Ramazan ÖDEŞ, Ömer Lütfi ERHAN, Mıhammed DEMİRCİ, Hülya GÖKSU

Effects of ketamine added to ropivacaine in pediatric caudal block

Amaç: İnguinal herni onarımı operasyonu geçiren çocuklarda kaudal anestezide ropivakainin ve ropivakaine eklenen ketaminin, hemodinamiye etkisi ve postoperatif ağrı tedavisindeki etkinliliğinin değerlendirilmesi amaçlandı. Gereç ve Yöntem: Çalışmaya 1-4 yaşlarında inguinal herni onarımı planlanan 45 olgu alındı. Anestezi indüksiyonu O2/N2O karışımı içinde sevofluran ile yapıldı. Vekuronyum ile yeterli kas gevşekliği sağlanarak endotrakeal entübasyon uygulandı. Anestezi O2/N2O hava karışımı içinde sevofluran ile sürdürüldü. Hastalarımız rastgele üç gruba ayrıldı. Endotrakeal entübasyondan sonra, Grup R’ye 2 mg/kg %0.2’lik ropivakain, Grup K’ya 0.5 mg/kg ketamin, Grup R+K’ya 2 mg/kg %0.2’lik ropivakain+0.5 mg/kg ketamin kaudal olarak verildi. Hastaların ağrı düzeyleri modifiye CHEOPS, sedasyon durumu Wilson sedasyon skalası kullanılarak değerlendirildi. Bulgular: Modifiye CHEOPS skorunun, Grup R’de postoperatif 45. dakikada Grup K ve R+K’ya göre, 60. dakikada ise Grup R+K’ya göre anlamlı derecede artmış olduğu saptandı (p

Pediyatrik kaudal blokta ropivakaine eklenen ketaminin etkinliği

Objectives: We aimed to determine the hemodynamic effects and postoperative pain control quality of ropivacaine and ketamine addition to ropivacaine in children undergoing inguinal hernia repair with caudal anesthesia. Methods: A total of 45 patients (1-4 years) scheduled to undergo inguinal hernia repair were studied. Anesthesia was induced with sevoflurane in O2/N2O and vecuronium was administered to facilitate endotracheal intubation. Anesthesia was maintained with sevoflurane in O2/N2O. Patients were randomly divided into three groups. Following endotracheal intubation, we administered 2 mg/kg 0.2% ropivacaine to Group R; 0.5 mg/kg ketamine to Group K; and 2 mg/kg 0.2% ropivacaine plus 0.5 mg/kg ketamine to Group R+K caudally. Pain levels were evaluated via modified CHEOPS, and sedation levels were assessed by the Wilson Sedation Scale. Results: At the postoperative 45th minute (min), the CHEOPS score was significantly higher in Group R compared to Group K and Group R+K (p<0.05). This score was significantly higher in Group R than in Group R+K at the postoperative 60th min (p<0.05). The effective analgesic period was significantly higher in Group K (852±309 min) and Group R+K (1032±270 min) than in Group R (435.5±273 min) (p<0.05). The analgesic requirement in the first 24 hours postoperatively was lower in Group R+K than the other groups. Sedation scores were below 2 in all groups. There were no significant differences between groups regarding adverse events. Conclusion: The results of the present study indicate that caudal ropivacaine, ketamine and ropivacaine plus ketamine provided effective postoperative analgesia. Additionally, ketamine combined with ropivacaine lengthened the duration of analgesia while lowering analgesic requirements.

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