Levobupivacaine–tramadol combination for caudal block in children: a randomized,double‐blinded,prospective study1

Background: The aim of this prospective study was to compare the postoperative analgesic efficacy and duration of analgesia after caudal levobupivacaine 0.125% or caudal tramadol 1.5 mg·kg⁻¹ and mixture of both in children undergoing day‐case surgery. Methods: Sixty‐three American Society of Anesthesiologists (ASA) I or II children between 1 and 7 years old scheduled for inguinal hernia repair under sevoflurane anesthesia were randomized to receive caudal levobupivacaine 0.125% (group L), caudal tramadol 1.5 mg·kg⁻¹ (group T) or mixture of both (group LT) (total volume of caudal solution was 1 ml·kg⁻¹). Duration of analgesia and requirement for additional analgesics were noted. Postoperative pain was evaluated using the Children’s and Infants’ Postoperative Pain Scale (CHIPPS) every 15 min for the first hour, and after 2, 3, 4, 6, 12, and 24 h. Analgesia was supplemented whenever pain score was ≥4. Results: No patient experienced significant intraoperative hemodynamic response to surgical incision. Duration of analgesia was significantly longer in group LT than in group L and group T (545 ± 160 min vs 322 ± 183 min and 248 ± 188 min, respectively) (P < 0.01). There were no significant differences between the group L and group T for duration of analgesia (P > 0.05). There were no significant differences among the groups in the number of patients requiring analgesia after operation (P = 0.7). No signs of motor block were observed after the first postoperative hour in any of the patients. Conclusion: Addition of tramadol increased the duration of analgesia produced by caudal levobupivacaine in children.