title: Ketamine versus magnesium sulfate with caudal bupivacaine block in pediatric inguinoscrotal surgery: A prospective randomized observer-blinded study.
abstract: BACKGROUND
  Possible approaches for postoperative analgesia after pediatric inguinoscrotal surgery are caudal block by bupivacaine/ketamine (BK) and bupivacaine/magnesium sulfate (BM).
  
  
  OBJECTIVE
  The purpose of the following study is to compare the analgesic efficacy and safety of ketamine and magnesium sulfate in combination with bupivacaine for caudal blockade in pediatric patients after inguinoscrotal operations.
  
  
  METHODS
  Patients randomly received one of the two solutions for caudal epidural injection after induction of general anesthesia. Group-BK: Were given a mixture of 0.25% bupivacaine and 0.5 mg/kg of ketamine. Group-BM: Were given a mixture of 0.25% bupivacaine and 50 mg magnesium sulfate. Postoperatively, a blinded post-anesthesia care unit nurse assessed the quality of analgesia with a visual pain analog scale (VPAS). Significant pain is defined as one that has a VAPS of ≥3.
  
  
  RESULTS
  Forty American Society of Anesthesiologists I-II children (20 in each group) completed the study. The two groups were comparable regards age, sex, body mass index, anesthesia and surgery durations, recovery time and sevoflurane concentration. The mean duration of caudal analgesia ± standard deviation was 462 ± 17.2 min versus 398.05 ± 12.9 min for BK and BM groups, receptively (P < 0.001). Supplemental rectal paracetamol within 12 h postoperatively were 15% for BK group versus 25% for BM (P = 0.05). Four patients in BK group only experienced postoperative nausea and vomiting (P = 0.053).
  
  
  CONCLUSIONS
  Caudal administration of BK is efficient and safe for pediatric inguinoscrotal operations with longer postoperative analgesia than BM sulfate.
authors.affiliation: Department of Urology, Assiut University, Asyut 71516, Egypt.
authors.forename: Waleed S H
authors.initials: WS
authors.lastname: Farrag
authors.affiliation: Department of Urology, Assiut University, Asyut 71516, Egypt.
authors.forename: Abdelrady S
authors.initials: AS
authors.lastname: Ibrahim
authors.affiliation: Department of Urology, Assiut University, Asyut 71516, Egypt.
authors.forename: Mostafa Galal
authors.initials: MG
authors.lastname: Mostafa
authors.affiliation: Department of Urology, Assiut University, Asyut 71516, Egypt.
authors.forename: Adel
authors.initials: A
authors.lastname: Kurkar
authors.affiliation: Department of Urology, Assiut University, Asyut 71516, Egypt.
authors.forename: Ahmad A
authors.initials: AA
authors.lastname: Elderwy
keywords: Ingunoscrotal surgery; ketamine; magnesium sulphate; pediatric caudal block