Abstract:
Purpose: This study was designed to compare the effects of Neostigmine vs. Ketamine co-administered 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% (0.5ml/kg). Group II: Plain Bupivacaine 0.25% (0.5ml/kg) mixed with Neostigmine 2µg/kg. Group III: Plain Bupivacaine 0.25% (0.5ml/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-neostigmine 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.
Introduction:
Caudal analgesia is the most popular and commonly used regional anesthesia technique for post-operative analgesia in children undergoing lower, anoperineal and abdominal surgical procedures. It is commonly applied in all the pediatric patients undergoing the above mentioned surgery, as the goal of balanced anesthesia is not only limited to intraoperative period but also good analgesia in post-operative period(1) .The quality and level of the caudal blockade is dependent on the dose, volume, and concentration of the injected drug. Although it is a versatile block, one of the major limitations of the single-injection technique is the relatively short duration of postoperative analgesia. The most frequently used method to further prolong postoperative analgesia following caudal block is to add different adjunct drugs to the local anesthetics solution(2).Adding neostigmine to Bupivacaine offers an advantage over Bupivacaine alone for post-operative pain relief in children undergoing lower abdominal surgeries with minimal incidence of adverse effects(3).Extradural Ketamine produces analgesia by a spinal mechanism. This (NMDA) receptor antagonist is devoid of opioids side effects but may produce behavioural side effects. In children, addition of Ketamine to local anaesthetics prolongs the duration of postoperative analgesia after inguinal hernia repair and orchidopexy (4).
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