Postoperative analgesic efficacy of caudal tramadol added to bupivacaine compared to bupivacaine alone for pediatric elective infra umbilical surgery at Tikur Anbessa Specialized Hospital, Ethiopia, a prospective cohort study

Abstract

BackgroundCaudal epidural analgesia is one of the most popular reliable, safe and commonly performed regional blocks in pediatric patients undergoing lower abdominal and lower limb surgery. Various adjuvants such as opioids or α2 agonists are being used to improve the quality and duration of caudal analgesia. Addition of Tramadol to local anesthetics has been noted to prolong the duration of analgesia after surgery. ObjectiveTo assess the efficacy of adding caudal tramadol to bupivacine for post operative analgesia in pediatric infraumblical surgery. MethodHospital based prospective cohort study design was employed. Comparison of two mean with equal sample size formula for two independent cohort was used to get sample size of 56 children's whose age is 1–14 years' old that undergone elective Infraumbilical surgery received caudal block with bupivacaine alone or with tramadol added. A systemic random sampling technique was used to select study participants. Postoperatively severity of pain either by FLACC/NRS, time to analgesic request and analgesic consumption were evaluated at 1st, 2nd,4th,8th,12th and 24th hrs. Pain severity, first analgesia request time and analgesic consumption were assessed using Mann–Whitney U test for 24 h. Chi-square test was used to assess homogenous categorical independent variables between the two groups and a p-value less than 0.05 was considered to be statically significant. ResultTramadol with bupivacaine has prolonged postoperative analgesia with a median duration of 14 h compared to 5 h in bupivacaine alone. Moreover, total Paracetamol analgesic consumption was lower in tramadol group with a median total dose of 250 mg compared with 437.5 mg in bupivacaine group with statistically significant difference within 24 h (p < 0.018). Also, reduced the pain score in tramadol group, being statically significant at 4th, 8th and12th hours. ConclusionCaudal tramadol with bupivacaine decrease postoperative pain severity, total analgesic consumption and prolong the duration of analgesia. Based on our finding we recommend the use of caudal tramadol with bupivacaine is effective for postoperative analgesia.