Caudal Neostigmine and Bupivacaine Facilitates Early Extubation and Provides Prolonged Postoperative Analgesia in Children Undergoing Open Heart Surgery

Abstract

Objective: This study was designed to examine the effect of single shot of caudal neostigmine with bupivacaine on early extubation versus standard intravenous fentanyl regimen without caudal block. Design: Prospective, randomized double blind controlled clinical trial Setting of the study: Children University Hospital Patients: 80 children (4 to 12 years) undergoing correction of congenital heart defects Methods: Patients were randomized into two equal groups (caudal neostigmine group and non-caudal group); Anesthesia was provided with sevoflurane, midazolam, plus fentanyl 5 mcg/kg and cisatracurium 0.1 mg/kg and maintained with sevoflurane, fentanyl 1 mcg/kg/h. and cisatracurium 0.05 mg/kg. In caudal group; caudal block with bupivacaine (0.125%) in a dose of 1.5 ml/kg plus neostigmine in a dose of 2 mcg/kg was performed after endotracheal intubation in the caudal group only. In non-caudal group intravenous fentanyl was continuously infused postoperatively until weaning from mechanical ventilation. Measurements and Main Results: Both groups were comparable as regard age, sex, weight, and bypass and aortic cross clamp times. In the caudal neostigmine group patients were early extubated, with shorter Pediatric Intensive Care Unit (PICU) stay and prolonged postoperative analgesia. Eleven patients had nausea and vomiting in caudal versus four in non-caudal group. Conclusion: Single dose of caudal bupivacaine with neostigmine provided optimum conditions for extubation and good control of postoperative pain in children undergoing cardiac surgery.