Comparison between Caudal Tramadol and Nalbuphine as Adjuvants to 0.2% Ropivacaine in Children Undergoing Hypospadias Surgery: A Randomised Clinical Trial

Background and Aims: Providing perioperative analgesia has become imperative in paediatric anaesthesia practice to prevent long term behavioural changes. Caudal route though very safe and reliable way of providing analgesia for lower abdominal surgeries, has the drawback of short duration of action with single shot technique which can be overcome by adding different adjuvants. We compared the analgesic effects of caudal tramadol and nalbuphine added as adjuvants to 0.2 % ropivacaine in children undergoing hypospadias surgery under general anaesthesia. METHODS: 128 patients aged 2-7 years, ASA grade 1 and 2, were randomly allocated to 2 groups: Group T: patients received caudal 0.2 % ropivacaine 0.75 ml/kg plus 1.5 mg/kg tramadol in 1ml saline. Group N: patients received caudal 0.2 % ropivacaine 0.75 ml/kg plus 0.05 mg/kg nalbuphine in 1ml saline. Primary outcome was duration of absolute analgesia. Total analgesic requirement was recorded for 24 hours post surgery. Data analysis was done using Chi square, student t or Mann Whitney U test depending on normality of the variable. RESULTS: The mean duration of analgesia was higher in Group T (12.5 2.4 hours) as compared to Group N (6.7 1.5 hours). Accordingly the requirement of rescue analgesic was lesser in group T as compared to group N. while no adverse effects were noticed in any group. CONCLUSION: Addition of tramadol to caudal ropivacaine significantly increased duration of postoperative analgesia as compared to nalbuphine.