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. 


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