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Comparing caudal and intravenous ketamine for supplementation of analgesia after Salter innominate osteotomy

  • Original Clinical Article
  • Published:
Journal of Children's Orthopaedics

Abstract

Purpose

Previous studies claim that caudal administration of ketamine causes effective analgesia. The aim of this study was to assess the clinical effectiveness of ketamine after caudal or intravascular administration in pediatric patients that underwent orthopedic surgery to distinguish between local and systemic analgesia.

Methods

After the induction of general anesthesia, 36 patients, aged 18 months to 10 years, assigned to undergo orthopedic surgery, received a caudal injection of bupivacaine and were randomly blinded into two groups: one group received 1 mg/kg S(+)-ketamine as the caudal group and the other group received 1 mg/kg S(+)-ketamine as the intravascular group. Postsurgical measurements included the effectiveness of postsurgical analgesia, which was assessed by using the observational pain scale (OPS), duration of analgesia, sedation score, and hemodynamic and respiratory monitoring.

Results

The mean time to first analgesia was clearly longer in the caudal ketamine group (13.35 h) than in the intravenous ketamine (9.93 h) group (P < 0.01). During the 24-h observation time, fewer children asked for additional analgesic drugs in the caudal group (8 of 18, 44.4 %) than in the intravenous group (12 of 18, 66.6 %; P = 0.01). The times to first micturation and spontaneous leg movements and the incidence of nausea and vomiting were similar in the two groups. The OPS and sedation scores after operation showed no obvious differences between the groups at any time.

Conclusion

Although caudal ketamine provides good postsurgical analgesia due to its potential neurotoxicity and only small clinical differences with intravenous ketamine, the administration of intravenous ketamine might be a reasonable option to potentially extend the postsurgical analgesic effect of the caudal administration of local anesthetics in children undergoing Salter osteotomy.

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References

  1. Melman E, Penuelas JA, Marrufo J (1975) Regional anesthesia in children. Anesth Analg 54(3):387–390

    Article  CAS  Google Scholar 

  2. Naguib M, Sharif AM, Seraj M, el Gammal M, Dawlatly AA (1991) Ketamine for caudal analgesia in children: comparison with caudal bupivacaine. Br J Anaesth 67(5):559–564

    Article  CAS  Google Scholar 

  3. Lee HM, Sanders GM (2000) Caudal ropivacaine and ketamine for postoperative analgesia in children. Anaesthesia 55(8):806–810

    Article  CAS  Google Scholar 

  4. Köknel Talu G, Ozyalçin NS, Balsak R, Karadeniz M (2008) The efficacy of preemptive ketamine and ropivacaine in pediatric patients: a placebo controlled, double-blind. Agri 20(2):31–36

    Google Scholar 

  5. Klimscha W, Horváth G, Szikszay M, Dobos I, Benedek G (1998) Antinociceptive effect of the S(+)-enantiomer of ketamine on carrageenan hyperalgesia after intrathecal administration in rats. Anesth Analg 86(3):561–565

    CAS  Google Scholar 

  6. Smith DJ, Bouchal RL, deSanctis CA, Monroe PJ, Amedro JB, Perrotti JM, Crisp T (1987) Properties of the interaction between ketamine and opiate binding sites in vivo and in vitro. Neuropharmacology 26(9):1253–1260

    Article  CAS  Google Scholar 

  7. Jahangir SM, Islam F, Aziz L (1993) Ketamine infusion for postoperative analgesia in asthmatics: a comparison with intermittent meperidine. Anesth Analg 76(1):45–49

    Article  CAS  Google Scholar 

  8. Dix P, Martindale S, Stoddart PA (2003) Double-blind randomized placebo-controlled trial of the effect of ketamine on postoperative morphine consumption in children following appendicectomy. Paediatr Anaesth 13(5):422–426

    Article  CAS  Google Scholar 

  9. American Academy of Pediatrics; American Academy of Pediatric Dentistry, Coté CJ, Wilson S; Work Group on Sedation (2008) Guidelines for monitoring and management of pediatric patients during and after sedation for diagnostic and therapeutic procedures: an update. Paediatr Anaesth 18(1):9–10

    Google Scholar 

  10. van Dijk M, de Boer JB, Koot HM, Duivenvoorden HJ, Passchier J, Bouwmeester N, Tibboel D (2001) The association between physiological and behavioral pain measures in 0- to 3-year-old infants after major surgery. J Pain Symptom Manage 22(1):600–609

    Article  Google Scholar 

  11. McGrath PJ, Johnson G, Goodman JT, Schillinger J, Dunn J, Chapman JA (1985) CHEOPS: a behavioral scale for rating postoperative pain in children. In: Fields HL, Dubner R, Cervero F (eds) Advances in pain research and therapy, vol 9. Raven Press, New York, pp 395–402

    Google Scholar 

  12. Wilson E, David A, MacKenzie N, Grant IS (1990) Sedation during spinal anaesthesia: comparison of propofol and midazolam. Br J Anaesth 64(1):48–52

    Article  CAS  Google Scholar 

  13. Koinig H, Krenn CG, Glaser C, Marhofer P, Wildling E, Brunner M, Wallner T, Grabner C, Klimscha W, Semsroth M (1999) The dose–response of caudal ropivacaine in children. Anesthesiology 90(5):1339–1344

    Article  CAS  Google Scholar 

  14. Turan A, Memiş D, Başaran UN, Karamanlioğlu B, Süt N (2003) Caudal ropivacaine and neostigmine in pediatric surgery. Anesthesiology 98(3):719–722

    Article  CAS  Google Scholar 

  15. Prosser DP, Davis A, Booker PD, Murray A (1997) Caudal tramadol for postoperative analgesia in pediatric hypospadias surgery. Br J Anaesth 79(3):293–296

    Article  CAS  Google Scholar 

  16. Cook B, Grubb DJ, Aldridge LA, Doyle E (1995) Comparison of the effects of adrenaline, clonidine and ketamine on the duration of caudal analgesia produced by bupivacaine in children. Br J Anaesth 75(6):698–701

    Article  CAS  Google Scholar 

  17. Semple D, Findlow D, Aldridge LM, Doyle E (1996) The optimal dose of ketamine for caudal epidural blockade in children. Anaesthesia 51(12):1170–1172

    Article  CAS  Google Scholar 

  18. De Negri P, Ivani G, Visconti C, De Vivo P (2001) How to prolong postoperative analgesia after caudal anaesthesia with ropivacaine in children: S-ketamine versus clonidine. Paediatr Anaesth 11(6):679–683

    Article  Google Scholar 

  19. Zeilhofer HU, Swandulla D, Geisslinger G, Brune K (1992) Differential effects of ketamine enantiomers on NMDA receptor currents in cultured neurons. Eur J Pharmacol 213(1):155–158

    Article  CAS  Google Scholar 

  20. Hirota K, Okawa H, Appadu BL, Grandy DK, Devi LA, Lambert DG (1999) Stereoselective interaction of ketamine with recombinant mu, kappa, and delta opioid receptors expressed in Chinese hamster ovary cells. Anesthesiology 90(1):174–182

    Article  CAS  Google Scholar 

  21. Ödeş R, Erhan ÖL, Demirci M, Göksu H (2010) Effects of ketamine added to ropivacaine in pediatric caudal block. Agri 22(2):53–60

    Google Scholar 

  22. Johnston P, Findlow D, Aldridge LM, Doyle E (1999) The effect of ketamine on 0.25% and 0.125% bupivacaine for caudal epidural blockade in children. Paediatr Anaesth 9(1):31–34

    Article  CAS  Google Scholar 

  23. Vranken JH, Troost D, de Haan P, Pennings FA, van der Vegt MH, Dijkgraaf MG, Hollmann MW (2006) Severe toxic damage to the rabbit spinal cord after intrathecal administration of preservative-free S(+)-ketamine. Anesthesiology 105(4):813–818

    Article  CAS  Google Scholar 

  24. Vranken JH, Troost D, Wegener JT, Kruis MR, van der Vegt MH (2005) Neuropathological findings after continuous intrathecal administration of S(+)-ketamine for the management of neuropathic cancer pain. Pain 117(1–2):231–235

    Article  CAS  Google Scholar 

  25. Jöhr M, Berger TM (2012) Caudal blocks. Paediatr Anaesth 22(1):44–50

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Anesthesiology, Imam University Hospital, Tehran University of Medical Sciences, Tehran, Iran

    Hamid Reza Amiri

  2. Department of Orthopedic Surgery, Imam University Hospital, Tehran University of Medical Sciences, Keshavarz Blvd., 1419733141, Tehran, Iran

    Ramin Espandar

  3. Autoimmune Bullous Disease Research Center, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran

    Mehdi Sanatkar

Authors
  1. Hamid Reza Amiri
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  2. Ramin Espandar
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  3. Mehdi Sanatkar
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Correspondence to Ramin Espandar.

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Amiri, H.R., Espandar, R. & Sanatkar, M. Comparing caudal and intravenous ketamine for supplementation of analgesia after Salter innominate osteotomy. J Child Orthop 6, 479–483 (2012). https://doi.org/10.1007/s11832-012-0452-9

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  • DOI: https://doi.org/10.1007/s11832-012-0452-9

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