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Indian Journal of Clinical Anaesthesia


A study of the effect of caudal epidural neostigmine for post operative pain relief in children undergoing lower abdominal surgery


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Author Details: Kannan Santhanakrishnan, VS Senthil Kumar

Volume : 4

Issue : 4

Online ISSN : 2394-4994

Print ISSN : 2394-4781

Article First Page : 463

Article End Page : 468


Abstract

Introduction and Objective: Providing adequate pain relief has always been part of anaesthesiologist’s role in the perioperative period beyond post anaesthesia care unit. Among the many adjuvants studied neostigmine was also found to be effective in acute post-operative and chronic pain. We have studied the analgesic efficacy of caudal bupivacaine with and without neostigmine in children.
Materials and Method: In this randomized double blind study, sixty children belonging to ASA I and II, aged 2-8 years undergoing lower abdominal surgeries were randomly allocated into two groups to receive a caudal injection of 0.25% bupivacaine alone or a mixture of 0.25% bupivacaine 0.5ml/kg with 2µg/kg neostigmine. Monitoring of scores for pain, postoperative nausea and vomiting was performed by an Anaesthesiologist blinded to the study allocations.
Results: Time to the first analgesic administration of syrup Paracetamol was longer (P<0.05) with mean duration of analgesia of 14.6 hrs in the bupivacaine-neostigmine than in the bupivacaine only group with a mean duration of 4.3 hrs. Side effect such as emesis was not significantly different between the two groups.
Conclusion: Caudal co-administration of bupivacaine with neostigmine produces significant prolongation of the duration of postoperative analgesia when compared to caudal bupivacaine alone.

Keywords: Bupivacaine, Caudal epidural, Neostigmine, Ramsay scale, Aldrete score