minutes. One of the main disadvantages of topical anesthesia is...