الفهرس 
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Abstract
Summary
ain is a highly unpleasant sensory and emotional
experience. Various pharmacological agents and
analgesic delivery systems have been employed to avoid
under-treatment of pain.
The goal of post-operative pain relief is to reduce or
eliminate pain with minimum side-effects and in our setup as
cheaply as possible. Effective pain relief means a smooth
postoperative period, increased patient compliance and an
early discharge from hospital.
Caudal anesthesia is one of the commonly used
regional blocks in children. This technique is a useful adjunct
during general anesthesia and also for postoperative
analgesia after lower abdominal operations.
Bupivacaine is the most commonly used local
anesthetic in caudal anesthesia in pediatric practice, and it
provides reliable, long-lasting anesthesia and analgesia when
given via the caudal route. However, the mean duration of
surgical analgesia provided by local anesthetics is limited
and thus single shot caudal anesthesia is indicated only for
surgery expected to last less than 90 min.
The administration of opioids into the epidural space
prolongs the duration of caudal analgesia such as tramadol.
P
Summary
82
In our study fifty pediatric patients scheduled for
elective lower abdominal, pelvic or lower limb surgeries,
aged 2-6 years of either sex, ASA (I -II) randomly allocated
into two groups 25 in each group.
One group received caudal block of 0.5ml/kg of 0.25%
plain bupivacaine solution following the induction of general
anesthesia while the other group received caudal block of 0.5
ml/kg of 0.25% bupivacaine in combination with 1 mg/kg of
tramadol following the induction of general anesthesia.
All patients in both groups were monitored for HR,
MBP, SpO2, RR and ETCO2 intraoperatively and
postoperatively.
Postoperative analgesia was assessed using a toddler
preschooler postoperative pain score (TPPPS).
TPPPS pain score was recorded at admission to PACU
(baseline), then hourly for first 2 hours, then every 2 hours
for next 12 hours and at 24 hours postoperative.
Results of our study were showing that addition of
tramadol to bupivacine in caudal block as above mentioned
dose leading to increase postoperative analgesia up to 14
hours approximately with no significant side effects.
Summary
83
So our recommendations to add tramadol (1 mg/kg)
with bupivacaine 0.25% (0.5 ml/kg) in caudal block for
lower abdominal surgeries in pediatric patients for prolonged
postoperative analgesia.