The Effect of Ketamine Adding to Ropivacaine on the Caudal Block in Pediatric Anesthesia

The effect of ketamine adding to ropivacaine on the caudal block inpediatric anesthesiaThe aim of this study was to identify the effectiveness of ropivacaine andropivacaine plus ketamine on the efficiency of anesthesia, haemodynamic parametersand the treatment of postoperative pain in pediatric patients were planned to performoperations for inguinal region.Materials and Methods: Forty-five patients with ASA score 1-2, between ages 1 to4 were enrolled to study approved by local ethic committee and by their family.Induction of anesthesia was performed via face mask with sevoflourane 8 % in 50 %O2 / 50% N2O mixture. Vecuronium was used to all subjects in dose of 1 mg kg-1 foradequate relaxation of muscles and intratracheal intubation was performed with tubewithout cuff. Maintenance dose of anesthesia was provided with sevoflourane 0.5-2.5% in 50 % O2 / 50% air mixture. Patients were randomly divided into 3 groups.Ropivacaine 0.2% 2 mg kg-1 was given to Group R via caudally, ketamine 0.5 mg kg-1was given to Group K via caudally and Ropivacaine 0.2% 2 mg kg-1 plus ketamine0.5 mg kg-1 was given to Group R+K via caudally.The degree of pain, the condition of sedation and the degree of motor activity in thepostoperative period were evaluated with Modified CHEOPS, Wilson sedation scaleand three point scale, respectively. SPSS 12.0 for windows was performed for theevaluation of statistically significance.Results: There were no differences between groups for ages, weight and types ofoperations. Modified CHEOPS scores were found to be significantly higher inpostoperative 45th minute in Group R compared with others (p<0.05). Similarly thisscore was found to be higher in postop. 60th minute in Group R compared withGroup R+K (p<0.05). The duration of analgesia was significantly longer in Group K(852±309 min) and Group R+K (1032±270 min) than Group R (435.6±273 min)(p<0.05). The necessity of analgesic medication was significantly found to be lowerin Group R+K in 24 hours following operations. The scores of sedations were <2 inall groups. Nausea and vomiting were noted in two patients in both Group R and K,urinary retention was noted in only one patient in Group R, hallucination wasconsidered in two patients in Group K and in one patient in Group R+K, and finallynistagmus was determined in three patients in Group K and one patient in GroupR+K.Conclusion: It was concluded that caudally administered ropivacaine, ketamine andropivacaine + ketamine were found to be an effective on postoperative analgesia inpediatric patients. Moreover ketamine adding to ropivacaine was considered toprolong the duration of analgesia and to reduce the postoperative analgesiarequirement.Key words: Caudal block, ropivacaine, ketamine, postoperative pain.