Effect of caudal ketamine on minimum local anesthetic concentration of ropivacaine in children: a prospective randomized trial

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 minimum local anesthetic concentration (MLAC) 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 K(0.25) (caudal ropivacaine plus 0.25 mg/kg ketamine), Group K(0.5) (caudal ropivacaine plus 0.5 mg/kg ketamine), Group K(0.75) (caudal ropivacaine plus 0.75 mg/kg ketamine), and Group K(1.0) (caudal ropivacaine plus 1.0 mg/kg ketamine). The primary outcome was the MLAC values 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 K(0.25), 0.112% (0.018%) in Group K(0.5), 0.110% (0.019%) in Group K(0.75), and 0.110% (0.020%) in Group K(1.0). 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, K(0.25), K(0. 5), K(0.75), and K(1.0) groups respectively, which shown that control group is significantly different from all ketamine groups. Also there were significant differences between K(0.25) and K(0.75) groups, and between K(1.0) groups and the other ketamine groups. 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. CLINICAL TRIAL REGISTRATION: ChiCTR-TRC-13003492. Registered on 13 August 2013.