Neostigmine as an Adjuvant to Caudal Bupivacaine in Paediatric Population

Abstract

Introduction: Postoperative pain in children is very distressing for the parents as well as the Anaesthesiologist involved. Pain assessment in children has its limitations. Caudal analgesia is the most popular central neuraxial block in paediatric age group for perioperative analgesia and attenuation of stress response particularly in infra umbilical surgeries. Use of adjuvants to local anaesthetic agents enhance the duration of analgesia. Aim: To assess the efficacy of Neostigmine as an adjuvant to Bupivacaine in Caudal blocks in paediatric inguinal herniotomies. Materials and Methods: This was a prospective, double blinded randomised clinical study. Forty ASA1 children in the age group, 2-6 years, were randomly allocated to two groups (n=20 each). The 1st group (Group B) received caudal injection of 0.25% Bupivacaine 1 mL/kg plus 1 mL NS after induction of general anaesthesia. The 2nd group (Group BN) received caudal injection of 0.25% Bupivacaine 1 mL/kg plus Neostigmine 2 mcg/kg made up in 1 mL NS after administration of general anaesthesia. Both groups received IV Ondansetron 0.1 mg/kg towards the end of the surgery. The pain scores, haemodynamic parameters, requirement of analgesics, duration of sedation and motor block, time to first micturition and incidence of nausea and vomiting were studied. The quantitative data was statistically analysed using Student’s t-test. Results: Demographics were similar and haemodynamics were stable in both groups. Better analgesia was noted in Group BN compared to Group B (15.16 hours vs 6.52 hours) with more post op analgesic requirement in group B compared to Group BN. There was no incidence of nausea and vomiting in both groups. Conclusion: Addition of Neostigmine as adjuvant to Bupivacaine in Caudal block resulted in superior analgesia in post paediatric inguinal herniotomy patients with lesser requirement of postop analgesics. Use of IV Ondansetron towards end of surgery prevented postoperative nausea and vomiting.

Keywords

• adjuncts
• caudal anaesthesia
• inguinal herniotomy
• postoperative analgesia