S(+)-ketamine for caudal block in paediatric anaesthesia

Abstract

We have evaluated the intra- and postoperative analgesic efficacy of preservative-free S(+)-ketamine compared with bupivacaine for caudal block in paediatric hernia repair. After induction of general anaesthesia, 49 children undergoing hernia repair were given a caudal injection (0.75 ml kg-1) of S(+)-ketamine 0.5 mg kg-1 (group K1), S(+)-ketamine 1.0 mg kg-1 (group K2) or 0.25% bupivacaine with epinephrine 1:200,000 (group B). No additional analgesic drugs were required during operation in any of the groups. Haemodynamic and respiratory variables remained stable during the observation period. Mean duration of analgesia was significantly longer in groups B and K2 compared with group K1 (300 (SD 96) min and 273 (123) min vs 203 (117) min; P < 0.05). Groups B and K2 required less analgesics in the postoperative period compared with group K1 (30% and 33% vs 72%; P < 0.05). Postoperative sedation scores were comparable between the three groups. We conclude that S(+)-ketamine 1.0 mg kg-1 for caudal block in children produced surgical and postoperative analgesia equivalent to that of bupivacaine.

A comparison of caudal bupivacaine and ketamine with penile block for paediatric circumcision

“…Higher doses of ketamine give a longer duration of analgesia but are associated with behavioural side-effects such as odd behaviour, vacant stares and abnormal affect [16][17][18].…”

The combination of epidural clonidine and S(+)-ketamine did not enhance analgesic efficacy beyond that for each individual drug in adult orthopedic surgery

“…In children, the epidural administration of 0.5 mg/kg S(+)-ketamine was more effective than 2 lg/kg clonidine when combined with ropivacaine [5], whereas caudal 1 mg/kg S(+)-ketamine produced surgical and postoperative analgesia equivalent to caudal bupivacaine [6], probably through a local analgesic effect [7]. In addition, the association of caudal clonidine and S(+)-ketamine resulted in prolonged analgesia (21 hours) [8], suggesting a synergist effect between both drugs in pediatric surgery.…”

Sublethal Spinal Ketamine Produces Neuronal Apoptosis in Rat Pups

“…These doses (rather than more than 3 mg/kg) are the comparative and relevant equivalents commonly employed for caudal anesthesia. 6 We have also some concerns regarding reporting of the apoptosis data. 1 First, the authors are assuming that the cells they are staining with active caspase-3 are indeed neurons without assessing the cell type.…”