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Comparative study of caudal bupivacaine versus bupivacaine with tramadol for postoperative analgesia in paediatric cancer patients

  • Published:
The Chinese-German Journal of Clinical Oncology

Abstract

Objective

Caudal epidural analgesia has become very common analgesic technique in paediatric surgery. Adding tramadol to bupivacaine for caudal injection prolongs duration of analgesia with minimal side effects. The aim of the study was to investigate the different effects of caudal bupivacaine versus bupivacaine with thamadol for postoperative analgesia in paediatric cancer patients.

Methods

A prospective randomized controlled trial was conducted over 40 paediatric cancer patients who were recruited from Children Cancer Hospital of Egypt (57357 Hospital). Patients were randomized into 2 groups: bupivacaine group (group B, 20 patients) to receive single shot caudal block of 1 mL/kg 0.1875% bupivacaine; tramadol group (group T, 20 patients) prepared as group B with the addition of 1 mg/kg caudal tramadol.

Results

The mean duration of analgesia was significantly longer among group T than group B [(24 ± 13.7) hours versus (7 ± 3.7) hours respectively with P = 0.001]. Group T showed a significantly lower mean FLACC score than group B (2.2 ± 0.9 versus 3.6 ± 0.6 with P = 0.002). The difference in FLACC score was comparable on arrival, and after 2 and 4 hours. At 8 and 12 hours the group B recorded significantly higher scores (P = 0.002 and 0.0001 respectively). There were no significant differences between the groups as regards sedation score [the median in both groups was 1 (0–1) with P value = o.8]. No one developed facial flush or pruritis.

Conclusion

Caudal injection of low dose tramadol 1 mg/kg with bupivacaine 0.1875% is proved to be effective, long standing technique for postoperative analgesia in major paediatric cancer surgery and almost devoid of side effect.

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References

  1. Kern FH. The Society of Paediatric Anesthesia: Fifteenth Annual Meeting, New Orleans, Louisiana, October 12, 2001. Anesth Analg, 2002, 94: 1661–1668.

    PubMed  Google Scholar 

  2. Sethna NF, Berde CB. Paediatric regional anesthesia. In: George G ed. Paediatric anesthesia. 4th ed. Churchill Livingstone Inc, 2003. 267–268.

    Google Scholar 

  3. Khan S, Memon MI. Comparison of caudal bupivacaine and bupivacaine-tramadol for postoperative analgesia in children with hypospadias repair. J Coll Physicians Surg Pak, 2008, 18: 601–604.

    PubMed  Google Scholar 

  4. Ozkan S, Poçan S, Bahar A, et al. The effect of caudal bupivacaine versus tramadol in post-operative analgesia for paediatric patients. J Int Med Res, 2003, 31: 497–502.

    PubMed  CAS  Google Scholar 

  5. Martindale M, Worsley M, Thomas M, et al. Caudal additives in children — solutions or problems? Br J Anaesth, 2003, 91: 300–301.

    Article  PubMed  CAS  Google Scholar 

  6. Majid Y, Mohammad K. A comparison of caudally administered single dose bupivacaine and bupivacaine-tramadol combination for postoperative analgesia in children. JK Science, 2004, 6: 19–22.

    Google Scholar 

  7. Budd K, Langford R. Editorial II: tramadol revisited. Br J Anaesth, 1999, 82: 493–495.

    Article  PubMed  CAS  Google Scholar 

  8. Senel AC, Akyol A, Dohman D, et al. Caudal bupivacaine-tramadol combination for postoperative analgesia in paediatric herniorrhaphy. Acta Anaesthesiol Scand, 2001, 45: 786–789.

    Article  PubMed  CAS  Google Scholar 

  9. Ozcengiz D, Gunduz M, Ozbek H, et al. Comparison of caudal morphine and tramadol for postoperative pain control in children undergoing inguinal herniorrhaphy. Paediatr Anaesth, 2001, 11: 459–464.

    Article  PubMed  CAS  Google Scholar 

  10. Shrestha SK, Bhattarai B. Caudal bupivacaine vs bupivacaine plus tramadol in post-operative analgesia in children. J Nepal Health Res Counc, 2010, 8: 99–102.

    PubMed  CAS  Google Scholar 

  11. Choudhuri AH, Dharmani P, Kumarl N, et al. Comparison of caudal epidural bupivacaine with bupivacaine plus tramadol and bupivacaine plus ketamine for postoperative analgesia in childre. Anaesth Intensive Care, 2008, 36: 174–179.

    PubMed  Google Scholar 

  12. Voepel-Lewis T, Zanotti J, Dammeyer JA, et al. Reliability and validity of the face, legs, activity, cry, consolability behavioral tool in assessing acute pain in critically ill patients. Am J Crit Care, 2010, 19: 55–61.

    Article  PubMed  Google Scholar 

  13. Prakash S, Tyagi R, Gogia AR, et al. Efficacy of three doses of tramadol with bupivacaine for caudal analgesia in paediatric inguinal herniotomy. Br J Anaesth, 2006, 97: 385–388.

    Article  PubMed  CAS  Google Scholar 

  14. Nagiub M, Sharif AM, Seraj M, et al. Ketamine for caudal analgesia in children: comparison with caudal bupivacaine. Br J Anaesth, 1991, 67: 559–564.

    Article  Google Scholar 

  15. Cook B, Grubb DJ, Aldridge LA, et al. Comparison of the effects of adrenaline, clonidine and ketamine on the duration of caudal analgesia produced by bupivacaine in children. Br J Anaesth, 1995, 75: 698–701.

    Article  PubMed  CAS  Google Scholar 

  16. Kelleher AA, Black A, Penman S, et al. Comparison of caudal bupivacaine and diamorphine with caudal bupivacaine alone for repair of hypospadias. Br J Anaesth, 1996, 77: 586–590.

    Article  PubMed  CAS  Google Scholar 

  17. Prosser DP, Davis A, Booker PD, et al. Caudal tramadol for postoperative analgesia in paediatric hypospadias surgery. Br J Anaesth, 1997, 79: 293–296.

    Article  PubMed  CAS  Google Scholar 

  18. New York School of Regional Anaesthesia (NYSORA). Pediatric epidural and caudal analgesia and anesthesia in children. Available at http://www.nysora.com/regional_anesthesia/subspecialties/pediatric_anesthesia/3087-pediatric_epidural_and_caudal_analgesia_and_anesthesia_in_childr.html.

  19. Murthy BV, Pandya KS, Booker PD, et al. Pharmacokinetics of tramadol in children after i.v. or caudal epidural administration. Br J Anaesth, 2000, 84: 346–349.

    Article  PubMed  CAS  Google Scholar 

  20. Batra YK, Prasad MK, Arya VK, et al. Comparison of caudal tramadol vs bupivacaine for post-operative analgesia in children undergoing hypospadias surgery. Int J Clin Pharmacol Ther, 1999, 37: 238–242.

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Anesthesia & Pain Management Department, National Cancer Institute, Cairo University, Cairo, Egypt

    Mohammed Hegazy & Ayman A. Ghoneim

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  1. Mohammed Hegazy
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  2. Ayman A. Ghoneim
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Correspondence to Mohammed Hegazy.

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Hegazy, M., Ghoneim, A.A. Comparative study of caudal bupivacaine versus bupivacaine with tramadol for postoperative analgesia in paediatric cancer patients. Chin. -Ger. J. Clin. Oncol. 12, 118–122 (2013). https://doi.org/10.1007/s10330-012-1124-4

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  • DOI: https://doi.org/10.1007/s10330-012-1124-4

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