Effects of ketamine added to ropivacaine in pediatric caudal block

Abstract

Objectives: We aimed to determine the hemodynamic effects and postoperative pain control quality of ropivacaine and ketamine addition to ropivacaine in children undergoing inguinal hernia repair with caudal anesthesia.

Methods: A total of 45 patients (1-4 years) scheduled to undergo inguinal hernia repair were studied. Anesthesia was induced with sevoflurane in O2/N2O and vecuronium was administered to facilitate endotracheal intubation. Anesthesia was maintained with sevoflurane in O2/N2O. Patients were randomly divided into three groups. Following endotracheal intubation, we administered 2 mg/kg 0.2% ropivacaine to Group R; 0.5 mg/kg ketamine to Group K; and 2 mg/kg 0.2% ropivacaine plus 0.5 mg/kg ketamine to Group R+K caudally. Pain levels were evaluated via modified CHEOPS, and sedation levels were assessed by the Wilson Sedation Scale.

Results: At the postoperative 45th minute (min), the CHEOPS score was significantly higher in Group R compared to Group K and Group R+K (p<0.05). This score was significantly higher in Group R than in Group R+K at the postoperative 60th min (p<0.05). The effective analgesic period was significantly higher in Group K (852+/-309 min) and Group R+K (1032+/-270 min) than in Group R (435.5+/-273 min) (p<0.05). The analgesic requirement in the first 24 hours postoperatively was lower in Group R+K than the other groups. Sedation scores were below 2 in all groups. There were no significant differences between groups regarding adverse events.

Conclusion: The results of the present study indicate that caudal ropivacaine, ketamine and ropivacaine plus ketamine provided effective postoperative analgesia. Additionally, ketamine combined with ropivacaine lengthened the duration of analgesia while lowering analgesic requirements.