Assessment of Postoperative Analgesic Effectiveness of Caudal Tramadol Added to Bupivacaine for Pediatric Elective Infra Umbilical Surgery.
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Date
2019-05
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Addis Ababa University
Abstract
Background: Caudal epidural analgesia is one of the most popular and commonly performed
regional blocks in pediatric anesthesia. It is a reliable and safe technique that can be used with
general anesthesia for intra- and postoperative analgesia in patients undergoing lower abdominal
and lower limb surgery. Various adjutants are being used to improve the quality and duration of
caudal analgesia. Addition of Tramadol to local anesthetics has been noted to prolong the
duration of analgesia after surgery.
Objective: To assess the effectiveness of adding 1mg/kg caudal tramadol to bupivacaine for
post-operative analgesia in pediatric patients during elective infra umbilical surgery at Tikur
Anbesa specialized hospital from February–May, 2019 G.C.
Method: Hospital based prospective cohort study design was employed. Comparison of two
mean with equal sample size formula for two independent cohort was used to get sample size of
56 children’s whose age is 1-14 years’ old that undergone elective Infraumbilical surgery
received caudal block with bupivacaine alone or with tramadol added. A systemic random
sampling technique was used to select study participants. Postoperatively severity of pain either
by FLACC/NRS, time toanalgesic request and analgesic consumption were evaluated up to 24
hours after operation. Based on normality assumption, analysis was done by independent sample
t test, Mann–Whitney U-test and χ2 test as appropriate. Value p<0.05 was considered as
statistically significant
Result: This study found that tramadol with bupivacaine has prolonged postoperative analgesia
with a median duration of 14 hours compared to 5 hours in bupivacaine alone. Moreover, total
Paracetamol analgesic consumption was lower in tramadol group with a median total dose of
250mg compared with 437.5mg in bupivacaine group with statistically significant difference
within 24 hours (p<0.018). Also, reduced the pain score in tramadol group, being statically
significant at 4th, 8th and12th hours.
Conclusion and Recommendation: We found caudal tramadol with bupivacaine
decrease postoperative pain score, total analgesic consumption and prolong the duration of
analgesia. Based on our finding we recommend the use of caudal tramadol with bupivacaine is
effective for postoperative analgesia in our setup.
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Keywords
Caudal Tramadol ,Bupivacaine , Umbilical Surgery.