BJA Advance Access originally published online on June 23, 2006
British Journal of Anaesthesia 2006 97(3):385-388; doi:10.1093/bja/ael155
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Efficacy of three doses of tramadol with bupivacaine for caudal analgesia in paediatric inguinal herniotomy
1 Department of Anaesthesia and Intensive Care, Vardhman Mahavir Medical College and Safdarjang Hospital New Delhi, India
2 Department of Biostatistics, AIIMS New Delhi, India
3 Central Hospital New Delhi, India
*Corresponding author. E-mail: drsunilprakash{at}rediffmail.com
Background. This study was designed to evaluate the analgesic efficacy of three doses of tramadol, administered caudally with bupivacaine, in providing postoperative pain relief in children.
Methods. Eighty children, aged between 2 and 8 yr, undergoing inguinal herniotomy were randomly allocated to receive bupivacaine 0.25% 0.75 ml kg–1 (Group B; n=20), bupivacaine 0.25% 0.75 ml kg–1 with tramadol 1 mg kg–1 (Group BT1; n=20), bupivacaine 0.25% 0.75 ml kg–1 with tramadol 1.5 mg kg–1 (Group BT1.5; n=20), or bupivacaine 0.25% 0.75 ml kg–1 with tramadol 2 mg kg–1 (Group BT2; n=20) by the caudal route immediately after induction of general anaesthesia. Heart rate, arterial pressure and oxygen saturation were monitored. Postoperative pain was assessed at regular intervals for 24 h using All India Institute of Medical Sciences pain score. Analgesia was supplemented whenever pain score was 
4. Duration of analgesia and requirement for additional analgesics was noted.
Results. Duration of analgesia was longer in Group BT2 [(mean (SD) 12 (0.9) h] compared with Group B [4 (1) h], Group BT1 [8 (0.9) h], or Group BT1.5 [11 (1) h]; all P<0.001. Total consumption of rescue analgesic was significantly lower in group BT2 compared with other groups (P<0.001). There were no significant changes in heart rate, arterial pressure and oxygen saturation between groups. Adverse effects were not observed.
Conclusions. Caudal tramadol 2 mg kg–1, combined with bupivacaine 0.25% 0.75 ml kg–1, provided longer duration of postoperative analgesia and reduced requirement for rescue analgesic compared with tramadol 1 mg kg–1 or 1.5 mg kg–1 in children undergoing inguinal herniotomy.