Key result
Adding caudal ketamine to ropivacaine fails to reduce minimum local anesthetic concentration in children.
Why the study?
The effect of caudal ketamine on the efficacy of ropivacaine for intra-operative analgesia was unclear.
Does adding caudal ketamine to ropivacaine reduce the minimum local anesthetic concentration of ropivacaine for intra-operative analgesia in children?
RCT (n=169)
Double-blind
Computer-generated table and sealed envelope
No
Does adding caudal ketamine to ropivacaine reduce the minimum local anesthetic concentration of ropivacaine for intra-operative analgesia in children?
Adding caudal ketamine to ropivacaine prolongs post-operative analgesia but does not decrease the minimum local anesthetic concentration of ropivacaine for intra-operative analgesia in children.
Does not reduce ropivacaine MLAC for intra-operative caudal block; extends evidence of prolonged post-operative analgesia in children.
Background Caudal ketamine has been shown to provide an effective and prolonged post-operative analgesia with few adverse effects. However, the effect of caudal ketamine on the efficacy of ropivacaine for intra-operative analgesia is unclear. Methods One hundred and sixty-nine children were randomized to five groups: Group C (caudal ropivacaine only), Group K0.25 (caudal ropivacaine plus 0.25 mg/kg ketamine), Group K0.5 (caudal ropivacaine plus 0.5 mg/kg ketamine), Group K0.75 (caudal ropivacaine plus 0.75 mg/kg ketamine), and Group K1.0 (caudal ropivacaine plus 1.0 mg/kg ketamine). The primary outcome was the minimum local anesthetic concentration (MLAC) of ropivacaine with/without ketamine for caudal block. Results The MLAC values of ropivacaine were 0.128% (0.028%) in the control group, 0.112% (0.021%) in Group K0.25, 0.112% (0.018%) in Group K0.5, 0.110% (0.019%) in Group K0.75, and 0.110% (0.020%) in Group K1.0. There were no significant differences among the five groups for the MLAC values (p=0.11). During the post-operative period the mean durations of analgesia were 270, 381, 430, 494, and 591 min in the control, K0.25, K0. 5, K0.75, and K1.0 groups respectively, which shown significant differences among the five groups (p<0.05). Conclusions Adding caudal ketamine to ropivacaine prolong the duration of post-operative analgesia; however, it does not decrease the MLAC of caudal ropivacaine for intra-operative analgesia in children.
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Wang et al. (2019) conducted an RCT in Elective hydrocele or inguinal hernia (n=169). Caudal ketamine vs. Caudal ropivacaine only was evaluated on Minimum local anesthetic concentration (MLAC) of ropivacaine (p=0.11). Adding caudal ketamine (0.25 to 1.0 mg/kg) to ropivacaine did not significantly decrease the minimum local anesthetic concentration of caudal ropivacaine for intra-operative analgesia in children compared to ropivacaine alone (p=0.11).
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