A comparative study between caudal bupivacaine and bupivacaine co-administered with neostigmine for postoperative analgesia in children

Abstract

Aims and Objectives: The aim of this study was to compare the duration of postoperative analgesia and possible adverse effects produced by caudal bupivacaine 0.25% at 1 ml/kg with or without 1.5 µg/kg of neostigmine in children undergoing unilateral herniotomy. Patients and Methods: Sixty-six children aged 1-6 years, of ASA physical status classes I or II for elective unilateral herniotomy under general anaesthesia without premedication were studied. The patients were randomly allocated into two groups of 33 each. Group B received caudal analgesia with plain bupivacaine 0.25% at 1ml/kg alone, while group BN received caudal analgesia using a mixture of plain bupivacaine 0.25% at 1ml/kg and neostigmine 1.5 µg/ kg. Postoperatively, monitoring of pain scores and time to first analgesic request and, total dose of analgesics administered in the first 24 hours were recorded. Results: All the patients participated throughout the study. There were no differences in the demographic characteristics (age, weight, ASA status)between the two groups. The mean duration of effective analgesia was significantly longer in group BN, 460±60.2 min. compared to group B, 286.4±47.8 mins, (p < 0.001). The analgesic requirement within the first 24 hours postoperatively was also significantly reduced in group BN, p < 0.001. Conclusion: The study shows that the addition of low dose neostigmine to caudal isobaric bupivacaine significantly prolonged the time to first analgesicrequest and hence significantly reduced postoperative analgesic requirement

Keywords

• isobaric bupivacaine
• caudal analgesia
• herniotomy
• neostigmine