Caudal ropivacaine and ketamine for postoperative analgesia in children

In a prospective, randomised, double-blind clinical study, we studied 32 AS A grade I and II boys aged 18 months to 12 years, scheduled for circumcisio n under general anaesthesia on an outpatient basis. They were randomly allo cated to one of two groups: those in the ropivacaine group received caudal ropivacaine 0.2% 1 ml.kg(-1) for postoperative analgesia and those in the k etamine/ropivacaine group received caudal ropivacaine 0.2% 1 ml.kg(-1) plus caudal ketamine 0.25 mg.kg(-1). Postoperative pain was assessed using a mo dified 10-cm visual analogue scale and analgesia was administered ii the pa in score exceeded a value of 3. The median duration of analgesia was signif icantly longer in the ketamine/ropivacaine group (12 h) than in the ropivac aine group (3 h, p < 0.0001), and subjects in the ropivacaine group require d significantly more doses of postoperative analgesia than those in the ket amine/ropivacaine group (p < 0.0001), There were no differences between the groups in the incidence of postoperative nausea, vomiting, sedation, emerg ence delirium, nightmares, hallucinations, motor block and urinary retentio n.