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Caudal neostigmine for postoperative analgesia in paediatric surgery
Dilek Memiş1, Alparslan Turan, Beyhan Karamanlioğlu
1Department of Anaesthesiology, Trakya University Medical Faculty, Edirne, Turkey. dilmemis@mynet.com
Insights
Adding neostigmine to caudal bupivacaine did not improve postoperative pain relief in paediatric surgery. This study found no significant difference in analgesia duration or side-effects when neostigmine was coadministered with bupivacaine.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Pain Management
Background:
- Evaluating the efficacy and safety of caudal neostigmine combined with bupivacaine for analgesia in pediatric surgical patients.
- Assessing potential benefits and adverse effects of this combination therapy in young children undergoing elective procedures.
Purpose of the Study:
- To determine if caudal neostigmine, when coadministered with bupivacaine, enhances postoperative pain relief in children.
- To compare the duration of analgesia and incidence of side-effects between bupivacaine alone and bupivacaine with neostigmine.
Main Methods:
- A randomized study involving children aged 1-5 years undergoing elective genitourinary surgery (inguinal hernia, hypospadias).
- Caudal anesthesia administered with either bupivacaine alone (Group 1) or bupivacaine with neostigmine (Group 2).
- Monitoring of hemodynamic parameters, pain scores (TPPPS), sedation, and recording the time to first analgesic rescue.
Main Results:
- No significant differences were observed between groups regarding demographics, hemodynamics, surgery/anesthesia duration, extubation time, or sedation scores.
- The duration of postoperative analgesia was comparable between the bupivacaine alone group (15.40 ± 10.97 h) and the bupivacaine-neostigmine group (15.45 ± 10.99 h).
- The incidence of nausea was low and not statistically significant between groups; no other adverse effects were reported.
Conclusions:
- A single caudal injection of neostigmine at 1 µg/kg mixed with bupivacaine provides no significant advantage for postoperative pain relief in children undergoing genitourinary surgery.
- Caudal bupivacaine alone appears to be as effective as the combination for managing pain in this pediatric surgical population.
Background:
This study was conducted to evaluate analgesia and side-effects of caudal neostigmine coadministered with bupivacaine in paediatric surgery.
Methods:
We studied children, aged 1-5 years, undergoing elective surgery (inguinal hernia and hypospadias). After standard induction of anaesthesia, caudal anaesthesia was performed. Group 1 received 0.25% bupivacaine 0.5 ml.kg-1 and Group 2 received 0.25% bupivacaine 0.5 ml x kg-1 with 1 microg x kg-1 neostigmine via the caudal route. Heart rate, mean arterial pressure, peripheral oxygen saturation were recorded before induction, after induction but before caudal anaesthesia, and then every 5 min after caudal anaesthesia. Haemodynamic, Toddler, Preschooler, Postoperative Pain Scale (TPPPS) pain score and sedation score values were recorded 30 min after extubation and at hours 2, 4, 6, 12 and 24. A pain score >3/10 resulted in administration of rectal paracetamol. The duration of postoperative analgesia was defined as the time between caudal drug injection and the first rectal paracetamol administration.
Results:
There were no differences between the groups in demographic and haemodynamic date, duration of surgery and anaesthesia, time to extubation or sedation scores. The duration of postoperative pain relief did not differ between the two groups; 15.40 +/- 10.97 h for group 1 vs. 15.45 +/- 10.99 h for group 2 (P > 0.05). The incidence of nausea (three patients in group 2 and one patient in group 1) was not statistically significant. No other side-effects were seen.
Conclusions:
We found that a single caudal injection of 1 microg x kg-1 neostigmine mixed with bupivacaine offers no significant advantage over bupivacaine alone for postoperative pain relief in children undergoing genitourinary surgery.