Comparison of caudal tramadol versus caudal fentanyl with bupivacaine for prolongation of postoperative analgesia in pediatric patients

Abstract

Background and Aims:Caudal block is a common technique for pediatric analgesia for infraumblical surgeries. Because of the short duration of analgesia with bupivacaine alone various additive have been used to prolong the action of bupivacaine. The present study was aimed to evaluate the analgesic effect of tramadol or fentanyl added to bupivacaine for infraumblical surgeries in pediatric patients.Materials and Methods:We conducted a prospective, randomized, single-blind controlled trial. After written informed consent from parents, 100 patients belonging to American Society of Anesthesiologist physical status I-II, in the age group of 1-12 years, of either sex undergoing infraumblical surgery under general anesthesia were divided into two groups. Group BT received 1 ml/kg of 0.25% bupivacaine with tramadol 2 mg/kg in normal saline and Group BF received 1 ml/kg of 0.25% bupivacaine with fentanyl 2 μg/kg in normal saline with maximum volume of 12 ml in both groups. All patients were assessed intraoperatively for hemodynamic changes, the requirement of sevoflurane concentration, as well as postoperatively for pain by using FLACC (F = Face, L = Leg, A = Activity, C = Cry, C = Consolability), pain score and for sedation by using four point sedation score.Results:The mean duration of analgesia was 10–18 h in Group BT while in Group BF it was 7-11 h. The postoperatively period up to 1½ h, Group BF had higher sedation score up to two as compared to that below one on Group BT.Conclusion:Caudal tramadol significantly prolongs the duration of analgesia as compared to caudal fentanyl without any side effects.

The impact of caudally administrated tramadol on immune response and analgesic efficacy for pediatric patients: a comparative randomized clinical trial

“…We did not observe any serious adverse effects, and our minor complication rates were very low, and comparable in the two studied groups. These results are in agreement with studies which reported the safety of caudal tramadol [ 28 31 ].…”

Comparative evaluation of caudal tramadol and fentanyl when mixed with bupivacaine in paediatric age group

“…This is desirable as the child is more calm and comfortable in the immediate postoperative period. 21 The duration of urinary retention in case of group-T was found to be 8.25±1.41 hours and in group-F was found to be 6.41±1.48 hours which was significantly longer in group T. In present study two identical twins who underwent urethroplasty for hypospadiasis both had a slightly longer sacral hiatus as compared to other children. Similar duration of analgesia in both the children (12 and 12.2 hours) was observed.…”

Comparison of a Combination of Caudal Levobupivacaine with Fentanyl and Levobupivacaine Alone for Alleviating Postoperative Pain During Infraumbilical Procedures in Children Under 3 Years

“…Post-operatively pain scale was monitored at 2,4, 6,12 [2] and 24 hours by using CHIPPS scale. Postoperatively monitored for blood pressure, heart [3] rate at 2, 4,6,12 and 24 hours. Side effects.…”

“…Caudal block is one of the main modes of posto-perative analgesia in children for infra umbilical surgeries [1]. Local anaesthetics which are commonly used in the caudal block are bupivacaine, levobupivacaine, and ropivacaine in different concentrations with additives like fentanyl, morphine, butorphanol, tramadol, clonidine, dexmedetomidine and dexamethasone which are added to improve their efficacy [2,3]. Epinephrine 1:200000 concentrations mixed with local anaesthetics marginally prolonged the effect of hydrophilic lignocaine but failed to do so with lipophilic bupivacaine due to its fat absorption and slow release [4].…”

“…Considering the useful properties of the above drug, a study was conducted aiming at a comparison of a combination of caudal 0.25% levobupivacaine with fentanyl 1µg/kg and levobupivacaine alone for alleviating postoperative pain during infra umbilical procedures in children under 3 years. Fentanyl is a synthetic opioid agonist, readily crosses the lumbar dura matter, penetrates rapidly the lipid moiety of underlying cord tissue and helps in the prevention of rostral migration of fentanyl avoiding central nervous system dependent depression of respiratory and cardiovascular system [3]. The most difficult task of pain management in children is the accuracy of assessment and obtaining a proper objective compelled us to adopt a simple Children and Infant Postoperative Pain Scale (CHIPPS) to assess pain in immediate post-operative period.…”