A COMPARISON OF CAUDAL BUPIVACAINE VS BUPIVACAINE TRAMADOL MIXTURE FOR POSTOPERATIVE ANALGESIA IN CHILDREN HAVING LOWER ABDOMEN AND LOWER LIMB SURGERIES

Abstract

Background: Caudal epidural block is widely used for perioperative analgesia in children undergoing infraumbilical surgery. Its utility, however, may be limited by the relatively short duration of analgesia achieved with a local anesthetic alone. The addition of tramadol as an adjuvant may prolong postoperative pain relief and improve analgesic quality without substantially increasing adverse effects. Objective: To compare the efficacy and safety of caudal bupivacaine alone versus caudal bupivacaine combined with tramadol for postoperative analgesia in children undergoing lower abdominal and lower limb surgeries. Study design: Prospective randomized controlled trial. Settings: Department of Anaesthesia, Aziz Bhatti Shaheed Teaching Hospital, Gujrat, Pakistan. Duration of study: July to December 2024. Methods: A total of 70 pediatric patients aged 2–10 years with American Society of Anesthesiologists physical status I–II were randomly assigned in a 1:1 ratio to two groups. Group A received caudal 0.25% bupivacaine at 1 mL/kg, while Group B received caudal 0.25% bupivacaine at 1 mL/kg combined with tramadol 1–2 mg/kg. Postoperative pain was assessed using a validated pediatric pain scale at predefined intervals over 24 hours. The primary outcome was duration of analgesia. Secondary outcomes included time first to rescue analgesia, total analgesic consumption in the first 24 hours, postoperative pain scores, and treatment-related adverse effects. Data were analyzed using SPSS, and p ≤0.05 was considered statistically significant. Results: The mean age of the study population was 5.84 ± 2.41 years, and 60% were male. Baseline demographic and clinical characteristics were comparable between the two groups. The mean duration of analgesia was significantly longer in the bupivacaine-tramadol group than in the bupivacaine-alone group (8.94 ± 1.76 vs 4.86 ± 1.21 hours; p <0.001). Similarly, time to first rescue analgesia was significantly prolonged in Group B (8.63 ± 1.69 vs 4.71 ± 1.19 hours; p <0.001). Total 24-hour analgesic consumption was significantly lower in the combination group (16.1 ± 7.2 vs 28.4 ± 8.7 mg/kg; p <0.001). Postoperative pain scores remained significantly lower in the tramadol group during the first 12 postoperative hours. Adverse effects were infrequent and comparable between groups, and no patient developed respiratory depression or any serious complication. Conclusion: The addition of tramadol to caudal bupivacaine significantly prolongs postoperative analgesia, lowers pain scores, and reduces rescue analgesic requirements in children undergoing lower abdominal and lower limb surgeries. This combination appears to be a safe and effective option for pediatric caudal analgesia.