This study was designed to compare the effects of Neostigmine vs. Ketamine coadministered caudally as adjunct to local anesthesia in children.
Patients and methods: The study comprised 75 children aged between 2 and 14 years undergoing elective lower abdominal surgeries. Patients were divided randomly into three equal groups: Group I (control group): Plain Bupivacaine 0.25% (0.5m1/kg). Group II: Plain Bupivacaine 0.25% (0.5m1/kg) mixed with Neostigmine 21.tg/kg. Group HI: Plain Bupivacaine 0.25% (0.5m1/kg) mixed with Ketamine 0.5mg/kg. At the end of the surgery and before recovery from the general anesthesia, caudal analgesia was performed. All patients were observed at 30min., 4h, 6h, 8h, 12h, and 24h postoperative to evaluate: Level of analgesia, Stress hormones (cortisol and Bl.glucose) level, Hemodynamic parameter and Post anesthetic side effects.
Results: Addition of either Neostigmine or ketamine to caudal bupivacaine significantly prolonged its analgesic effect but the bupivacaine-neostigrnine mixture had longer effect than bupivacaine or bupivacaine-ketamine mixture. In patients receiving neostigmine added to caudal bupivacaine, we noticed hemodynamic stability, pain scores showing no or minimal pain, normal hormonal levels and no major complications were noticed. This analgesic effect of both drugs extends from 16 to 20 hours postoperatively.
By this study, epidural neostigmine has proved to be safe in the concentration used and proved to prolong the local anesthetic analgesic duration by a period that reached up to 20 hours postoperatively. Conclusion: The current study establishes Bupivacaine neostigmine and Bupivacaine ketamine caudal mixtures produced longer duration of postoperative analgesia after lower abdominal surgery in pediatrics than caudal bupivacaine alone. |
