Background and Aims:

Caudal block is a safe and simple method of pain relief in young children with the drawback of a short duration of analgesia which can be overcome by adding various adjuvants to the injected local anaesthetic. We compared the effects of caudal levobupivacaine, tramadol and a combination of both in paediatric patients undergoing inguinal herniotomy.

Method:

After permission from the hospital ethics committee, in this randomised double blinded interventional study 78 children aged 1 to 7 years, planned for inguinal herniotomy were randomly allocated to 3 groups. Group L was administered levobupivacaine 0.125% 1ml/kg, Group T received tramadol 1.5 mg/kg in 0.9% NS and Group LT 1ml/kg of 0.125% levobupivacaine with 1.5mg/kg tramadol caudally. Observations were made for postoperative pain, rescue analgesic doses and any adverse effects for 12 hours postoperatively. The quantitative data collected was analysed by ANOVA test.

Results:

All the groups were comparable with regards to age, sex and duration of surgery. No motor block was observed in any of the patients. The mean duration of analgesia in Group L was 321.46 + 84.76 minutes and in Group T was 565.19 + 107.08 minutes. The requirement for rescue analgesia in tramadol group was significantly less as compared to levobupivacaine group. In contrast, none of the patients in Group LT required additional analgesia during the 12-hour study period. Sedation scores and adverse effects were comparable among all groups.

Conclusion:

Addition of tramadol to caudal levobupivacaine significantly increased the duration and effectiveness of postoperative analgesia.