A comparative study on postoperative analgesic effectiveness of caudal morphine added to bupivacaine in comparsion with bupivacine alone for elective pediatric undergoing below umbilical surgery at Minilik Ii Hospital, Addis Ababa, Ethiopia 2017/18
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Date
2018-06
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Addis Ababa Universty
Abstract
Introduction: One of the most commonly used regional anesthetic techniques in pediatric surgeries is the caudal epidural block. Its main disadvantage remains the short duration of action.Hence, different additives have been used. The use of additives drug caudal anesthesia have increased in last decade by 58%. Uses of opioids additive has decreased from 36% to 18% due to high incidence of complications but other studies show that opioids prolong analgesia with minimum side effect; morphine is one of the opioid used additives used.
Objective: To compare the effectiveness of combination of bupivacaine with morphine and bupivacaine alone injected into the caudal space for relief of postoperative pain in pediatric undergoing below umbilical Surgery at Minilik II hospital from December – April 2017/2018.
Methods: The total of 60 pediatric patients from age 2-12 were participated in the study as standards of ASA I and II who underwent below umbilical surgery. After induction of general anesthesia, 30 children in Group-B received 1 ml/kg of 0.25% bupivacaine alone and the other 30 in Group-BM received 1 ml/kg of 0.25% bupivacaine with 20mic/kg morphine caudally. Demographic data, hemodynamic data before and after caudal, ASA status, duration of general anesthesia, duration of surgery, episode of post-operative nausea and vomiting (PONV) and pain score were recorded. Analgesic duration was defined as time from caudal injection to first rescue analgesic administration. Mann-Whitney test to compare median values and chi-square test and Fisher exact test for nominal data were used. A value “P<0.05” was considered as statistically significant.
Results: The median analgesic duration in Group-B was 360(495-338) minutes and 910(1200-705) minutes in Group-BM (p<0.001). The PONV incidence was observed in Group-B 6 (20%) and Group- BM 8 (26.7%) and respiratory depression 1 (3.3%) and itching within Group-BM 2(6.7%) but not statistically significant difference across the groups (p>0.05).
Conclusion and Recommendation: In routine clinical practice, addition of morphine to caudally administered bupivacaine prolongs analgesic duration without significant difference in postoperative complications.
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Keywords
Caudal epidural block; Analgesia; Bupivacaine; Morphine; Postoperative