Objectives: This study aimed to evaluate the additive effects oj using caudal neostigmine, midazolam or tramadol in conjunction with bupivacaine to the resultant postoperative (PO) analgesia in children undergoing hypospadius repair. Patients & Methods: The study included 80 male children aged 5-8.5 years allocated randomly to Jour equal groups; Group B: received 0.25% plain bupivacaine (1 ml/kg), Group M received midazolam (50 fig/kg), Group T received tramadol (1.5119/k9) and Group N received neostigmine (2 fig/kg) in combination with 0.25% plain bupivacaine (1 ml/kg). Pain was assessed with a 5-point verbal pain score hourly Jor 24 hours and evaluated collectively Jor every 3 hours. The duration ojabsolute analgesia was deJmed as the timeJrom caudal iryection until the pain score was >2 and rescue analgesic was given at pain score ?4. Sedation scores were measured at PO 30 and 120 minutes. Motor block was assessed on awakening by using a modified Bromage scale. Results: The quality oj PO pain relief, as judged by the duration oj complete PO analgesia, was excellent in all studied groups. The mean duration oj PO pain scored ~2 and the time till the first request oj rescue analgesia was signijkantly longer and the consumption ojrescue analgesia was signijkantly less in groups M, T anaN compared to group Band in group N compared to groups M and T with a signijkant dUference inJavor ojgroup T. Up to 6-hrs postoperatively, Rain scores were significantly lower in group N to the other groups and in group M T compared to group B with within the penod 6-9 hrs surgery, estimated pain scores were in groups T and N to both group Band M with a lower scores in group N compared to group T and the intergroup were non-signifzcant. All patients their motor power by 150 minutes after the end ojsurgery. with a non-significant difJerence between the studied groups as regards being higher in group. There was a between sedation scores recorded in the studied groups and no patient had score oj>2 at 30 minutes after surgery. Vomiting occurred in the recol)ery room in 5 |
