Comparative Study of Caudal Ropivacaine Combined with Ketamine and with Midazolam for Analgesic Efficiency in Pediatric Infraumbilical Procedures

Abstract

Background: Postoperative pain management in pediatric patients undergoing infraumbilical surgeries can be challenging. Caudal epidural analgesia with local anesthetics like ropivacaine is commonly used, but adjunct medications like ketamine and midazolam are often added to enhance analgesic efficacy.

Aim: To compare the analgesic efficacy of caudal ropivacaine combined with ketamine versus ropivacaine combined with midazolam in pediatric patients undergoing infraumbilical surgeries. Material and Methods: A prospective, randomized study was conducted with pediatric patients aged 2-12 years undergoing elective infraumbilical surgeries. Group A received caudal ropivacaine + ketamine, and Group B received ropivacaine + midazolam. Postoperative pain scores, opioid consumption, and adverse effects were assessed at various time points.

Results: Group A demonstrated significantly lower pain scores at 1, 4, and 8 hours postoperatively and required less opioid consumption compared to Group B. No significant differences were observed at 24 hours. Both combinations had similar safety profiles, with mild sedation and nausea observed in both groups.

Conclusion: Caudal ropivacaine combined with ketamine provides superior early postoperative pain relief and reduces opioid consumption compared to ropivacaine with midazolam in pediatric infraumbilical surgeries.