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Caudal additives for postoperative pain management in children: S(+)-ketamine and neostigmine

N Almenrader1, M Passariello, G D'Amico

  • 1Department of Anesthesia and Intensive Care Medicine, University of Rome, La Sapienza, Rome, Italy. nicalm@tiscali.it

Paediatric Anaesthesia
|January 29, 2005
PubMed

Insights

This pilot study found that caudal S(+)-ketamine alone or with neostigmine provided similar postoperative pain relief in children. However, the combination increased the risk of vomiting, warranting further investigation.

Area of Science:

  • Anesthesiology
  • Pediatric Surgery
  • Pharmacology

Background:

  • Caudal blockade is common in pediatric surgery for pain management.
  • S(+)-ketamine is a potential analgesic agent for this procedure.
  • The combination of ketamine with neostigmine is being explored for enhanced analgesia.

Purpose of the Study:

  • To compare the analgesic efficacy of caudal S(+)-ketamine versus S(+)-ketamine plus neostigmine in pediatric surgery.
  • To evaluate postoperative pain and sedation levels in children receiving these caudal blocks.

Main Methods:

  • A pilot study involving 40 children undergoing surgery.
  • Random assignment to receive either caudal S(+)-ketamine (1 mg/kg) or S(+)-ketamine (0.5 mg/kg) with neostigmine (10 µg/kg).
  • Postoperative pain and sedation assessed for 24 hours using validated scales.

Main Results:

  • No significant difference in the duration of analgesia or sedation between the two groups.
  • Mean analgesia duration was 18 hours (ketamine) vs. 21.8 hours (ketamine + neostigmine).
  • A significantly higher incidence of postoperative vomiting (30%) was observed in the ketamine-neostigmine group compared to the ketamine-only group (0%).

Conclusions:

  • Both caudal S(+)-ketamine regimens provided equivalent postoperative pain relief in children.
  • Caudal neostigmine in combination with ketamine did not improve analgesia duration but increased vomiting incidence.
  • Further research is needed to determine the clinical utility of caudal neostigmine in pediatric practice.
Abstract

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