Analgesic effects of caudal and intramuscular S(+)-ketamine in children.
BACKGROUND
Previous studies suggest that caudal administration of ketamine cause effective analgesia. The purpose of the current study was to compare the clinical effectiveness and plasma concentrations of S(+)-ketamine after caudal or intramuscular administration in children to distinguish between local and systemic analgesia.


METHODS
After induction of general anesthesia, 42 patients, aged 1 to 7 yr, scheduled to undergo inguinal hernia repair randomly received a caudal (caudal group) or intramuscular (intramuscular group) injection of 1 mg/kg S(+)-ketamine. Intraoperatively, heart rate (HR), mean arterial pressure (MAP) and arterial oxygen saturation were measured. Postoperative measurements included duration of analgesia, a four-point sedation score, and hemodynamic and respiratory monitoring for 6 h in the recovery room. Analgesic requirements in the recovery room were assessed by an independent blinded observer using an observational pain/discomfort scale (OPS). Plasma samples for determination of ketamine concentrations were obtained before and 10, 20, 30, 45, 60, 90, 120, and 180 min after injection of S(+)-ketamine.


RESULTS
A significantly longer duration of analgesia (P < 0.001) was observed after caudal administration (528 min [220-1,440 min]; median [range]) when compared with intramuscular administration (108 min [62-1,440 min]) of S(+)-ketamine. Plasma levels of ketamine were significantly lower from 10 to 45 min after caudal administration than after intramuscular injection.


CONCLUSIONS
Caudal S(+)-ketamine provides good intra- and postoperative analgesia in children. Despite similar plasma concentrations during most of the postoperative observation period, caudal S(+)-ketamine provided more effective analgesia than did intramuscular S(+)-ketamine, indicating a local analgesic effect.
Koinig
H
H
Departments of Anesthesiology and Intensive Care and Pharmacology, University of Vienna, Vienna, Austria. Herbert.Koinig@unvie.ac.at
Marhofer
P
P
Krenn
C G
CG
Klimscha
W
W
Wildling
E
E
Erlacher
W
W
Nikolic
A
A
Turnheim
K
K
Semsroth
M
M
D000042:Absorption; D000698:Analgesia / Q000379:methods; D015360:Analgesia, Epidural / Q000379:methods; D000700:Analgesics / Q000008:administration & dosage* / Q000097:blood / Q000493:pharmacokinetics; D001794:Blood Pressure / Q000187:drug effects; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D006339:Heart Rate / Q000187:drug effects; D006552:Hernia, Inguinal / Q000601:surgery; D006801:Humans; D007223:Infant; D007268:Injections, Epidural; D007273:Injections, Intramuscular; D007649:Ketamine / Q000008:administration & dosage* / Q000097:blood / Q000493:pharmacokinetics; D010100:Oxygen / Q000097:blood; D010149:Postoperative Pain / Q000517:prevention & control; D011446:Prospective Studies
D000700:Analgesics; D007649:Ketamine; D010100:Oxygen