title: Caudal tramadol for postoperative analgesia in pediatric hypospadias surgery.
abstract: Ninety boys, aged 13-53 months, undergoing repair of hypospadias, were allocated randomly to receive 0.8 ml kg-1 of one of three solutions into the caudal extradural space: group B received bupivacaine 2 mg kg-1, group T received tramadol 2 mg kg-1 in 0.9% saline and group BT a mixture of both. Postoperative pain was assessed hourly for 12 h after injection using a modified TPPPS pain score and additional analgesia was administered to those children whose pain scores were > 3/10. Nine patients (30%) in group T required additional analgesia within 1 h of surgery compared with only two (6.7%) and three (10%) patients in groups B and BT, respectively (P = 0.04). Mean duration before additional analgesia was required in the remaining patients was 9.3 (SD 3.0) h in group B, 10.7 (2.2) h in group T and 10.5 (2.0) h in group BT (P > 0.20). There were no significant differences between the groups in mean ventilatory frequency, sedation scores, incidence of emesis, facial flushing or pruritus. We conclude that caudal tramadol had a slow onset of action and that the addition of tramadol to bupivacaine, when both drugs were administered caudally, did not significantly prolong the duration of action of bupivacaine.
authors.affiliation: Department of Anaesthesia, Royal Liverpool Children's NHS Trust.
authors.forename: D P
authors.initials: DP
authors.lastname: Prosser
authors.forename: A
authors.initials: A
authors.lastname: Davis
authors.forename: P D
authors.initials: PD
authors.lastname: Booker
authors.forename: A
authors.initials: A
authors.lastname: Murray
mesh_terms: D015360:Analgesia, Epidural / Q000379:methods*; D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use*; D000779:Anesthetics, Local / Q000009:adverse effects / Q000627:therapeutic use; D002045:Bupivacaine / Q000009:adverse effects / Q000627:therapeutic use; D002675:Child, Preschool; D004359:Drug Therapy, Combination; D006801:Humans; D007021:Hypospadias / Q000601:surgery*; D007223:Infant; D008297:Male; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D014147:Tramadol / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D014147:Tramadol; D002045:Bupivacaine