To Compare the duration and side effects of caudal tramadol bupivacaine versus Ketamine-Bupivacaine for Postoperative analgesia in the pediatric age group

Aim: to compare and contrast the side effect profile and the duration of action for tramadol-bupivacaine and ketamine-bupivacaine,as post operative pain management in the pediatric age group. method: the type of study is a randomized control trial,conducted at a tertiary care hospital in karachi,pakistan,from february 2013 to august 2013. the study sample is of 36 children,age range from three to eight years of age,who underwent inguinoscrotal operations and were divided in to two groups randomly,one group receiving tramadol-bupivacaine (2mg per kg and 0.5mg per kg of 0.25%) and the other group receiving ketamine and bupivacaine (1mg per kg and 0.5mg per kg of 0.25%),right after anesthesia. no pain management treatment was utilized during the surgical procedure. modified objective pain scoring system was used to assess the postoperative analgesic effect. sedation effect was assessed at five time intervals. side effect profile including but not limited to,cardiac issues,respiratory depression,psychomotor effects,retention of urine,nausea and vomiting were evaluated for all the patients understudy. results: caudal tramadol with bupivacaine produced significantly increased postoperative analgesia. the duration of postoperative analgesia was 18.01 +/-1.85 hoursin tramadol-bupivacaine group as compared to 11.92 +/-1.69 hours in ketamine-bupivacaine group. the sedation score was high in tramadol-bupivacaine group only during 1st hour postoperatively. no other side effects like respiratory depression,urinary retention,pruritus were found in any group. the demand for rescue analgesia was high (2.39+/-0.51) in ketamine-bupivacaine group as compared to tramadol-bupivacaine group (0.40+/-0.60) four children in ketamine-bupivacaine group experienced psychomotor effects. conclusion: based on the results of our study,tramadol-bupivacaine combination provided a long time post operative pain relief,had a lower side effect profile and had a higher sedation score (at 1 hour interval ) when compared to ketamine-bupivacaine combination.