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PEDIATRIC ANESTHESIA

Caudal Neostigmine, Bupivacaine, and Their Combination for Postoperative Pain Management After Hypospadias Surgery in Children

Department of Anesthesiology, Cairo University, Egypt

Address correspondence and reprint requests to Mohamed Abdulatif, MD, PO Box 147, Panorama October 11811, Nasr City, Cairo, Egypt. Address e-mail to abdulatif{at}hotmail.com

In a randomized, double-blinded study, we examined the analgesic efficacy of caudal neostigmine, bupivacaine, or a mixture of both drugs in 60 children. After the induction of general anesthesia, children were allocated randomly into three groups (n = 20) to receive a caudal injection of either 0.25% bupivacaine 1 mL/kg, with or without neostigmine 2 µg/kg, or neostigmine 2 µg/kg in normal saline 1 mL/kg. Intraoperatively, children receiving caudal bupivacaine or a bupivacaine/neostigmine mixture maintained hemodynamic stability, required less inhaled anesthetics, and had a shorter recovery time compared with the caudal neostigmine alone. Postoperatively, the caudal bupivacaine/neostigmine mixture resulted in superior analgesia compared with the other two groups. Recovery to first rescue analgesic times were (mean ± SD) 22.8 ± 2.9 h, 8.1 ± 5.9 h, and 5.2 ± 2.1 h in the bupivacaine/neostigmine, bupivacaine, and neostigmine groups, respectively (P < 0.001). In addition, the bupivacaine and neostigmine groups received more doses of paracetamol than the bupivacaine/neostigmine group to maintain adequate analgesia in the first 24 postoperative h. Postoperative vomiting occurred in 25%, 10%, and 30% in the caudal bupivacaine/neostigmine, bupivacaine, and neostigmine groups, respectively (P < 0.01). We conclude that caudal neostigmine 2 µg/kg provides postoperative analgesia comparable to caudal bupivacaine in children undergoing hypospadias repair surgery.

IMPLICATIONS: Caudal neostigmine 2 µg/kg provides postoperative analgesia comparable to caudal bupivacaine in children undergoing hypospadias repair surgery. Co-administration of the two drugs is associated with extended postoperative analgesia and reduced need for supplementary analgesics.

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