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ORIGINAL ARTICLE
Year : 2018  |  Volume : 46  |  Issue : 4  |  Page : 239-244

Prospective randomized study comparing the efficacy of caudal bupivacaine versus bupivacaine–neostigmine in children undergoing congenital inguinal hernia repair


Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Tanta University, Tanta, Egypt

Correspondence Address:
M.Sc Omnia A.H El-Miseery
Department of Anesthesia and Surgical, Intensive Care, Faculty of Medicine, Tanta University, El-Gharbia, El-Mahalla El-Kobra, El-Sheteewy Street, Tanta
Egypt
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DOI: 10.4103/tmj.tmj_25_17

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Background Posthernioraphy pain in children is an unpleasant subjective sensation. The concept of postoperative pain relief and its utilization in the pediatric age group has improved dramatically over the recent years. Caudal block is one of the most common regional anesthetic techniques used in children that reduce the amount of inhaled and intravenous anesthetic administration, alter the stress response to surgery, and facilitate a rapid and smooth postoperative analgesia. Neostigmine is one of the additives known for significant analgesic prolongation, and it has been used safely in both adults and children. Aim The aim of the present study was to evaluate the effect of neostigmine as an additive for caudal analgesia in congenital inguinal hernia repair in pediatrics. Patients and methods This study was carried out on 70 children, with age range from 1 month to 6 years, having ASA status I–II, and scheduled for elective congenital inguinal hernia repair. Patients were randomized into two equal groups (35 patients in each group): group I, as bupivacaine group, where patients received 1 ml/kg bupivacaine 0.25%, and group II, as bupivacaine–neostigmine group, where patients received 1 ml/kg bupivacaine 0.25% and neostigmine 2 μg/kg. Heart rate and mean arterial blood pressure were recorded intraoperatively and postoperatively. Postoperative pain was assisted by face legs activity cry consolability pain scale, and the number of patients who needed postoperative rescue analgesia, total amount of rescue analgesia, and any undesirable adverse effects have been recorded. Results Heart rate and mean arterial blood pressure were statistically significantly lower in group II than in group I. Similarly, the face legs activity cry consolability behavioral pain score was significantly lower in group II than in group I. Moreover, the total number of patients who needed rescue analgesia and the total amount of rescue analgesia were significantly lower in group II than in group I. Patients who developed bradycardia were significantly higher in group II. There was no difference between both the groups in the incidence of pruritus or vomiting. None of our patients developed urine retention. Conclusion Addition of neostigmine to bupivacaine in a dose of 2 μg/kg results in superior analgesia than bupivacaine alone.


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