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BJA Advance Access originally published online on March 15, 2008
British Journal of Anaesthesia 2008 100(5):701-706; doi:10.1093/bja/aen048
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2008. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Analgesic effectiveness of caudal levobupivacaine and ketamine

B. G. Locatelli1, G. Frawley2,*, A. Spotti1, P. Ingelmo3,4, S. Kaplanian2, B. Rossi1, L. Monia1 and V. Sonzogni1

1 Department of Anaesthesia and Intensive Care, Ospedali Riuniti di Bergamo, Bergamo, Italy
2 Department of Paediatric Anaesthesia and Pain Management, Royal Children's Hospital, Melbourne, Australia
3 Department of Anaesthesia and Intensive Care, A.O San Gerardo, Monz, Italy
4 Dipartimento di medicina sperimentale ambientale e biotecnologie mediche, Università degli Studi Milano Bicocca, Milan, Italy

* Corresponding author. E-mail: geoff.frawley{at}rch.org.au

Background: Ketamine is used increasingly in paediatric anaesthetic practice to prolong the action of a caudal block. This study was designed to determine if adding S(+)-ketamine 0.5 mg kg–1 allows a lower concentration of levobupivacaine to be used for caudal anaesthesia without loss of clinical effectiveness.

Methods: One hundred and sixty-four children (ASA I or II) aged 3 months–6 yr were randomly allocated to receive 1 ml kg–1 of levobupivacaine 0.15% with 0.5 mg kg–1 S(+)-ketamine (Group 1), levobupivacaine 0.175% with 0.5 mg kg–1 S(+)-ketamine (Group 2), or levobupivacaine 0.2% (Group 3) by the caudal route. Pain, motor block, sedation, and requirement for postoperative analgesia were assessed up to 6 h after operation.

Results: There was no significant difference between the groups in effectiveness at first surgical incision. Significantly lower analgesic requirements were reported in Group 2 compared with Group 3 at wakeup, 180 and 360 min after operation. Time to first rescue analgesia was longer in Group 2 compared with Group 1 or 3. Kaplan–Meier survival analysis of analgesia free time demonstrated a significant advantage of Group 2 over Groups 1 and 3 (log rank P=0.05). The incidence of postoperative motor block was not significantly different between the groups. No excess sedation or dysphoric reactions were observed in the ketamine groups.

Conclusions: The addition of 0.5 mg kg–1 S(+)-ketamine to levobupivacaine 0.175% for caudal analgesia for lower abdominal and urological surgery is significantly more effective in providing postoperative analgesia than levobupivacaine 0.15% with 0.5 mg kg–1 S(+)-ketamine or levobupivacaine 0.2%.

Keywords: anaesthetic techniques, regional, caudal; anaesthetics local, steriosomers; anaesthetics, pharmacology, ketamine; analgesia, postoperative


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