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Tahira Akhter (MD Anesthesiology SKIMS), Sheikh Irshad Ahmad(Associate Professor Anesthesiology SKIMS), Tanveera Gani(Diploma Anesthesiology), Syed Qazi (Professor Anesthesiology SKIMS), Tantry Tariq Gani (MD Anesthesiology SKIMS)*, Zaffar Malik(MD Anesthesiology SKIMS)


Background: Caudal block has evolved to become the most popular regional anesthetic technique for use in children. It provides excellent analgesia during surgery as well as during postoperative period in infra umblical surgeries in children, however one of the major limitations of the single injection is relative short duration of post operative analgesia even with long acting local anesthetics such as Bupivacaine. This problem can be circumvented by the use of different adjunct drugs to the local anesthetic solutions. The aim of the present study was to compare the analgesic efficacy and safety of Neostigmine - bupivacaine mixture to that of bupivacaine with saline following caudal administration in children undergoing infra umbilical surgeries Methods: In a prospective, randomized, double blind study, 100 patients of ASA physical status I of either sex in the age range of 1 to 5 years scheduled for elective infra- umbilical surgical procedures were randomly allocated to one of the groups of 50 patients each to receive caudal injection of either 1ml/kg of 0.25% bupivacaine hydrochloride with saline 0.2ml/kg in group B(Control group) or 2μg/Kg(10 μg/m) of neostigmine added to 1ml/kg of 0.25% bupivacaine hydrochloride in Group BN(Study group). The perioperative hemodynamic effects, post operative pain scores(OPS), supplementary analgesic requirement and side effects were assessed by a blind observer during 24 hour observation period. Results: Both the groups were homogenous with reference to age, sex, weight and duration of anesthesia and duration of surgery. No significant differences with respect to mean heart rate, blood pressure (systolic and diastolic) and oxygen saturation were noted during perioperative period between the two groups. The mean duration of analgesia in group B was 4.16±1.687hours while in group BN mean duration of analgesia was 11.87±3.502hours. The duration of analgesia in group BN was longer and the difference was statistically significant (p< 0.05). In the postoperative period rescue analgesia in the form of diclofenac suppository (1mg/kg) was required in 15 patients (30%) in the study group and 31 (62%) patients in the control group. Statistically a significant difference (p<0.001) was observed between the two groups. In our study 2 patients in study group had nausea and vomiting (4%), while in control group 3 patients had nausea and vomiting (6%). The total number of patients who had side effects was less in study group compared to control group. However, the difference was statistically insignificant (p>0.05) between the two groups. None of our patient developed any other complication. In our study there was very low incidence of nausea and vomiting (10%) which was probably due to i/v ondansetron given intraoperatively. Conclusion: Caudal neostigmine provides effective and prolonged intra and postoperative analgesia in patients undergoing infra-umbilical surgeries. Neostigmine in the dose of 2μg/kg body weight when added to caudal bupivacaine is safe and without any significant side effects.

Keywords: caudal anesthesia, neostigmine, post operative pain, children, bupivacaine.

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