Study of morphine with ropivacaine and ropivacaine alone for caudal epidural analgesia in children

Sailo, Saidingpuii; Zodinpuia, Micky; Naveen, P

doi:10.18203/2349-2902.isj20200822

Cited by 3 publications

(1 citation statement)

References 11 publications

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“…The caudal block is widely accepted due to its technical simplicity, safety, reliability and fast operation in a wide range of children and infants. The pharmacodynamic and pharmacokinetic properties of bupivacaine have been assessed in hundreds of studies over thirty years [14][15] . Caudal bupivacaine solitarily can produce outstanding analgesic effects in the initial period after surgery.…”

Section: Discussionmentioning

confidence: 99%

A Comparative Study on Caudal Bupivacaine with and without Tramadol for Analgesia Postoperatively in Paediatric Inguino Scrotal Surgeries

Ashfaq¹,

Asghar²,

Channa³

et al. 2022

PJMHS

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Objective: The objective of this analysis was to govern the analgesic effect of tramadol with caudal bupivacaine in children enduring inguinal-scrotal surgery postoperatively. Study design: A Quasi experimental study. Methods: In this comparative and double-blind study, 120 children undergoing inguinal scrotal surgery were involved in the analysis. They were 2-12 years old. The inclusion standards were children from ASA I and II. The two identical groups were formed. After initiation of general anesthesia, group A patients (n = 60) 0.25% bupivacaine 0.75 ml / kg was administered and tramadol 1 mg / kg with 0.25% bupivacaine 0.75 ml / kg were administered in B group (n = 60). Postoperative pain was evaluated with a visual analogue pain score in 6-7 years of age children and with behavioural reflexion in pre-speech children. Using a 4-point sedation scale; Sedation was assessed; heart rate, mean arterial pressure, arterial oxygen saturation and respiration rate. The sedation and pain were documented at consistent duration up to 24 hours after surgery immediately after recovery from anesthesia. If the pain score was higher than 4, paracetamol (20 mg / kg) was administered rectally. Results: Addition of intravenous bupivacaine and tramadol suggestively have longer postoperative analgesia (10.1 ± 2.1 hours) in group B, while the mean duration of analgesia (2.90 ± 0.79 hours) in group A, where bupivacaine alone was, provided. No significant changes were observed in blood pressure, O2 saturation and heart rate between groups. Apart from vomiting and nausea, no side effects like retention of urine, depression and pruritus were observed. Conclusion: In children undergoing inguinal scrotal surgery, caudal bupivacaine and tramadol have more lasting and better postoperative analgesia than bupivacaine alone. Keywords: Postoperative analgesia, tramadol, Caudal and bupivacaine.

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Section: Discussionmentioning

confidence: 99%

A Comparative Study on Caudal Bupivacaine with and without Tramadol for Analgesia Postoperatively in Paediatric Inguino Scrotal Surgeries

Ashfaq¹,

Asghar²,

Channa³

et al. 2022

PJMHS

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Comparison between Caudal Dexmedetomidine and Morphine for Postoperative Analgesia in Pediatric Infraumbilical Surgeries

Mahmoud

Abdelfattah

Mahmoud

et al. 2021

The Egyptian Journal of Hospital Medicine

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Background: The usage of caudal opioids extends the length of analgesia substantially, but it often comes with a slew of adverse side effects, including fatigue, vomiting, pruritus, urinary retention, and a chance of respiratory distress later on. Objective: The aim of this analysis was to compare the effects of caudal dexmedetomidine versus morphine in conjunction with bupivacaine in pediatric infraumbilical surgeries. Patients and Methods: This randomized controlled sample involved 90 pediatric patients aged 1 to 7 years old, of American Society of Anesthesiologists (ASA) physical status I-II, of both sexes, who were scheduled for lower abdominal surgeries. Patients were allocated to three equal groups. Group D got a 0.25% bupivacaine + 1 g/kg dexmedetomidine. Group M obtained a 0.25% bupivacaine + 30 g/kg morphine mixture. Group MD: dexmedetomidine 1 g/kg and morphine 30 g/kg with bupivacaine were used in a single dose caudal epidural analgesia. Results: Intraoperative heart rate, mean arterial blood pressure at 20, 25, 30 and 45 min was significantly decreased in group MD than group D and group M while in postoperative period were insignificantly among the three groups at all times of measurement. FLACC was significantly lower in MD group at discharge, 1, 2, 3, 6, 12 and 18 hours. Ramsey sedation score (RSS) at 30 min was significantly decreased in group M than group D and in group MD than group M. Time for 1 st analgesia and paracetamol dosage was significantly earlier in group M than group D and group MD. Pruritus and vomiting were significantly lower in group D than other groups. Conclusions: The addition of dexmedetomidine to caudal morphine in pediatric patients produced longer postoperative analgesia, more sedation and with better emergence from anesthesia and hemodynamic stability, with fewer side effects than morphine.

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A double-blinded randomized control trial to compare the duration of analgesia using morphine, clonidine, or dexmedetomidine as adjuvants to ropivacaine in caudal anesthesia in children undergoing infraumbilical surgeries

Pallapati,

Jose,

Devadharshini

et al. 2023

Journal of Anaesthesiology Clinical Pharmacology

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Background and Aims: Adjuvants added to the caudal block prolong the duration of analgesia. In a developing country with economic constraints, the choice of an adjuvant will be the medication with a longer duration of analgesia, a favorable side-effect profile, and the least expensive option. We wished to study the duration of postoperative analgesia afforded by three adjuvants: morphine, clonidine, and dexmedetomidine, at doses wherein minimal or nil adverse effects would be attributed to the adjuvant. The primary objective of the current study is to compare the duration of postoperative analgesia with morphine, clonidine, or dexmedetomidine as adjuvants to 0.2% ropivacaine in a for caudal block, in children undergoing elective abdominal, urogenital, and lower limb surgeries. The secondary objectives are (a) to study the total analgesic requirement during the first 24 hours after surgery and (b) to compare the incidence of complications among the three groups. Material and Methods: Sixty-three children aged 1–6 years, belonging to American Society of Anesthesia (ASA) physical status I, II, and scheduled to undergo elective infraumbilical surgeries, were enrolled in the study. The children were randomly assigned to one of three groups: Group D received a caudal block with dexmedetomidine 1 μg/kg, Group M received morphine 30 μg/kg, and Group C received clonidine 1.5 μg/kg. All groups also received 0.2% ropivacaine (1–1.25 ml/kg) as part of the caudal block. The duration of analgesia, total analgesic requirements during the first 24 hours after the surgery, and the incidence of complications in the three groups were monitored by a pain nurse who was blinded to the study allocation. Results: The three groups were comparable with respect to age, sex, weight, and duration of surgery. The median time taken for the first rescue analgesic in the dexmedetomidine group was 380 minutes, in the clonidine group was 360 minutes, and in the morphine group was 405 minutes. Though the morphine group had a longer duration of analgesia, it was not statistically significant (P = 0.843). The total perioperative opioids used and side effects were similar among the three groups. There were no episodes of intraoperative bradycardia noted in Groups D, M, and C. However, one patient in Group D required treatment for bradycardia in the postanesthesia care unit. In terms of intraoperative hypotension, 10 patients (43.5%) in Group D, 5 patients (27.8%) in Group C, and 5 patients (22.7%) in Group M required treatment, but this difference was not statistically significant (P = 0.299). There was no significant difference observed in the time to awakening after the anesthesia among the three groups. Postoperative nausea and vomiting were noted in five patients (21.7%) in Group D, one patient (5.6%) in Group C, and four patients (18.2%) in Group M (P = 0.382). One patient in Group M had a sedation score of 5 and required 4 hours of supplemental oxygen via face mask in the ward. Additionally, one patient in Group D reported numbness in both feet lasting 12 hours with spontaneous resolution. While a significant number of patients in all three study groups experienced urinary retention, no patient reported pruritus in the ward. Conclusion: Caudal administration of morphine, dexmedetomidine, and clonidine in children undergoing infraumbilical surgery resulted in an equivalent duration of analgesia.

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Study of morphine with ropivacaine and ropivacaine alone for caudal epidural analgesia in children

Cited by 3 publications

References 11 publications

A Comparative Study on Caudal Bupivacaine with and without Tramadol for Analgesia Postoperatively in Paediatric Inguino Scrotal Surgeries

A Comparative Study on Caudal Bupivacaine with and without Tramadol for Analgesia Postoperatively in Paediatric Inguino Scrotal Surgeries

Comparison between Caudal Dexmedetomidine and Morphine for Postoperative Analgesia in Pediatric Infraumbilical Surgeries

A double-blinded randomized control trial to compare the duration of analgesia using morphine, clonidine, or dexmedetomidine as adjuvants to ropivacaine in caudal anesthesia in children undergoing infraumbilical surgeries

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