Double-blind randomized controlled trial of caudal versus intravenous S(+)-ketamine for supplementation of caudal analgesia in children

Martindale, Sarah J.; Dix, P.; Stoddart, Peter

doi:10.1093/bja/aeh076

Cited by 49 publications

(48 citation statements)

References 22 publications

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“…10 Similarly a study performed by Martindale SJ et al demonstrate that ketamine prolongs the duration of post-operative analgesia. 16 Naguib et al compared bupivacaine 0.25% 1 ml/kg with or without ketamine 0.5 ml/kg and ketamine 0.5 mg /kg with normal saline 1 ml/kg. 17 There was no significant difference in the quality of pain between the ketamine and the other two groups.…”

Section: Resultsmentioning

confidence: 99%

Comparison of Ketamine, Fentanyl and Clonidine as an Adjuvant During Bupivacaine Caudal Anaesthesia in Paediatric Patients

Singh

Shah

Vaidya

et al. 2013

Kathmandu Univ. Med. J.

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Background Caudal epidural analgesia with bupivacaine is very popular in paediatric anaesthesia for providing intra- and postoperative analgesia. Several adjuvants have been used to prolong the action of bupivacaine. Objectives To compare the efficacy of ketamine, fentanyl and clonidine in terms of quality and duration of analgesia they produce when added with caudal bupivacaine by single shot technique in children. Methods Eighty children, age one to ten years, undergoing sub-umbilical surgery, were prospectively randomized to one of four groups: caudal analgesia with 0.75 ml/kg of 0.25% bupivacaine in normal saline (Group B) or caudal analgesia with 0.75 ml/kg of 0.25% bupivacaine with 1 μg/kg of clonidine in normal saline (Group BC) or caudal analgesia with 0.75ml/kg of 0.25% bupivacaine with ketamine 0.5mg/kg (Group BK) or caudal analgesia with 0.75ml/kg of 0.25% bupivacaine with fentanyl 1mcg/kg (Group BF). Post-operative pain was assessed for 24 hours using the FLACC scale. Results The mean duration of analgesia was significantly longer in Group BC (629.06 ± 286.32 min) than other three groups P < 0.05. The pain score assessed using FLACC scale was compared between the four groups, and children in Group BC had lower pain scores, which was statistically significant. The requirement of rescue medicine was lesser in Group BC. Clonidine in a dose of 1 μg/kg added to 0.25% bupivacaine for caudal analgesia, during sub-umbilical surgeries, prolongs the duration of analgesia of bupivacaine, without any side effects in compare to fentanyl or ketamine. Conclusion We conclude that clonidine in a dose of 1 μg/kg, added to 0.25% bupivacaine for caudal analgesia and administered as a 0.75 ml/kg mixture in children, for sub-umbilical surgery, significantly prolongs the duration of post-operative analgesia when compared to 0.75 ml/kg of 0.25% bupivacaine in normal saline than 0.75 ml/kg of 0.25% bupivacaine with ketamine 0.5 mg/kg or 0.75 ml/kg of 0.25% bupivacaine with fentanyl 1 mcg/kg or 0.75 ml/kg of 0.25% bupivacaine alone, without any side effects. Kathmandu University Medical Journal | VOL.10 | NO. 3 | ISSUE 39 | JUL- SEP 2012 | Page 25-29 DOI: http://dx.doi.org/10.3126/kumj.v10i3.8013

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Section: Resultsmentioning

confidence: 99%

Comparison of Ketamine, Fentanyl and Clonidine as an Adjuvant During Bupivacaine Caudal Anaesthesia in Paediatric Patients

Singh

Shah

Vaidya

et al. 2013

Kathmandu Univ. Med. J.

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“…Epidural ketamine has been reported to provide prolonged analgesia when administered alone or added to local anesthetics (49)(50)(51). Epidural injection has an additional benefit Table II.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the effects of ketamine on spinal anesthesia with levobupivacaine or ropivacaine

Zhang

Lin

Wen-bo

2016

Experimental and Therapeutic Medicine

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Abstract. Spinal anesthesia or regional anesthesia is a potent anesthetic procedure. Additional modalities have been sought to increase the duration of block in spinal anesthesia. Ketamine is an N-methyl-D-aspartate (NMDA) receptor blocker that has an anesthetic effect when injected intrathecally and has a synergic effect with bupivacaine. Ketamine also has potent analgesic properties. The present study investigated the effect of intrathecally administered ketamine on spinal anesthesia with levobupivacaine or ropivacaine. Sprague-Dawley rats at post-natal day 21 were exposed to spinal anesthesia with 0.5% levobupivacaine or 0.5% ropivacaine. Separate groups of rats were treated with intrathecal ketamine at a 5 or 10 mg/kg bodyweight dose along with ropivacaine or levobupivacaine. The thermal and mechanical withdrawal latencies of the animals were determined using hot plate and von Frey filaments, respectively. A rotarod apparatus was employed to assess the capacity of the rats to rotate the spindle at 24 h following anesthesia. The gait of the rat pups was also assessed. Intrathecal administration of ketamine resulted in dense blocks and extended the duration of spinal blocks as evidenced by thermal latencies and responses to von Frey filaments. The latency to fall was shorter in rats exposed to ketamine along with ropivacaine or levobupivacaine spinal anesthesia. The gait parameters were also more disturbed upon ketamine administration. In conclusion, ketamine administration with ropivacaine or levobupivacaine increased the intensity and duration of spinal blockade, thereby increasing the anesthetic effects.

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“…Ketamine used in our study was a preservative free preparation containing S (+) and R (-) enantiomers 12 in equal amounts available in 50 mg/mL ampoules.…”

Section: Groupmentioning

confidence: 99%

Caudal Analgesia in Paediatrics: Comparison Between Bupivacaine Alone and in Combination With Ketamine for Postoperative Analgesia in Gvmc, Vellore

Thendralarasu¹,

Balamurugan²

2016

jemds

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Double-blind randomized controlled trial of caudal versus intravenous S(+)-ketamine for supplementation of caudal analgesia in children

Cited by 49 publications

References 22 publications

Comparison of Ketamine, Fentanyl and Clonidine as an Adjuvant During Bupivacaine Caudal Anaesthesia in Paediatric Patients

Comparison of Ketamine, Fentanyl and Clonidine as an Adjuvant During Bupivacaine Caudal Anaesthesia in Paediatric Patients

Evaluation of the effects of ketamine on spinal anesthesia with levobupivacaine or ropivacaine

Caudal Analgesia in Paediatrics: Comparison Between Bupivacaine Alone and in Combination With Ketamine for Postoperative Analgesia in Gvmc, Vellore

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