title: Topical versus caudal ketamine/bupivacaine combination for postoperative analgesia in children undergoing inguinal herniotomy.
abstract: BACKGROUND
  Multiple studies claim that caudal administration of ketamine causes effective postoperative analgesia. The aim of this study was to assess the clinical effectiveness of ketamine after caudal or topical administration in pediatric patients undergoing inguinal herniotomy.
  
  
  METHODS
  This randomized, comparative, double-blind study included eighty children (aged 6 months to 6 years) received either 1 ml/kg of 0.25% bupivacaine/ketamine 0.5 mg/kg for caudal analgesia (caudal group) or 0.3 ml/kg of 0.25% bupivacaine/ketamine 0.5 mg/kg sprayed by the surgeon around the spermatic cord and upon the ilioinguinal nerve before wound closure for topical analgesia (topical group). The duration of postoperative analgesia, pain scores, rescue analgesic consumption, sedation score, hemodynamic monitoring, and side-effects were evaluated 48 h postoperative.
  
  
  RESULTS
  Kaplan-Meier survival analysis of analgesia free time demonstrated a significant advantage of topical ketamine (TK) group over caudal ketamine (CK) group. The duration of postoperative analgesia was longer in TK group than in CK group (28.74 ± 2.88 vs. 21.43 ± 5.01 h,P= 0.000). Fewer children asked for oral analgesics in the topical group (24 of 36, 66.7%) than in the caudal one (28 of 32, 87.5%;P< 0.01). Postoperative pain scores at the 6thtill 48thh were lower in topical group with comparable analgesic consumption between two groups. In the caudal group, four subjects suffered from retention of urine: Two presented with a residual motor block and two had photophobia.
  
  
  CONCLUSIONS
  Wound instillation of bupivacaine/ketamine is a simple, noninvasive, and effective technique that could be a safe alternative to CK for postoperative analgesia in children undergoing inguinal hernia repair.
authors.affiliation: Department of Anesthesia and Intensive Care, Faculty of Medicine, Assiut University, Assiut, Egypt.
authors.forename: Hala Saad
authors.initials: HS
authors.lastname: Abdel-Ghaffar
authors.affiliation: Department of Anesthesia and Intensive Care, Faculty of Medicine, Assiut University, Assiut, Egypt.
authors.forename: Seham Mohamed
authors.initials: SM
authors.lastname: Moeen
authors.affiliation: Department of Urology, Faculty of Medicine, Assiut University, Assiut, Egypt.
authors.forename: Ahmed Mohamed
authors.initials: AM
authors.lastname: Moeen
keywords: Analgesia; caudal; day-case anesthetic techniques; ketamine; pediatrics; postoperative; topical