Comparative Evaluation of Caudal Ropivacaine with Ketamine versus Midazolam for Postoperative Analgesia in Children Undergoing Infraumbilical Surgery

Background: For pediatric patients having infraumbilical surgery, efficient postoperative pain management is crucial. While ropivacaine is frequently used for caudal epidural analgesia, the quality and duration of postoperative analgesia may be affected by the use of adjuvant drugs such ketamine or midazolam. In pediatric patients undergoing infraumbilical surgery, the analgesic effectiveness of caudal ropivacaine with ketamine versus ropivacaine plus midazolam was studied. The objective is to evaluate the analgesic effectiveness of caudal ropivacaine combined with ketamine versus caudal ropivacaine combined with midazolam in children having infraumbilical surgery. Material and Methods: One hundred fifty pediatric patients undergoing infraumbilical surgery participated in a comparative study. Two groups of 75 patients each were formed. Caudal ropivacaine was administered with ketamine to Group A and caudal ropivacaine and midazolam to Group B. The FLACC scale was used to measure postoperative pain at 30 minutes, 2, 4, 6, and 12 hours. Acetaminophen consumption over a 24-hour period, analgesic duration, and postoperative complications were measured and compared between the groups. Results: The groups had similar baseline clinical and demographic features. Group A experienced analgesia for an average of 14.4±2.36 hours compared to 12.0±3.69 hours in Group B (p=0.002). Mean FLACC scores were significantly lower in Group A at 2 hours (0.3±0.48 vs. 0.5±0.51), 4 hours (0.5±0.67 vs. 1.0±0.79), 6 hours (0.6±0.59 vs. 1.9±1.21), and 12 hours (0.6±1.40 vs. 1.3±1.62), with significant differences between groups. Total 24-hour acetaminophen consumption was also lower in Group A than Group B (102.6±89.62 vs. 118.99±98.71 mg; p=0.012). No statistically significant difference was observed in the reported postoperative complications. Conclusion: In pediatric patients receiving infraumbilical surgery, caudal ropivacaine plus ketamine produced more potent and prolonged postoperative analgesia than caudal ropivacaine plus midazolam. The ketamine combination was associated with lower postoperative pain scores and reduced 24-hour acetaminophen consumption.

Keywords: Infraumbilical Surgery, Ketamine, Midazolam, Ropivacaine.