Caudal bupivacaine-neostigmine effect on postoperative pain relief in children

ABSTRACT

To assess the effect of different neostigmine doses added to caudal bupivacaine on postoperative pain relief in assigned pediatric herniotomy surgery. Our randomized, double-blinded and prospective investigation included 134 patients, aged 7-14 years, classed I - II physical status class by the American Society of anesthesiologists [ASA], of both genders and scheduled for herniotomy. Children were randomly assigned into four groups to receive a caudal administration of 0.25% plain bupivacaine 0.5ml/kg [group I, n= 33]. For the following three groups, bupivacaine was mixed with neostigmine in the following manner 1.5mcg/kg neostigmine [group II, n= 34], 3mcg/kg neostigmine [group III, n= 33] and 6mcg/kg neostigmine [group IV, n= 34], with a total caudal volume of 1 ml/kg administered in all groups after induction of general anesthesia. Postoperative use of rescue analgesics using paracetamol during the first postoperative 24 hours was recorded. Postoperative pain was evaluated using the numerical pain rating scale with a score from zero to 10. The Chi-square and Students t test were used to test statistical significance where P <0.05 was considered significant. Mean duration of postoperative analgesia was 4.7 hours, 16.35 hours, 16.8 hours and 16.65 hours in groups I, II, III and IV, respectively, [p<.05]. Mean postoperative paracetamol consumption was 41.9mg/kg in group I, 12.8mg/kg,14.1 mg/kg and 11.4mg/kg in groups II, III and IV, respectively [P<0.05], during the first 24 postoperative hours. Administration of caudal neostigmine combined with bupivacaine significantly prolongs the duration of postoperative pain relief with decreased requirement for rescue analgesics