Publication: Tramadol along with local anaesthetics in the penile block for the children undergoing circumcision
Date
2005
Authors
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Journal ISSN
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Publisher
Kathmandu University
Abstract
Objective: This study was to find out the total duration of postoperative analgesia following circumcision in
children when Tramadol was used as an adjunct to local anaesthetics in penile block. Methods: Forty children of
age 5 – 13 yrs, ASA I & II were enrolled in this study. Patients were premedicated with ketamine and atropine
intramuscularly prior to separation from their parents and IV cannulation. Penile block was then performed under
strict aseptic precautions with paramedian approach by 3cm long 23g ordinary needle where 4 ml of mixture of local
anaesthetics and tramadol was given on each side of the base of penis at 11 and 2 o~ clock positions. Duration of
analgesia was recorded from the time of completion of surgery till the patients’ first complain of pain and when
additional analgesic was given. Intraoperative analgesia duration achieved by the penile block was not included in
this study due to unavoidable overlapping of sedation and analgesia produced by the premedicated IM Ketamine
(4-5 mg/kg) ,which lasts for 25 minutes to 30 minutes. Unless complicated, this is the usual surgery time in our
hospital for this procedure. Because of this reason, the sedation score was not used in this study. Moreover,
paediatric sedation score remains too impractical and unreliable in our context. Results: Addition of Tramadol with
local anaesthetics in penile block prolonged the postoperative analgesia even up to 40hours. Conclusion: Tramadol
as an adjunct with Local Anaesthetics extends the duration of postoperative analgesia and can be used safely for this
purpose in the children.
Key words: Penile Block, Circumcision, Tramadol, Postoperative Analgesia.