Comparing midazolam-bupivacaine and neostigmine-bupivacaine for caudal anesthesia among pediatric patients undergoing herniorrhaphy operations

Afsaneh Sadeghi--- Pediatric Surgery Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran,
Ahmad Khaleghnejad Tabari--- Pediatric Surgery Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran,
Seyed Sajad Razavi--- Pediatric Surgery Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran,
Ahmad Eghbali--- Pediatric Surgery Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran,
Alireza Mahdavi--- Pediatric Surgery Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran



Background:Neostigmine and midazolam are each added to bupivacaine for the purposes of caudal anesthesia. In this study, we compared neostigmine and midazolam, each coadministered with bupivacaine, in terms of analgesia and side effects during pediatric inguinal hernia operations.

Methods: We included 60 children 1–6 years of age who were candidates for elective unilateral herniorrhaphy. After general anesthesia induction with inhaled sevoflurane, a caudal block was performed. Patients were randomly allocated to one of two trial groups: midazolam group patients received bupivacaine 25% 1 ml/kg with midazolam 50µg/kg, and neostigmine group patients received bupivacaine 25% 1 ml/kg with neostigmine 2 µg/kg through the caudal route. Heart rate, mean arterial pressure, and oxygen saturation were recorded before induction and every five minutes after caudal anesthesia up to 30 minutes. Pain and sedation scores were recorded at two, four, six, 12, and 24 hours after the operation, along with rescue analgesia dosage, vomiting, and respiratory depression.

Results: Mean duration of analgesia in the midazolam group was similar to the neostigmine group (18.8±9 vs. 20.4±7.5; P= 0.44). The analgesic dosage required was not significantly lower in the  neostigmine group compared to the midazolam group (58.3±121.7 VS .70.8±125.8; P=0.63).The number of patients who needed analegesic agents was similar in two trial groups ( P= 0.76 ),Nausea(P= <0.05) and vomiting (P=0.01) rates were higher in the neostigmine group.

Conclusion: Midazolam (50 µg/kg) compared to neostigmine (2 µg/kg) provided higher sedation, lower incidence of postoperative nausea and vomiting. 



Midazolam, Bupivacain, Neostiminecaudal, Pediatr

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Kehlet H: Modification of responses to surgery by neural blockade. /11Cousins MJ, Bridenbaugh PO (eds): Neural Blockade in Clinical Anesthesia and Management of Pain, 3rd ed. Philadelphia, Lippincott-Raven Publishers, 1998.

Kehlet I-I, Holte K: Effect of postoperative analgesia on surgical outcome. Br J Anaesth, 87:62, 2001.

Desborough JP: The stress response to trauma and surgery. Br J Anaesth, 85:109, 2000.

Fratacci MD, Kimball WR, Wain JC, et al: Diaphragmatic shortening after thoracic surgery in humans. Effects of mechanical ventilation and thoracic epidural anesthesia. Anesthesiology, 79:654, 1993.

Abdulatif M, El-Sanabary M. Caudal neostigmine, bupivacaine, and their combination for postoperative pain management after hypospadias surgery in children. Anesth Analg, 2002; 95:1-4.

Lauretti GR, Mattos AL, Reis MP, Prado WA. Intrathecal neostigmine for postoperative analgesia after orthopedic surgery. J clin Anesth,1997; 9:473-7.

Batra YK, Arya VK, Mahajan R, Chari P. Dose response study of caudal neostigmine for postoperative analgesia in paediatric patients undergoing genitourinary surgery. Paediatr Anasth, 2003;13:515-21.

Kohno, Tatsuro, et al.: Actions of midazolam on excitatory transmission in dorsal horn neurons of adult rat spinal cord. The journal of ASA, 2000, 2006; February, 104:338-343.

S. Prakash, MD. et. al: Analgesic efficacy of Two Doses of Intrathecal Midazolam With Bupivacaine in Patients Undergoing Cesarean Delivery, Reg Anesth Pain Med, 2006; 31: 221-226.

NishiymaT, Hirasaki A, Odaka Y, et al. Epidural midazolam with saline: optimal dose for postoperative pain. Masui, 1992;41:49-54.

Kumar P , Rudra A , Pan AK , Acharya A . Caudal additives in pediatrics : A comparison among midazolam , ketamin and neostigmin co-administered with bupivacaine. Anesth Analg, 2005 Jul; 101(1): 69-73

Mireskandari M et .al :Bupivacaine - Neostigmine comparison ith Bupivacaine caudal blok .Iranian journal of Anesthesialogy and critical care , 2005 ; 4: 37-45 (Full Text in Farsi )

M. Boussofara MD. et. al: Effects of Intrathecal Midazoalm on Post-operative Analgesia When Added to a Bupivacaine-Clonidine Mixture. Reg Anesth Pain Med, 2006; 31: 501-505.

S. Canavero, MD., V. Bonicalzi, MD., M. Clemente, MD.: No Neurotoxicity from Long-Term (>5 Years) Intrathecal Infusion of Midazolam in Humans. J of Pain and Symptom Management, 2006; 32: 1-2.

A. P. Tucker, et. al: Intrathecal Midazolam I: A Cohort Study Investigating Safety. Anesthesia & Analgesia, 2004; 98: 1512-1520.

Mahajan R, Batra YK , Grover VK , Kajal J : A comparative study of caudal bupivacaine and midazolam - bupivacaine mixture for post – operative analgesia in children undergoing genitourinary surgery . int j clinical pharmacol ther, 2001 mar; 39(3):116-20

Baris S , karakaya D , Kelsaka E : Comparison of fentanyl – bupivacaine or midazolam – bupivacaine mixture with plain bupivacaine for caudal anesthesia in children . Pediatric Anesthesia, 2003 Feb; 13(2):126-31

Pradhan B, Bajracharya GR. Midazolam for caudal analgesia in children : comparison with caudal bupivacaine . Kathmandu Univ Med J ( KUMJ ), 2008 Apr-jun; 6 (2): 166-72.



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