title: Tramadol along with local anaesthetics in the penile block for the children undergoing circumcision.
abstract: OBJECTIVE
  This study was to find out the total duration of postoperative analgesia following circumcision in children when Tramadol was used as an adjunct to local anaesthetics in penile block.
  
  
  METHODS
  Forty children of age 5 - 13 yrs, ASA I & II were enrolled in this study. Patients were premedicated with ketamine and atropine intramuscularly prior to separation from their parents and IV cannulation. Penile block was then performed under strict aseptic precautions with paramedian approach by 3 cm long 23 g ordinary needle where 4 ml of mixture of local anaesthetics and tramadol was given on each side of the base of penis at 11 and 2 o clock positions. Duration of analgesia was recorded from the time of completion of surgery till the patients' first complain of pain and when additional analgesic was given. Intraoperative analgesia duration achieved by the penile block was not included in this study due to unavoidable overlapping of sedation and analgesia produced by the premedicated IM Ketamine (4-5 mg/kg) ,which lasts for 25 minutes to 30 minutes. Unless complicated, this is the usual surgery time in our hospital for this procedure. Because of this reason, the sedation score was not used in this study. Moreover, paediatric sedation score remains too impractical and unreliable in our context.
  
  
  RESULTS
  Addition of Tramadol with local anaesthetics in penile block prolonged the postoperative analgesia even up to 40 hours.
  
  
  CONCLUSIONS
  Tramadol as an adjunct with Local Anaesthetics extends the duration of postoperative analgesia and can be used safely for this purpose in the children.
authors.affiliation: Department of Anaesthesiology and Intensive care, Kathmandu Medical College, Sinamangal, Kathmandu, Nepal. barashrestha@yahoo.co.in
authors.forename: B R
authors.initials: BR
authors.lastname: Shrestha
authors.forename: B
authors.initials: B
authors.lastname: Bista
mesh_terms: D000759:Adjuvants, Anesthesia; D000293:Adolescent; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D002648:Child; D002675:Child, Preschool; D002944:Circumcision, Male; D006801:Humans; D008297:Male; D009407:Nerve Block / Q000379:methods*; D010149:Postoperative Pain / Q000517:prevention & control*; D010413:Penis / Q000294:innervation; D013997:Time Factors; D014147:Tramadol
chemical_list: D000759:Adjuvants, Anesthesia; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D014147:Tramadol