Comparative study between caudal ropivacaine and bupivacaine with and without neostigmine in pediatric surgery

ABSTRACT

In a randomized, double-blinded study we examined the analgesic efficacy of caudal nesostigmine-ropivacaine mixture and caudal neostigmine-bupivacaine mixture in 75 pediatric patients schedulled for various surgical procedures such as lower abdominal, urologic and lower limb operations-After induction of general anaesthesia patients were allocated randomly into [5] equal group [n=15] to receive caudal analgesia. [I] Bupivacaine group 0.25% 1 mL/kg [2] Ropivacaine group 0.25% 1 mL/kg [3] Neostigmine group 2 micro g/kg [4] Bupivacaine 0.25% 1 mL/Kg +/- Neostiginine 2 micro g/Kg group [5] Ropivacaine .0.25% 1 mL/Kg+Neostigmine 2 micro g/Kg Group. There were no differences between the groups in demographic and haemodynamic data. Intraoperatively, children receiving caudal mixture of bupivacaine-neostigmine and ropivacaine-Neostigmine maintained haemodynaniiic stability and required less inhaled anaesthelics and had a short recovery time compared with the other groups. Postoperatively the caudal ropivacaine neostigmine mixtures resulted in superior analgesia and less motor blocks compared with the caudal bupivacaine-neostigmine mixtures. Recovery to first rescue analgesic times were [mean +/- SD] 384.33 +/- 302 min, 508 +/- 87.44 min, 266 +/- 58.7 and, 893.67 +/- 429.46 min and 1325 +/- 207.11 mm in the bupivacaine group, ropivacaine group, neostigmine group, bupivacaine neostigmine mixture group and ropivacaine-neostigmine mixture group respectively [P<0.001]. In addition, "ropivacaine-neostigmine" mixture group received the least number of paracetamol suppositories followed by "bupivacaine-neostigmine" mixture group then ropivacaine-group" followed by "bupivacaine group" and lastly "neostigmine group" which received the biggest number of paracetamol-suppositories to maintain adequate analgesia in the first 24 h postoperatively. Postoperative vomiting occurred in [2] patients [13.3] in both of caudal "bupivacaine-neostigmine and ropivacaine-neostigmine group. And in [4] patients [26.6%] in the neostigmine group otherwise, no patient in any of the other [2] groups had emetic side-effects. We conclude that caudal ropivacaine-neostigmine mixture resulted in superior analgesia and less motor blocks in the postoperative period compared with the caudal bupivacaine-neostigmine mixture