Comparison of pre-emptive analgesic effect of rectal ketamine and caudal bupivacaine in pediatric lower abdominal surgery

Amir Shafa, Seyedjalal Hashemi, Seyedmorteza Heidari, zeynab Talebi



Background: Ketamine is a medication that suppresses the central nervous system and can be used as an analgesic. The aim of this study isto compare the post-operative pain reduction of rectal ketamine and caudal bupivacaine in pediatric lower abdominal surgery.

Method: This was a double-blind clinical trial studywhich performed on 68 children aged 1-7 years that allocated into two groups of 34 patients. The first Group received rectal ketamine (2mg/kg), and the second received 0.75mg/kg caudal bupivacaine (0.125%). Mean pain intensity and hemodynamic variables were recorded 2,6,12 and 24 hours after lower abdominal surgery in children. Pain was assessed using FLACC (Face, Legs, Activity, Cry, Consolability) Scale.

Results: No significant difference was found in terms of pain intensity between admission and discharge from recovery (p>0.05). Patients who received ketamine endured less pain than bupivacaine 2, 6, and 12 hours following surgery (p<0.05). Mean extubation time and duration of recovery stay was significantly shorter in ketamine group. 

Conclusion: Rectal ketamine was associated with more effective pain control and shorter recovery stay, when compared to caudal bupivacaine in lower abdominal pediatric surgery.


Postoperative pain,Rectal Ketamine, Caudal Bupivacaine, Pain Management, Lower abdominal surgery

Full Text:




Burton MJ, GlasziouPP: Tonsillectomy or adenotonsillectomyadenotonsillectomy versus

non-surgical treatment for chronic/recurrent acute tonsillitis. Cochrane Database Syst Rev 2009;


Umuroglu T, Eti Z, Ciffci H, et al: Analgesia for adenotonsillectomy in children: A comparison

of morphine, ketamine and tramadol. PaediatrAnaesth 2004;14(7):568-73.

Hosseini Jahromi SA, Sadeghi Poor S, Hosseini Valami SM, et al: Effects of suppository

acetaminophen, bupivacaine wound infiltration and caudal block with bupivacaine on

postoperative pain in pediatric inguinal herniorrhaphy. Anesth Pain Med. 2012;1(4):243-7. doi:

5812/aapm.3551. Epub 2012 Apr 1.Miller’s Anesthesia , Eriksson LI: Elsevier Health Sciences;


Tanaka M , Sato M, Saito A, et al: Reevaluation of rectal ketamine premedication in children:

comparison with rectal midazolam. Anesthesiology 2000;93(5):1217-24.

Somdas MA, Senturk M, Ketenci I, et al: Efficacy of bupivacaine for post-tonsillectomy pain: a

study with the intra-individuldesing. J Pediatr Otorhinolaryngol 2004;68(11):1391-1395.

Sorensen WT, Wagner N, Aarup AT Bonding P: Beneficial effect of low-dose peritonsillar

injection of lidocaine- adrenaline before tonsillectomy. A placebo-controlled clinical trial, Auris

Nasus Larynx 2003;30(2):159-162.

Engindeniz Z, Demircab C, Karli N, et al: Intramuscular tramadol vs.diclofenac sodium for the

treatment of acute migraineattacks in emergency department: a perspective randomized doubleblind

study. Headache Pain 2005;6(3):143-148.

Ozcan S, Yilmaz E, Buyukkocak U, et al: Comparison of three analgesics for extracorporeal

shockwave lithotripsy. J Urol Nephrol 2002;36(4):281-285.

Jain A, Muralidhar V, Aneja S, et al: A prospective observational study comparing criteriabased

discharge method with traditional time-based discharge method for discharging patients

frompost-anaesthesia care unit undergoing ambulatory or outpatient minor surgeries under general

anaesthesia. Indian J Anaesth 2018;62(1):61-65.

Dwivedi R, Cipolle C, Hoefer C: Development and Assessment of an Interprofessional

Curriculum for Managing Diabetes during Ramadan. Am J Pharm Educ 2018;82(7):6550.

Moshiri, E, Noruzi,A, SH, Gazerani N, et al: The effect of low dose ketamine on postoperative

pain after spinal anesthesia in elective cesarean section. Arak Medical University Journal (AMUJ)

; 14(55): 81-88.

SayinVoepel-Lewis T, Merkel S, TaitAR: Cry Consolability observational tool as a measure of

Iranian Journal of Pediatric Surgery Vol. 4 No. 2/ 2018

Comparison of Pre-emptive Analgesic Effect of Rectal Ketamine and Caudal Bupivacaine Shafa et al. 70

pain in children with cognitive impairment. Anesth Analg 2002;95(5): 1224-9.

Sayin MM, Mercan A, Ture H, et al: The effect of 2 different concentrations of rectal ketamine

on its premedicant features in children. Saudi Med J 2008;29(5):683-7.

Tyler DC, Krane EJ, Hester NO, et al: Measurement of pain in children: Generalizability and

validity of the pain ladder and the poker chip tool. Pediatric pain 1990;15:79-93.

Arbabi S, Shirmohammadi M, Ebrahimsoltani A, et al: The effect of caudal anesthesia with

bupivacaine and its mixture with midazolam or ketamine on postoperative pain control in children

JAP 2013;3(4):210-215.

Mirlohi SZ, Hashemi SJ. Heidari SM: Comparison of the preventive analgesic effect of rectal

ketamine and rectal acetaminophen after pediatric tonsillectom. Int J Prev Med 2012;3(Suppl




  • There are currently no refbacks.