Bupivacaine For Caudal Analgesia Research Articles

“Comparative Evaluation of Caudal Tramadol and Adjuvant to Bupivacaine in Paediatric Age Group”

Background: Caudal anaesthesia is a type of regional anaesthesia in which local anesthetic is injected into epidural space. It is most popular regional anaesthesia with a predictable level of blockade used in paediatric surgeries. Adjuvants can be added to local anaesthetics for prolonging the duration of analgesia. Objective: To find out the duration of analgesia of caudal Bupivacaine in combination with Tramadol. Methods: This prospective, randomised, double-blind, comparative study was done in Department of Anesthesiology, Sher-e-bangla Medical College Hospital, Barishal, Bangladesh from June to December 2020. Total of 50 patients, aged between 2 to 9 years undergoing elective lower abdominal, urological and lower extremity surgeries. The patients were randomized to group A (n=25) receiving 1 ml/kg of 0.25% bupivacaine and group B (n=25) receiving 1 ml/kg of 0.25% bupivacaine plus 1mg/kg of tramadol caudally. Duration of analgesia, hemodynamic responses and adverse effects were noted and analysed. Results: Thirty patients in both groups were comparable with regard to demographic data and hemodynamic response and were statistically non-significant (P>0.05). It was observed that the mean duration of analgesia was significantly longer in group B (468.5±164.5 min versus 241.5±69.4 min, P<0.001). One patient in each group had postoperative vomiting. Conclusion: This study concludes that Tramadol 1 mg/kg can be added to 0.25% Bupivacaine for caudal analgesia with total volume of 1 ml/kg to prolong the duration of postoperative analgesia in children undergoing lower abdominal, urological, lower extremity surgery without an increase of adverse effects.

Addition of Clonidine or Dexmedetomidine With Bupivacaine to Prolong Caudal Analgesia in Children Undergoing Infraumbilical Surgery.

IntroductionClonidine, a selective α2 adrenergic receptor agonist, combined with caudally administered bupivacaine, is frequently used in children to prolong the duration of postoperative analgesia following infraumbilical surgery. On the other hand, dexmedetomidine is highly selective and has a greater affinity toward α2 adrenergic receptors, especially toward its α2a subtype, accountable for more analgesic and hypnotic effects than clonidine.Aims and objectivesWe designed a prospective, double-blinded, randomized controlled trial to compare the analgesic efficacy and adverse effects of clonidine and dexmedetomidine when combined with bupivacaine for caudal analgesia in children undergoing infraumbilical surgeries.Materials and methodsA total of 60 children aged one to eight years were randomly assigned into two different groups in a double-blinded manner. Following induction of general anesthesia, every patient received a single dose of caudal bupivacaine 0.25% (0.75 ml/kg) mixed with either clonidine (1 µ/kg) in normal saline or dexmedetomidine (1 µ/kg) in normal saline. We noted the hemodynamic variables and postoperative sedation scores. Duration and quality of postoperative analgesia and the number of rescue analgesic drug doses required were recorded during the first 24 hours postoperatively. We also observed the patients for any adverse effects to the study drugs.ResultAdding dexmedetomidine to caudally administered bupivacaine significantly increased the duration of analgesia (15 ± 0.78 hours) and decreased the need for rescue drug doses than the addition of clonidine to bupivacaine (9.63 ± 1.95 hours) in children undergoing infraumbilical surgeries. Incidences of hemodynamic changes or other side effects were comparable between patients of two groups.ConclusionThe addition of dexmedetomidine to caudally administered bupivacaine in children undergoing infraumbilical surgeries may provide a longer duration of analgesia than the addition of clonidine, with less requirement of rescue analgesic doses and without any significant differences in the hemodynamic parameters or other side effects.

A randomised controlled trial comparing the efficacy of varying doses of dexmedetomidine along with 0.125% bupivacaine for caudal analgesia in children undergoing subumblical surgery

A randomised controlled trial comparing the efficacy of varying doses of dexmedetomidine along with 0.125% bupivacaine for caudal analgesia in children undergoing subumblical surgery

The Association of Clonidine with Bupivacaine in Caudal Analgesia for Children

The Association of Clonidine with Bupivacaine in Caudal Analgesia for Children

To Study and Compare Efficacy of Ropivacaine and Bupivacaine for Caudal Analgesia in Paediatric Patients

To Study and Compare Efficacy of Ropivacaine and Bupivacaine for Caudal Analgesia in Paediatric Patients

A comparative study to compare the efficacy of hyperbaric bupivacaine alone and hyperbaric bupivacaine with clonidine in caudal block in paediatric lower abdominal surgeries

Background: The aim was to compare the efficacy of addition of clonidine to hyperbaric bupivacaine and to compare it with plain hyperbaric bupivacaine for caudal analgesia in children aged 3 months to 3 years in term of analgesic duration, hemodynamic change and degree of sedation.Methods: Sixty ASA I and II children undergoing lower abdominal surgeries were divided into two groups of 30 each, plain hyperbaric bupivacaine group (Group B) and hyperbaric bupivacaine with clonidine group (Group C). Group B received only bupivacaine and Group C received bupivacaine with clonidine in caudal block.Results: Hemodynamic and demographic profiles were comparable between both the groups. Addition of clonidine significantly prolonged duration of caudal analgesia and significantly reduce the FLACC scores in group C as compared to group B. Mean sedation score immediately after postoperative period was higher in group C but after 4 hours of awakening, there was gradual fall in mean sedation score in both groups.Conclusions: Addition of clonidine to bupivacaine in caudal analgesia significantly increases the duration of post-operative analgesia.

Dexmedetomidine as an adjuvant to bupivacaine in caudal analgesia in children

Context:Postoperative pain management is becoming an integral part of anesthesia care. Various techniques of pediatric pain relief have been designed among which the most commonly practiced is caudal epidural block. Several adjuvants have been used to prolong the duration of caudal analgesia such as clonidine, neostigmine, ketamine, opioids, and ephedrine. We have designed the study using dexmedetomidine as an adjuvant to assess analgesic efficacy, duration of postoperative analgesia, hemodynamic stability, postoperative sedation, and any adverse effects in children.Aims:The aim is to study the effects of dexmedetomidine as an adjuvant to bupivacaine in caudal analgesia in pediatric patients posted for infraumbilical surgeries.Settings and Design:This is a randomized, double-blind study in which effect of dexmedetomidine is studied when added to bupivacaine in the caudal epidural block. The observations are made intraoperatively for hemodynamic stability and postoperatively for the duration of analgesia.Subjects and Methods:This study was conducted in 100 children of American Society of Anesthesiologists physical status I and II, aged 2–10 years, undergoing elective infraumbilical surgeries. They were divided into two groups as follows: Group A: (0.25%) bupivacaine 1 ml/kg + normal saline (NS) 1 ml. Group B: (0.25%) bupivacaine 1 ml/kg + 1 μg/kg dexmedetomidine in 1 ml NS. As this study was double-blind, patients were randomly assigned to receive either (bupivacaine + saline) or (bupivacaine + dexmedetomidine) in each group. The patients were observed for hemodynamic stability, respiratory depression, and postoperative pain using face, legs, activity, cry, consolability (FLACC) pain scale for 24 h postoperatively.Statistical Analysis Used:Unpaired Student's t-test.Results:The mean duration of effective analgesia in Group A patients was 4.33 ± 0.98 h versus 9.88 ± 0.90 h in Group B patients. Likewise, the difference in mean FLACC score of both the groups was also statistically significant, 7.21 ± 0.76 and 6.49 ± 1.72 in Group A and Group B, respectively.Conclusion:Dexmedetomidine as adjuvant to Bupivacaine increases duration of caudal analgesia and improves hemodynamic stability without an increase in adverse effects in children undergoing infraumbilical surgeries.

Enhancement of bupivacaine caudal analgesia by using dexamethasone or clonidine in children undergoing subumbilical surgery

Background and aims Caudal analgesia produces profound intraoperative, as well as postoperative analgesia, with minimal psychological alteration in children. Because of its short duration, various additives have been used to prolong the duration of analgesia. The present study aimed to evaluate the effect of adding dexamethasone and clonidine to bupivacaine in caudal analgesia for children undergoing subumbilical surgeries. Patients and methods We conducted a prospective, randomized, single-blinded study on 100 patients of either sex belonging to the American Society of Anesthesiologists' physical status I, II in the age group 1-12 years, and undergoing subumbilical surgery under general anesthesia, were enrolled. Written informed consent was obtained from their parents. Patients were randomly divided into two groups (group D and C). Group D received 1 ml/kg of 0.25% bupivacaine with 0.2 mg/kg of dexamethasone in normal saline and group C received 1 ml/kg of 0.25% bupivacaine with 1 mg/kg of clonidine in normal saline, with maximum volume of 12 ml in both the groups. All patients were assessed intraoperatively for hemodynamic changes and requirement of sevoflurane concentration and postoperatively for pain by using FLACC pain score and for sedation by using four-point sedation score. Results The mean duration of analgesia was 18-24 h in group D, whereas in group C it was 12-15 h. Group C had a higher sedation score up to 2 in immediate postoperative period for 1 h compared with below 1 h in group D. Conclusion Postoperative analgesia is longer with dexamethasone compared with clonidine without any side effects.

Fentanyl, dexmedetomidine, dexamethasone as adjuvant to local anesthetics in caudal analgesia in pediatrics: A comparative study

BackgroundCaudal analgesia is a good, reliable and easy method to provide intraoperative and postoperative analgesia in the infraumbilical surgery in pediatrics. Many additives were used in combination with local anesthetics in caudal block to prolong the postoperative analgesia (fentanyl, dexmedetomidine and dexamethasone).Aim of the studyThis study aimed to compare the intraoperative hemodynamics, postoperative analgesia, postoperative sedation and postoperative side effects of fentanyl, dexmedetomidine and dexamethasone as adjuvant to bupivacaine in caudal analgesia in pediatrics.Methods120 pediatric patients (3–10 years old) scheduled for lower abdominal surgeries under general anesthesia allocated to 4 groups. Group I (control), in this group the patients received 0.5 ml of a equal mixture of bupivacaine 0.25% and lidocaine 1% diluted in saline (in a dose of 0.5 ml/kg) caudally. In Group II (fentanyl group), the patients received the same mixture of Group I + fentanyl (1 μg/kg) caudally. In Group III (dexmedetomidine group), the patients received the same mixture of Group I + dexmedetomidine (1 μg/kg) caudally. In Group IV (dexamethasone group), the patients received the same mixture of Group I + dexamethasone (0.1 mg/kg) caudally.ResultsThe demographics and hemodynamics were comparable among the studied groups. The dexmedetomidine group and dexamethasone group were less in pain score, prolong the duration of analgesia and less in number of patients required analgesia compared to control and fentanyl groups. More sedation was present in the fentanyl and dexmedetomidine groups. The fentanyl group showed significant increase in the adverse effect incidence.ConclusionBoth caudal dexmedetomidine and caudal dexamethasone added to local anesthetics are good alternatives in prolongation of postoperative analgesia compared to caudal local anesthetic alone or added to caudal fentanyl. Also they showed less side effects compared to caudal fentanyl.

Efficacy and Safety of Dexmedetomidine Added to Caudal Bupivacaine in Pediatric Major Abdominal Cancer Surger

Background: Caudal analgesia has been prolonged by the addition of various adjuvants. Dexmedetomidine is a highly selective α2agonist with sedative and analgesic properties. Objective: To investigate the effect of addition of dexmedetomidine to 0.25% bupivacaine for caudal analgesia in children undergoing major abdominal cancer surgery. Study Design: A randomized double-blind trial. Setting: Academic medical center. Methods: Forty pediatric patients, aged 3 – 12 years, weighting 10 – 40 kg, and of American Society of Anesthesiologists (ASA) physical status I and II scheduled for major abdominal cancer surgeries under general anesthesia combined with caudal analgesia were enrolled. They were randomly allocated into 2 groups: Group I (BD): (n = 20) received 1 mL/kg bupivacaine 0.25% with dexmedetomidine 1 µg/kg and group II (B): (n = 20) received 1 mL/kg bupivacaine 0.25%. Heart rate (HR), mean arterial pressure (MAP), and oxygen saturation (SPO2) were recorded for 120 minutes. Pain was assessed immediately postoperative and at hours 2, 4, 6, 12, 18, and 24 of postoperative period by Face, Legs, Activity, Cry and Consolability (FLACC) score. Time to first request for analgesia and total analgesic consumption [Intravenous acetaminophen 15mg/kg (perfalgan, Squibb)] in the first 24 hours were recorded. The level of sedation was recorded using Ramsay’s sedation scale. Adverse effects were recorded and treated. Results: There was significant reduction in FLACC score in group BD at 2, 4, 6, and 12 hours postoperatively compared to group B. At the eighteenth and twenty-fourth hour there was no significant difference. Time of the first rescue analgesic requirement was significantly prolonged in group BD compared to group B. The mean total consumption of rescue analgesia in the 24 hours of the postoperative period was significantly decreased in group BD (405.00 ± 215.03) mg when compared with group B (810.35 ± 200.93) mg. Limitations: This study is limited by its small sample size. Conclusion: Addition of dexmedetomidine (1 µg/kg) to caudal bupivacaine 0.25% (1 mL/kg) in pediatric major abdominal cancer surgeries achieved significant postoperative pain relief for up to 19 hours, with less use of postoperative analgesics, and prolonged duration of arousable sedation. Hemodynamic changes were statistically significant, yet of no clinical significance. Key words: Dexmedetomidine, caudal block, pediatric cancer surgery

A COMPARATIVE STUDY BETWEEN DEXMEDETOMIDINE AND CLONIDINE USED AS ADJUNCTS TO BUPIVACAINE FOR POST-OPERATIVE ANALGESIA BY CAUDAL BLOCK IN PAEDIATRIC PATIENTS

Caudal anaesthesia/analgesia is simple to perform, reliable and safe. Various adjuvants are tried with local anaesthetic to prolong duration of post-operative a nalgesia in caudal block in paediatric patients wit h variable results. This prospective study was designed to ass ess and compare the efficacy of clonidine and dexme detomidine used as an adjuvants to bupivacaine for caudal anal gesia in paediatric patients. A 100 patients of ASA grade I or II ,age group of 6 months to 6 years undergoing infra- umblical surgeries were included in one of the foll owing two groups. Group D received 1 µg/kg Dexmedetomidine while group C received 1 µ g/kg Clonidine both with Bupivacaine plain 0.25% 1 ml/kg. Post-operative analgesia was assessed using CRIES scale. The mean duration of post-operative analgesia in group D was 14.16 ± 1 .65 hours and in group C it was 11.24 ± 2.48. The p rolongation of post-operative analgesia was significantly longe r in group D compared to group C and the requirement of rescue analgesic doses in the first 24 post-operative hour s was less in group D compared to group C. The inci dence of adverse effects were statistically insignificant be tween the two groups.The addition of both dexmedetomidine and clonidine with bupivacaine administered caudally s ignificantly increase the duration of post-operativ e analgesia.

Comparison of Ketamine, Fentanyl and Clonidine as an Adjuvant During Bupivacaine Caudal Anaesthesia in Paediatric Patients

Caudal epidural analgesia with bupivacaine is very popular in paediatric anaesthesia for providing intra- and postoperative analgesia. Several adjuvants have been used to prolong the action of bupivacaine. To compare the efficacy of ketamine, fentanyl and clonidine in terms of quality and duration of analgesia they produce when added with caudal bupivacaine by single shot technique in children. Eighty children, age one to ten years, undergoing sub-umbilical surgery, were prospectively randomized to one of four groups: caudal analgesia with 0.75 ml/ kg of 0.25% bupivacaine in normal saline (Group B) or caudal analgesia with 0.75 ml/kg of 0.25% bupivacaine with 1 μg/kg of clonidine in normal saline (Group BC) or caudal analgesia with 0.75 ml/kg of 0.25% bupivacaine with ketamine 0.5mg/kg (Group BK) or caudal analgesia with 0.75 ml/kg of 0.25% bupivacaine with fentanyl 1 mcg/kg (Group BF). Post-operative pain was assessed for 24 hours using the FLACC scale. The mean duration of analgesia was significantly longer in Group BC (629.06 ± 286.32 min) than other three groups P < 0.05. The pain score assessed using FLACC scale was compared between the four groups, and children in Group BC had lower pain scores, which was statistically significant. The requirement of rescue medicine was lesser in Group BC. Clonidine in a dose of 1 μg/kg added to 0.25% bupivacaine for caudal analgesia, during sub-umbilical surgeries, prolongs the duration of analgesia of bupivacaine, without any side effects in compare to fentanyl or ketamine. We conclude that clonidine in a dose of 1 μg/kg, added to 0.25% bupivacaine for caudal analgesia and administered as a 0.75 ml/kg mixture in children, for subumbilical surgery, significantly prolongs the duration of post-operative analgesia when compared to 0.75 ml/kg of 0.25% bupivacaine in normal saline than 0.75 ml/kg of 0.25% bupivacaine with ketamine 0.5 mg/kg or 0.75 ml/kg of 0.25% bupivacaine with fentanyl 1 mcg/kg or 0.75 ml/kg of 0.25% bupivacaine alone, without any side effects.

Comparision of Caudal Ropivacaine, Ropivacaine Plus Ketamine and Ropivacaine Plus Fentanyl Administration for Postoperative Analgesia in Children

Introduction: The purpose of the study was to compare the analgesic quality and duration of Ropivacaine 0.2% with the addition of Fentanyl (1 mcg/kg) with that of Ropivacaine 0.2% and the addition of Ketamine (0.5 mg/kg) and also compare the post complications. Materials and Methods: Ninety children, age one to ten years, undergoing sub-umbilical surgery, were prospectively randomized to one of three groups: caudal analgesia with 0.75 ml/kg of 0.2% Ropivacaine in normal saline (Group R) or caudal analgesia with 0.75 ml/kg of 0.2% Ropivacaine with Ketamine 0.5 mg/kg (Group RK) or caudal analgesia with 0.75 ml/kg of 0.2% Ropivacaine with Fentanyl 1 mcg/kg (Group RF). Post-operative pain was assessed for 24 hours using the FLACC scale. Results: The mean duration of analgesia was significantly longer in Group RK (629.06 ± 286.32 min) than other two groups P &lt; 0.05. The pain score assessed using FLACC scale was compared between the three groups, and children in Group RK had lower pain scores, which was statistically significant. The requirement of rescue medicine was lesser in Group RK. Ketamine in a dose of 0.5 mg/kg added to 0.2% bupivacaine for caudal analgesia, during sub-umbilical surgeries, prolongs the duration of analgesia of Ropivacaine, without any side effects in compare to Ropivacaine alone or Fentanyl. Conclusion: We conclude that Ketamine in a dose of 0.5 mg/kg, added to 0.2% Ropivacaine for caudal analgesia and administered as a 0.75 ml/kg mixture in children, for sub-umbilical surgery, significantly prolongs the duration of post-operative analgesia without any side effects. DOI: http://dx.doi.org/10.3126/jnps.v32i3.6956 J. Nepal Paediatr. SocVol.32(3) 2012 210-215

Randomized controlled trial comparing morphine or clonidine with bupivacaine for caudal analgesia in children undergoing upper abdominal surgery

BackgroundVarious additives have been used to increase the duration of analgesia provided by bupivacaine administered by single-shot caudal injection in children. MethodsA prospective, randomized, double-blind controlled study in 50 ASA I–II children (34 boys and 16 girls) aged 1–6 yr undergoing upper abdominal surgery was conducted. Patients were divided into two groups to receive either morphine 30 µg kg−1 (MB) or clonidine 2 µg kg−1 (CB) in bupivacaine 0.2% (1.25 ml kg−1) for caudal analgesia. The duration of analgesia (FLACC scale) and sedation and side-effects such as vomiting, itching, respiratory depression, hypotension, and bradycardia were observed. ResultsThe mean duration of analgesia was 16.5 (3.6) h in the CB group compared with 10.2 (2.3) h (P<0.01) in the MB group. Subjects who received clonidine (CB) were sedated for longer [7.1 (0.8) h] compared with the MB group [3.8 (0.7) h; P<0.01]. Vomiting was observed in 4% and 12% of subjects in the CB and MB groups, respectively. Sixteen per cent of subjects reported itching in the MB group (P=0.03), and none in the CB group. No hypotension, bradycardia, or respiratory depression was observed in any subjects. ConclusionsCaudal clonidine 2 µg kg−1 in bupivacaine 0.2% provides a longer duration of analgesia and sedation compared with caudal morphine 30 µg kg−1 in bupivacaine 0.2% without significant side-effects in children undergoing upper abdominal surgery.

Efficacy of Three Doses of Tramadol With Bupivacaine for Caudal Analgesia in Paediatric Inguinal Herniotomy

Efficacy of Three Doses of Tramadol With Bupivacaine for Caudal Analgesia in Paediatric Inguinal Herniotomy

Efficacy of three doses of tramadol with bupivacaine for caudal analgesia in paediatric inguinal herniotomy

This study was designed to evaluate the analgesic efficacy of three doses of tramadol, administered caudally with bupivacaine, in providing postoperative pain relief in children. Eighty children, aged between 2 and 8 yr, undergoing inguinal herniotomy were randomly allocated to receive bupivacaine 0.25% 0.75 ml kg(-1) (Group B; n=20), bupivacaine 0.25% 0.75 ml kg(-1) with tramadol 1 mg kg(-1) (Group BT1; n=20), bupivacaine 0.25% 0.75 ml kg(-1) with tramadol 1.5 mg kg(-1) (Group BT1.5; n=20), or bupivacaine 0.25% 0.75 ml kg(-1) with tramadol 2 mg kg(-1) (Group BT2; n=20) by the caudal route immediately after induction of general anaesthesia. Heart rate, arterial pressure and oxygen saturation were monitored. Postoperative pain was assessed at regular intervals for 24 h using All India Institute of Medical Sciences pain score. Analgesia was supplemented whenever pain score was >or=4. Duration of analgesia and requirement for additional analgesics was noted. Duration of analgesia was longer in Group BT2 [(mean (SD) 12 (0.9) h] compared with Group B [4 (1) h], Group BT1 [8 (0.9) h], or Group BT1.5 [11 (1) h]; all P<0.001. Total consumption of rescue analgesic was significantly lower in group BT2 compared with other groups (P<0.001). There were no significant changes in heart rate, arterial pressure and oxygen saturation between groups. Adverse effects were not observed. Caudal tramadol 2 mg kg(-1), combined with bupivacaine 0.25% 0.75 ml kg(-1), provided longer duration of postoperative analgesia and reduced requirement for rescue analgesic compared with tramadol 1 mg kg(-1) or 1.5 mg kg(-1) in children undergoing inguinal herniotomy.

Efficacy of three doses of Ketamine with Bupivacaine for caudal analgesia in pediatric inguinal herniotomy

Background and objectives Ketamine administered systemically is a potent analgesic at subanesthetic plasma concentrations. Addition of ketamine to bupivacaine for caudal epidural block significantly prolongs the duration of postoperative analgesia. The purpose of this prospective, randomized double-blind study is to identify the optimal dose of ketamine that produces the maximum duration of caudal analgesia with minimal adverse effects as an adjuvant to bupivacaine for caudal epidural block. Methods Sixty children, aged 6 months to 10 years, undergoing inguinal herniotomy were allocated randomly to receive 1 of 3 solutions for caudal epidural block. Group 1 received 0.75 mL/kg of bupivacaine 0.25% with preservative-free ketamine 0.25 mg/kg, group 2 received 0.75 mL/kg of bupivacaine 0.25% with ketamine 0.5 mg/kg, and group 3 received 0.75 mL/kg of bupivacaine 0.25% with ketamine 1 mg/kg. Postoperative pain was assessed using the All India Institute of Medical Sciences pain discomfort scale. Rescue analgesia in the form of pethidine 1 mg/kg intramuscularly was administered when this score exceeded 4. Results The mean duration of caudal analgesia was 8.8 hours in group 1 compared with 22.1 hours in group 2 ( P < .001) and 25.2 hours in group 3 ( P < .001). Supplemental analgesia requirements with pethidine were significantly less in group 2 (4 subjects) and group 3 (no subject) when compared with group 1 (18 subjects). There were no differences between the groups in the incidence of motor blockade, urinary retention, emesis, or sedation. Group 3 had a significantly higher incidence of behavioral side effects such as odd behavior, agitation, or restlessness than groups 1 and 2. Conclusions The optimal dose of ketamine in our study was 0.5 mg/kg added to 0.75 mL/kg bupivacaine 0.25% for caudal epidural block without an increase in side effects.

Efficacy of Three Doses of Ketamine With Bupivacaine for Caudal Analgesia in Pediatric Inguinal Herniotomy

Efficacy of Three Doses of Ketamine With Bupivacaine for Caudal Analgesia in Pediatric Inguinal Herniotomy

POSTOPERATIVE ANALGESIA AFTER PAEDIATRIC ORCHIDOPEXY: EVALUATION OF A BUPIVACAINE-MORPHINE MIXTURE

The value of combining morphine with bupivacaine for caudal analgesia was investigated. Thirty children, undergoing orchidopexy, received a caudal block of 0.125% bupivacaine with or without morphine 0.05 mg kg-1. Analgesia, side-effects, ventilatory frequency and oxygen saturation (SaO2) were recorded after operation. None of the 15 patients receiving the bupivacaine-morphine mixture required post-operative opioids, whereas eight of 15 patients receiving bupivacaine alone needed additional opioid analgesia. The incidence of side effects after surgery was similar for the two groups and there was no detectable difference in ventilatory frequency or SaO2.