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Levobupivacaine-tramadol combination for caudal block in children: a randomized, double-blinded, prospective study
Tulay S Yildiz1, Dilek Ozdamar, Fazilet Bagus
1Department of Anesthesiology, Medical Faculty, University of Kocaeli, Kocaeli, Turkey. tsyildiz@yahoo.com
Insights
Adding tramadol to caudal levobupivacaine significantly extended postoperative pain relief in children undergoing day-case surgery. This combination offers prolonged analgesia compared to either agent alone.
Area of Science:
- Pediatric Anesthesiology
- Pain Management
- Pharmacology
Background:
- Assessing postoperative pain management in pediatric day-case surgery is crucial.
- Comparing analgesic efficacy of caudal levobupivacaine, tramadol, and their combination is needed.
Purpose of the Study:
- To compare the analgesic efficacy and duration of caudal levobupivacaine, tramadol, and their mixture in children undergoing day-case surgery.
Main Methods:
- Prospective study of 63 pediatric patients (1-7 years) undergoing inguinal hernia repair.
- Randomization into three groups: caudal levobupivacaine, caudal tramadol, or a mixture.
- Pain assessment using the Children's and Infants' Postoperative Pain Scale (CHIPPS) up to 24 hours post-surgery.
Main Results:
- The combination group (levobupivacaine + tramadol) showed significantly longer analgesia duration (545 min) compared to levobupivacaine alone (322 min) or tramadol alone (248 min).
- No significant difference in analgesia duration was found between levobupivacaine and tramadol groups.
- No significant differences in the number of patients requiring additional analgesia or motor block were observed.
Conclusions:
- Combining tramadol with caudal levobupivacaine enhances the duration of postoperative analgesia in pediatric patients.
- Caudal levobupivacaine and tramadol alone provide comparable, shorter durations of pain relief.
- The combination strategy offers a potential improvement for pediatric pain management post-surgery.
Background:
The aim of this prospective study was to compare the postoperative analgesic efficacy and duration of analgesia after caudal levobupivacaine 0.125% or caudal tramadol 1.5 mg.kg(-1) and mixture of both in children undergoing day-case surgery.
Methods:
Sixty-three American Society of Anesthesiologists (ASA) I or II children between 1 and 7 years old scheduled for inguinal hernia repair under sevoflurane anesthesia were randomized to receive caudal levobupivacaine 0.125% (group L), caudal tramadol 1.5 mg.kg(-1) (group T) or mixture of both (group LT) (total volume of caudal solution was 1 ml.kg(-1)). Duration of analgesia and requirement for additional analgesics were noted. Postoperative pain was evaluated using the Children's and Infants' Postoperative Pain Scale (CHIPPS) every 15 min for the first hour, and after 2, 3, 4, 6, 12, and 24 h. Analgesia was supplemented whenever pain score was > or =4.
Results:
No patient experienced significant intraoperative hemodynamic response to surgical incision. Duration of analgesia was significantly longer in group LT than in group L and group T (545 +/- 160 min vs 322 +/- 183 min and 248 +/- 188 min, respectively) (P < 0.01). There were no significant differences between the group L and group T for duration of analgesia (P > 0.05). There were no significant differences among the groups in the number of patients requiring analgesia after operation (P = 0.7). No signs of motor block were observed after the first postoperative hour in any of the patients.
Conclusion:
Addition of tramadol increased the duration of analgesia produced by caudal levobupivacaine in children.
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