title: Comparison of the effect of ketamine added to bupivacaine and ropivacaine, on stress hormone levels and the duration of caudal analgesia.
abstract: BACKGROUND
  The aim of this study was to compare bupivacaine 0.25% and ropivacaine 0.2%, singly and in combination with ketamine, for caudal administration in children. Duration of analgesia, the need for other analgesics and the stress response were measured.
  
  
  METHODS
  Eighty children were randomized into four groups of twenty. The bupivacaine group received bupivacaine 0.25% and the ketamine/bupivacaine group received bupivacaine 0.25% plus 0.5 mg/kg ketamine. The ropivacaine group received ropivacaine 0.2%, and the ketamine/ropivacaine group received ropivacaine 0.2% plus 0.5 mg/kg ketamine. The duration of analgesia and analgesic requirements were recorded for each group, as were peri-operative and post-operative concentrations of the stress hormones insulin, glucose and cortisol.
  
  
  RESULTS
  Ketamine, added to either bupivacaine or ropivacaine for caudal analgesia, gave a longer duration of analgesia (P < 0.05) than bupivacaine or ropivacaine alone. In all groups, blood insulin concentration was increased, and cortisol concentration reduced. Glucose concentration was significantly increased in all groups (P < 0.05).
  
  
  CONCLUSIONS
  Ketamine can safely be added to ropivacaine 0.2% or bupivacaine 0.25% for caudal anesthesia in order to prolong duration of analgesia and reduce the need for additional analgesics. Stress hormone levels are partially attenuated.
authors.affiliation: Department of Anaesthesiology, Akdeniz University Medical Faculty, Antalya, Turkey. akbasmert@akdeniz.edu.tr
authors.forename: M
authors.initials: M
authors.lastname: Akbas
authors.forename: T A
authors.initials: TA
authors.lastname: Titiz
authors.forename: F
authors.initials: F
authors.lastname: Ertugrul
authors.forename: H
authors.initials: H
authors.lastname: Akbas
authors.forename: M
authors.initials: M
authors.lastname: Melikoglu
mesh_terms: D000577:Amides; D000763:Anesthesia, Caudal; D000778:Anesthetics, Dissociative; D000779:Anesthetics, Local; D001786:Blood Glucose / Q000378:metabolism; D002045:Bupivacaine; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D005260:Female; D006439:Hemodynamics; D006728:Hormones / Q000097:blood*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007328:Insulin / Q000097:blood; D007649:Ketamine; D007866:Leg / Q000601:surgery; D008297:Male; D019637:Orthopedic Procedures; D010149:Postoperative Pain / Q000188:drug therapy; D000077212:Ropivacaine; D013312:Stress, Physiological / Q000097:blood
chemical_list: D000577:Amides; D000778:Anesthetics, Dissociative; D000779:Anesthetics, Local; D001786:Blood Glucose; D006728:Hormones; D007328:Insulin; D007649:Ketamine; D000077212:Ropivacaine; D006854:Hydrocortisone; D002045:Bupivacaine