Comparison of caudal bupivacaine and bupivacaine-midazolam for peri and postoperative analgesia in children

ABSTRACT

To compare the duration and side effects of postoperative analgesia of caudal bupivacaine and bupivacaine-midazolam mixture. Design: Single blinded, interventional experimental study. Place and Duration of Study The Department of Anesthesiology and Surgical Intensive Care Unit, Dow Medical College and Civil Hospital, Karachi from May to November, 2002. Subjects and Sixty children, aged 1-8 years, ASA physical status I and II, undergoing inguinal and urogenital surgery were randomly allocated to receive either 0.25% bupivacaine 0.75 ml/kg [group A] or 0.25% bupivacaine 0.75 ml/kg along with 0.1% midazolam 50mg/kg [group B] by caudal route immediately after induction of general anesthesia. Anesthesia was maintained till the end of surgery. Cardiorespiratory data, sedation and pain score were recorded for 24 hours following recovery from anesthesia. Analgesia was supplemented [diclofenac suppository] whenever the pain score was > or = 4. Duration of analgesia was recorded. The duration of analgesia was 21.41 + 2.7 hours in bupivacaine midazolam group and 9.97 + 2.25 hours in bupivacaine group, which showed a significant difference [p < 0.001]. There was no significant difference in heart rate, respiratory rate, blood pressure and the incidence of side effects in both groups [p = 0.716]. The sedation score were significantly higher in bupivacaine-midazolam group during first hour postoperatively [*p = 0.003]. Addition of midazolam to caudal bupivacaine provides longer duration of postoperative analgesia without having significant side effects but with higher sedation score for 1 hour postoperatively