Caudal neostigmine with bupivacaine produces a dose-independent analgesic effect in children

Abstract

P Pu ur rp po os se e: : To evaluate the analgesic efficacy and duration of varying doses of caudal neostigmine with plain bupivacaine and its side effects in children undergoing genito-urinary surgery. M Me et th ho od ds s: :In a randomized double-blind prospective study 80 boys aged two to eight years scheduled for surgical repair of hypospadias were allocated randomly to one of four groups (n = 20 each) and received either only caudal 0.25% plain bupivacaine 0.5 mL·kg -1 (Group I) or 0.25% plain bupivacaine 0.5 mL·kg -1 with neostigmine (Groups II-IV) in doses of 2, 3 and 4 µg·kg -1 respectively. Postoperative pain was assessed for 24 hr using an objective pain score. Blood pressure, heart rate, oxygen saturation, total amount of analgesic consumed and adverse effects were also recorded.R Re es su ul lt ts s: : The duration of postoperative analgesia in Group I (5.1 ± 2.3 hr) was significantly shorter than in the other three groups (II -16.6 ± 4.9 hr; III -17.2 ± 5.5 hr; IV -17.0 ± 5.8 hr; P < 0.05). Total analgesic (paracetamol) consumption was significantly more in Group I (697.6 ± 240.7 mg) than in the groups receiving caudal neostigmine (II -248.0 ± 178.4; III -270.2 ± 180.8 and IV -230.6 ± 166.9 mg; P < 0.05). Groups II, III and IV were comparable with regards to duration of postoperative analgesia and total analgesic consumption (P > 0.05). Incidence of nausea and vomiting were comparable in all four groups. No significant alteration in vital signs or any other adverse effects were observed. C Co on nc cl lu us si io on ns s: : Caudal neostigmine (2, 3 and 4 µg·kg -1 ) with bupivacaine produces a dose-independent analgesic effect (. 16-17 hr) in children as compared to those receiving caudal bupivacaine alone (approximately five hours) and a reduction in postoperative rescue analgesic consumption without increasing the incidence of adverse effects. 6 ± 4,9 h ;2 ± 5,5 h ;0 ± 5,8 h ; P < 0,05). La consommation totale d'analgésique (paracétamol) a été significativement plus élevée dans le Groupe I (697,6 ± 240,7 mg) que dans les groupes avec néostigmine caudale 0 ± 178,4 ;2 ± 180,6 ± 166,9 mg ; P < 0,05 Objectif

Effects of epidural neostigmine and clonidine in labor analgesia: A systematic review and meta‐analysis

“…It can treat myasthenia gravis and antagonize remnants of non‐depolarizing muscle relaxant in clinical anesthesia . Neostigmine increases the concentration of acetylcholine in the synapses and thus enhances acetylcholine‐mediated mechanisms of analgesia . It inhibits the activity of spinal cord dorsal horn Fos protein‐positive neurons relating to conduction of feelings of harm, inhibits central sensitization, blocks transmission of feelings of harm from the spinal cord, and produces antinociception .…”

Comparison between the intravenous and caudal routes of sufentanil in children undergoing orchidopexy and further evaluation of the association of caudal adrenaline and neostigmine

“…In the present study, the dose of caudal neostigmine was 2 μg/kg, as it was previously demonstrated to be effective dose in adults[8] and children. [910] Epidural neostigmine has been shown to potentiate opioids. In fact, in our present study, caudal sufentanil alone was no better than when administered in the IV route, and the caudal route would just be justified by the association of neostigmine, but not adrenaline in this population.…”

Neuraxial Agents

“…Neostigmine has also been coadministered for caudal analgesia in children with bupivacaine [179][180][181] or ropivacaine, 182 where it was reported to provide prolonged analgesia without any adverse effects. This benefit was demonstrated in a double-blind, randomized, prospective study by Karaaslan and coworkers,183 whereby 60 male patients between the ages of 5 months and 5 years undergoing genitourinary surgery were allocated randomly to one of three groups.…”