Comparing midazolam-bupivacaine and neostigmine-bupivacaine for caudal anesthesia in children undergoing herniorrhaphy
Iranian Journal of Pediatric Surgery,
Vol. 2 No. 2 (2016),
11 February 2017
Introduction: Neostigmine and midazolam are each added to bupivacaine for the purpose 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.
Material and Methods: We included 60 children 1–6 years-old, 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 received bupivacaine 25% 1 ml/kg with midazolam 50µg/kg, and neostigmine group 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 analgesic agents was similar in both 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 along with lower incidence of postoperative nausea and vomiting.
Kehlet H: Modification of responses to surgery by neural blockade. /11Cousins MJ, BridenbaughPO (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 2001;87:62.
Desborough JP: The stress response to trauma and surgery. Br J Anaesth 2000;85:109.
Fratacci MD, Kimball WR, Wain JC, et al: Diaphragmatic shortening after thoracic surgery inhumans. Effects of mechanical ventilation and thoracic epidural anesthesia. Anesthesiology 1993;79:654.
Abdulatif M, El-Sanabary M: Caudal neostigmine, bupivacaine, and their combination for postoperative pain management after hypospadias surgery in children. AnesthAnalg, 2002; 95:1-4.
Lauretti GR, Mattos AL, Reis MP, et al: Intrathecal neostigmine for postoperative analgesia after orthopedic surgery. J clinAnesth 1997; 9:473-7.
Batra YK, Arya VK, Mahajan R, et al: Dose response study of caudal neostigmine for postoperative analgesia in pediatric patients undergoing genitourinary surgery. Paediatr Anasth 2003; 13:515-21.
Kohno T, Wakai A, et al: Actions of midazolam on excitatory transmission in dorsal horn neurons of adult rat spinal cord. The journal of ASA 2000, 2006; 104:338-343.
Prakash S, Joshi N, Gogia A.R, 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,ketamine and neostigmine co-administered with bupivacaine. AnesthAnalg 2005; 101: 69-73
Mireskandari M et al: Bupivacaine - Neostigmine comparison with Bupivacaine caudal block. Iranian journal of Anesthesiology and critical care 2005; 4: 37-45 (Full Text in Farsi )
Boussofara, M Carlès, M Raucoules-Aimé, M. et al: Effects of Intrathecal Midazoalm on Post-operative Analgesia WhenAdded to a Bupivacaine-Clonidine Mixture. RegAnesth Pain Med 2006; 31: 501-505.
Canavero S, Bonicalzi V, Clemente, M: No Neurotoxicity from Long-Term (>5Years) Intrathecal Infusion of Midazolam in Humans. J of Pain and Symptom Management 2006;32: 1-2.
Tucker A.P, Lai C, Nadeson R, et al: Intrathecal Midazolam I: A Cohort Study Investigating Safety. Anesthesia &Analgesia 2004; 98:1512-1520.
Mahajan R, BatraYK , Grover VK , et al: A comparative study of caudal bupivacaine and midazolam - bupivacaine mixture for post – operative analgesia in children undergoing genitourinary surgery . int j clinical pharmacolther 2001; 39:116-20.
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;13:126-31
Pradhan B, Bajracharya GR: Midazolam for caudal analgesia in children: comparison with caudal bupivacaine. Kathmandu Univ Med J ( KUMJ ) 2008;6:166-72.
Davoudi M, Kamali A.R : A Comparison of Caudal Anesthesia with midazolam and neostigmine Coadminstered with bupivacaine in reduction of post-operative pain following lower abdominal surgery in pediatrics (2-8 years old ) . AMJU 2011;14:27-34.
. Jarahzadeh MH,Vaziribozorg S, Heiranzadeh N, et al: Evaluation of bupivacaine coadministered with midazolam or neostigmine in pediatric inguinal hernia surgery –A randomized clinical trial . British Journal of medicine and medical research 2016; 17:12. 21 . Chaudhary A, chaudhari V: Comparison between caudal bupivacaine and caudal midazolam for post operative analgesia in pediatric patients. National J of med Res 2012 ; 2:8-11.
Elwaleed Ibrahim S, Zeinab Musa M, Aziza Mustafa: The effect of adding midazolam in caudal block for prolongation of post-operative Analagesia in children underwent hypospadias repair , in soba university hospital ; “ parallel randomized trial “ . Journal of Anesthesia and critical care: 2016; 14:6.
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