Comparison of effects of epidural ropivacaine and ropivacaine plus tramadol on postoperative analgesia in children undergoing major abdomen surgery

ABSTRACT COMPARISON OF EFFECTS OF EPIDURAL ROPIVACAINE AND ROPIVACAINE PLUS TRAMADOL ON POSTOPERATIVE ANALGESIA IN CHILDREN UNDERGOING MAJOR ABDOMEN SURGERY Epidural blockade is recently the choice of postoperative pain management in children undergoing major abdomen surgery(7'8'9). Ropivacaine, a new local anesthetic agent, has been reported to have lower toxic effects on cardiovasculary and central nervous systems(7"13). Although, a weak opiad synthesized in recent years, tramadol, has been reported to be effective in caudal blockade in children, studies regarding its use in lumbar epidural blockade are rare. Thus, we aimed to compare the effects of sole ropivacaine and ropivacaine plus tramadol administered epidurally on postoperative analgesia in children. 44 children, aged between 2 to 12, with ASA physical status I and II, undergoing major abdomen surgery, included in the study after approval by the ethic committee. Following induction of anesthesia and tracheal entubation, patients were placed into left lateral decubitis position and an epidural catheter (22-24G) was inserted by using Tuohy needle (19-20G). Patients were randomly divided into two groups to receive sole ropivacaine (0.2%) 0.7 ml/kg (group I), and ropivacaine (0.2%) plus tramadol (2mg/kg) with total volume 0.7 ml/kg epidurally. Sevoflurane concentrations, SBP, DBP, and HR values were recorded preoperative^ and intraoperative at 5th, 10th, 15th, 20th, 25th, 30th, and 45th minutes. SBP, DBP, HR, breath rate, CHEOPS and sedation scores, and probable adverse effects were recorded postoperatively at 5th, 10th, 15th, 30th, 45th minutes and 1st, 2nd, 3rd, 4th, 6th, 12th, and 24th hours. Postoperative analgesia durations were also recorded. Demographical data were similar between the groups. Postoperative analgesia durations were found significantly longer in group II (p<0.05). CHEOPS scores recorded postoperatively at 30th min., 45th min., and 3rd hour were significantly lower in group II (p<0.05). We concluded that epidural ropivacaine-tramadol combination prolonged the analgesia duration and required less supplementary analgesics. Key words: Children, postoperative pain, epidural block, ropivacane, tramadol. VTT -r_.,-»;-. ''Vi'.? T.f,. v1XCFKP7r