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Midazolam for caudal analgesia in children: comparison with caudal bupivacaine
M Naguib1, M el Gammal, Y S Elhattab
1Department of Anaesthesia and ICU, King Saud University, Faculty of Medicine, King Khalid University Hospital, Riyadh, Saudi Arabia.
Insights
Caudal midazolam offers pain relief comparable to bupivacaine in children undergoing inguinal herniotomy. This study found no significant differences in pain management or behavior between midazolam and bupivacaine groups.
Area of Science:
- Pediatric Anesthesiology
- Pain Management
- Pharmacology
Background:
- Postoperative pain management in pediatric surgery is crucial for recovery.
- Caudal anesthesia is commonly used for lower abdominal procedures in children.
- Evaluating novel analgesic agents or combinations is essential for improving patient outcomes.
Purpose of the Study:
- To compare the analgesic efficacy of caudal midazolam, bupivacaine, and a combination of both in children undergoing inguinal herniotomy.
- To assess postoperative pain, behavior, and analgesic requirements.
- To evaluate the safety profile of caudal midazolam.
Main Methods:
- A randomized, double-blind study involving 45 children undergoing inguinal herniotomy.
- Three groups received caudal injections: bupivacaine, bupivacaine-midazolam mixture, or midazolam with saline.
- Pain relief, behavior, analgesic needs, and side effects were monitored.
Main Results:
- No significant differences in pain relief quality or postoperative behavior were observed between groups.
- The bupivacaine-midazolam group had longer times to first analgesic administration (paracetamol) compared to other groups (P < 0.001).
- Caudal midazolam alone did not result in adverse effects like motor weakness or respiratory depression.
Conclusions:
- Caudal midazolam (50 mcg/kg) provides analgesia equivalent to 0.25% bupivacaine (1 ml/kg) in pediatric patients after inguinal herniotomy.
- The combination of bupivacaine and midazolam may offer prolonged analgesia.
- Caudal midazolam is a safe and effective option for postoperative pain management in this population.
Abstract:
In a randomized, double-blind study we have examined the analgesic efficacy of caudal administration of midazolam, bupivacaine, or a mixture of both drugs in 45 children, undergoing inguinal herniotomy. They were allocated randomly into three groups (n = 15 in each) to receive a caudal injection of either 0.25% bupivacaine 1 ml.kg-1 with or without midazolam 50 micrograms.kg-1 or midazolam 50 micrograms.kg-1 with normal saline 1 ml.kg-1. There were no differences in quality of pain relief, postoperative behaviour or analgesic requirements between the midazolam group and the other two groups. Times to first analgesic administration (paracetamol suppositories) were longer (P < 0.001) in the bupivacaine-midazolam group than in the other two groups. Further, the bupivacaine-midazolam group received fewer (P < 0.05) doses of paracetamol than the bupivacaine group. Side effects such as motor weakness, respiratory depression or prolonged sedation were not observed in patients who received caudal epidural midazolam only. We conclude that caudal midazolam in a dose of 50 micrograms.kg-1 provides equivalent analgesia to bupivacaine 0.25%, when administered postoperatively in a volume of 1 ml.kg-1 for children following unilateral inguinal herniotomy.