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Topical versus caudal ketamine/bupivacaine combination for postoperative analgesia in children undergoing inguinal

Hala Saad Abdel-Ghaffar¹, Seham Mohamed Moeen¹, Ahmed Mohamed Moeen²

¹Department of Anesthesia and Intensive Care, Faculty of Medicine, Assiut University, Assiut, Egypt.

Saudi Journal of Anaesthesia

|February 21, 2017

Insights

Topical ketamine provided longer postoperative analgesia than caudal ketamine in pediatric patients undergoing inguinal herniotomy. This simple technique offers a safe alternative for effective pain management.

Area of Science:

Anesthesiology
Pediatric Surgery
Pain Management

Background:

Caudal ketamine is reported to provide effective postoperative analgesia.
This study aimed to compare caudal versus topical ketamine for pain relief in pediatric inguinal herniotomy.

Purpose of the Study:

To assess the clinical effectiveness of ketamine after caudal or topical administration in pediatric patients undergoing inguinal herniotomy.

Main Methods:

Eighty children (6 months to 6 years) were randomized to receive caudal or topical bupivacaine/ketamine.
Postoperative analgesia duration, pain scores, rescue analgesic use, sedation, hemodynamics, and side-effects were evaluated for 48 hours.

Main Results:

Topical ketamine (TK) significantly prolonged postoperative analgesia duration compared to caudal ketamine (CK) (28.7 vs. 21.4 hours).
Fewer children in the TK group required oral analgesics (66.7% vs. 87.5%).
The CK group experienced adverse events including urinary retention and photophobia.

Conclusions:

Wound instillation of bupivacaine/ketamine is a simple, noninvasive, and effective analgesic technique.
Topical ketamine serves as a safe and effective alternative to caudal ketamine for postoperative pain management in pediatric inguinal hernia repair.

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Abstract

Background:

Multiple studies claim that caudal administration of ketamine causes effective postoperative analgesia. The aim of this study was to assess the clinical effectiveness of ketamine after caudal or topical administration in pediatric patients undergoing inguinal herniotomy.

Patients And Methods:

This randomized, comparative, double-blind study included eighty children (aged 6 months to 6 years) received either 1 ml/kg of 0.25% bupivacaine/ketamine 0.5 mg/kg for caudal analgesia (caudal group) or 0.3 ml/kg of 0.25% bupivacaine/ketamine 0.5 mg/kg sprayed by the surgeon around the spermatic cord and upon the ilioinguinal nerve before wound closure for topical analgesia (topical group). The duration of postoperative analgesia, pain scores, rescue analgesic consumption, sedation score, hemodynamic monitoring, and side-effects were evaluated 48 h postoperative.

Results:

Kaplan-Meier survival analysis of analgesia free time demonstrated a significant advantage of topical ketamine (TK) group over caudal ketamine (CK) group. The duration of postoperative analgesia was longer in TK group than in CK group (28.74 ± 2.88 vs. 21.43 ± 5.01 h, P = 0.000). Fewer children asked for oral analgesics in the topical group (24 of 36, 66.7%) than in the caudal one (28 of 32, 87.5%; P < 0.01). Postoperative pain scores at the 6^th till 48^th h were lower in topical group with comparable analgesic consumption between two groups. In the caudal group, four subjects suffered from retention of urine: Two presented with a residual motor block and two had photophobia.

Conclusion:

Wound instillation of bupivacaine/ketamine is a simple, noninvasive, and effective technique that could be a safe alternative to CK for postoperative analgesia in children undergoing inguinal hernia repair.

Keywords:

Analgesia caudal day-case anesthetic techniques ketamine pediatrics postoperative topical

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