The effect of ketamine on 0.25% and 0.125% bupivacaine for caudal epidural blockade in children

Abstract

Forty boys aged from one to five years undergoing orchidopexy were randomly allocated to receive one of two solutions for caudal epidural injection. Group A received 1 ml.kg-1 of 0.125% bupivacaine with ketamine 0.5 mg.kg-1 and Group B received 1 ml.kg-1 of bupivacaine 0.25% with ketamine 0.5 mg.kg-1. Postoperative pain was assessed by means of a modified Objective Pain Score and analgesia was administered if this score exceeded four. The median duration of caudal analgesia was 8 h in Group A compared with 9.5 h in Group B (P<0.05). The time taken to recover the ability to walk was a median of two h in Group A and three h in Group B (P<0.05). There were no differences between the groups in the incidence of urinary retention or postoperative sedation.

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

“…The dose of ketamine 0.5 mg kg 21 used in this study is not associated with an increased incidence of behavioural side-effects [9,13], our findings support this. 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 median time for Group C was 11 min (interquartile range [5][6][7][8][9][10][11][12][13][14][15], and for Group P the median was 9 min (interquartile range [5][6][7][8][9][10][11][12][13][14], P 5 n.s. There was no difference in time to micturition.…”

“…Caudal with bupivacaine and ketamine causes motor block and delay in walking [13]. We used delay in walking as a measure of motor block.…”

How to prolong postoperative analgesia after caudal anaesthesia with ropivacaine in children: S‐ketamine versus clonidine

“…In order to enhance this duration and the quality of epidural analgesia, various drugs have been added to local anaesthetics. Clonidine seems to be one of the most attractive and safe adjuvants and ketamine, in its racemic form, has been added to bupivacaine producing a significant prolongation of postoperative analgesia (15–19). Recently, preservative free S‐ketamine has become available for use.…”

Caudal bupivacaine and s(+)‐ketamine for postoperative analgesia in children

“…Variations of the bupivacaine dosage have not been found to influence the duration of analgesia. Caudal epidural bupivacaine in a dose exceeding 1.25 mg·kg −1 does not cause significant prolongation of analgesia (3, 4). Bupivacaine dosages of more than 2.5 mg·kg −1 lead to motor blockade of the lower limb and bring about the risk of local anaesthetic toxicity (5).…”