الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Background: Addition of tramadol to ropivacaine during caudal epidural analgesia might prolong the duration of postoperative analgesia without increasing the incidence of adverse effects. So, this study was designed to evaluate the effect of caudal ropivacaine, caudal tramadol and caudal ropivacaine tramadol combination for postoperative analgesia in pediatric patients subjected to minor lower abdominal surgery. Methods: This study was carried out on 40 pediatric patients of either sex with age ranging from 2 - 6 years submitted at pediatric Mansoura University Hospital for elective minor lower abdominal surgery (herniotomy, orchidopexy and hypospadias repair). Anesthesia was induced with oxygen/halothane via face mask, then tracheal intubation, was done and anesthesia was maintained with N2O : oxygen in 1 : 1 ratio, halothane and spontaneous breathing until the end of surgery. Then caudal block was induced. Patients were classified into 4 groups, 10 patients each: Group I: Received general anesthesia only. Group II: Received general anesthesia plus caudal isobaric ropivacaine 0.75% at a dose of 2.5mg/kg (1ml/kg). Group III: Received general anesthesia plus caudal tramadol at a dose of 2mg/kg. Group IV: Received general anesthesia plus caudal isobaric ropivacaine 0.75% at a dose of 2.5mg/kg (1ml/kg) and tramadol at a dose of 2mg/kg. Intraoperative monitoring for heart rate, arterial blood pressure, oxygen saturation and end tidal carbon dioxide. Postoperative monitoring for heart rate, arterial blood pressure, oxygen saturation, respiratory rate, sedation score, pain score and duration of postoperative analgesia. Results: Pain score was significantly decreased in groups II, III and IV when compared with group I from 1st to 24th hours and in groups III and IV when compared with group II at 6th, 12th and 24th hours and in group IV when compared with group III from 1st to 6th hours. There was significant increase in duration of analgesia in groups II, III and IV when compared with group I. Also, duration of analgesia was significantly increased in groups III and IV when compared with group II and in group IV when compared with group III. The incidence of postoperative emesis was 20% in both groups III and IV. Hemodynamic stability occurred in all groups intraoperatively and postoperatively. Conclusion: caudal administration of ropivacaine with addition of tramadol resulted in a longer duration of analgesia without demand for additional analgesics compared with caudal ropivacaine alone without increase of side effects.