The effect of caudal anesthesia with bupivacaine and its mixture with midazolam or ketamine on postoperative pain control in children

Aim and This clinical trial was conducted to evaluate the effectiveness of adding midazolam or S-Ketmine to caudal bupivacaine in order to prolong the postoperative analgesis duration. Methods and Materials: 60 children with ASA physical status I or II and scheduled for elective surgery below the umbilicus, were enrolled in this double blinded clinical trial. The patients were placed in three different groups. In the 1st group 1 ml/kg of 0.25% bupivacaine, in the 2nd group 1 ml/kg of 0.25% bupivacaine with 0.5 mg/kg ketamine, and in the 3rd group 1 ml/kg of 0.25% bupivacaine with 50 µg/kg midazolam were used. There were no differences between the groups in demographic and haemodynamic state, duration of surgery and anaesthesia, time to extubation or sedation score.The mean duration of postoperative analgesia were 19 h, 14.5 h, and 8 h in the 3rd, 2nd, and the 1st groups, respectively.Although there were more episodes of nausea and vomiting emergence reaction in the 2nd group, the difference did not seem significant. Addition of preservative-free S-Ketamine (0.5 mg/kg) or midazolam (50 µg/kg) to caudal bupivacaine provides significant prolongation of analgesia without producing significant negative side-effects.