Title: A Comparative Study of Caudal Epidural Injection of Morphine-Bupivacaine and Ketamine-Morphine-Bupivacaine Combination for Post-Operative Pain Management in Children
Authors: Dr Sukham Thoibahenba Singh, Dr Keisham Upendra Singh
DOI: https://dx.doi.org/10.18535/jmscr/v6i7.151
Abstract
Background: It is an accepted fact that children and infants do feel pain and should be treated adequately. The importance and benefit of regional technique to ameliorate postoperative pain is well-known. Various drugs and combinations have been tried to find a best solution. This study is done to assess if Ketamine when added to Morphine and Bupivacaine in Epidural block improves the quality and duration of pain relief.
Methods: 40 children were allocated to two groups- Group A was given 50 µg/Kg with 0.25% bupivacaine and Group B received ketamine 0.5 mg/Kg in addition. The degree of pain relief was compared between the two groups.
Results: It was observed that in Group A 20% of the children were pain free and majority of the patients (40%) required supplementary analgesia. 50% of the patients in Group B required no supplementary analgesia and the rest required mostly only 1 dose of supplementary analgesia in the next 72hours of post operative period.
Conclusion: It may be concluded that addition of ketamine 0.5 mg/Kg to morphine 50 µg/Kg and 0.25% bupivacaine administered through Epidural route provides better quality and the longer duration of analgesia in the post operative period.
Keywords: Postoperative Pain, Morphine, Bupivacaine, Ketamine, Caudal Epidural.
References
- Haberkern CM, Donald CT, Krane EJ. Post operative pain management in children. Mount Sinai Journal of Medicine 1991;58: 247-256.
- VenKeuren K and Eland JA. Postoperative pain management in children. Nursing Clinic of North America 1997;32: 31-44
- Howard R. preoperative and postoperative pain control. Archives of Disease in Childhood 1993;69: 699-703
- Naguib M, Sharif AMY, Seraj M, Gammal ME and Dawlatly AA. Ketamine for caudal analgesia in children comparison with caudal bupivacaine. British Journal of Anaesthesia1991;67: 559-564
- Chugani HT, Phelps ME. Maturation changes in cerebral functions in infants determined by FDG positron emission tomography. Science 1986;231: 840-843
- Wolf AR and Hughes D. Pain relief for infants undergoing abdominal surgery: comparison of infusion of I.V. morphine and extradural bupivacaine. British Journal of Anaesthesia 1993;70: 10-16
- Findlow D, Aldridge LM and Doyle E. Comparison of caudal block using bupivacaine and ketamine with ilioing-uinal nerve block for orchidopexy in children. Anaesthesia1997;70: 10-16
- Nalini V, Erika S, et al. Role of ketamine for analgesia in adults and children. Journal of Anaesthesiology Clinical Pharmacology 2016;32(3): 298-306.
- Mendonça FT, Almeida MFC, Guimarães CCR et al., Comparative study between epidural ketamine and morphine in patients submitted to mastectomy. Rev Dor. São Paulo, 2013;14(3):169-73
- Sethi M, Sethi N, Jain P, Sood J. Role of epidural ketamine for postoperative analgesia after upper abdominal surgery. Indian J Anaesth 2011;55:141-5.
- William MS, Juan B, Lydia K. Regional anaesthesia for hernia repair in children: local vs. caudal anaesthesia. Canadian Journal of Anaesthesia 1995;42: 197-200
- Atia J, Ecoffey C, Sandouk P, Gross JB and Samil K. Epidural morphine in children pharmacokinetics and CO2 Anesthesiology 1986;65: 590-594.
- Jensen BH, Caudal block for postoperative pain relief in children: a comparison between bupivacaine and morphine. Acta Anaesthesiologica Scandinavica 1981;25: 373-375.
- Cook B, Grubb DJ, Aldridge LA, Doyle E. Comparison of the effects of adrenaline, clonidine and ketamine on the duration of caudal analgesia by bupivacaine in child. British Journal of Anaesthesia1995;75: 698-701.
- Dalens B, Tanguy A, Haberer JP. Lumbar epidural anaesthesia for operative and postoperative pain relief in infants and young children. Anesthesia and Analgesia1986;65: 1069-1073.
- Wolf AR, Hughes D, Wade A, Mather SJ and Prys-Roberts C. Postoperative analgesia after paediatricorchidopexy evaluation of a bupivacaine-morphine mixture. British Journal of Anaesthesia 1990;64: 430-435.