Post-operative analgesic effect of caudal neostigmine added to bupivacaine as compared with caudal bupivacaine alone for pediatric elective infra umbilical surgery at Tikur Anbesa specialized hospital.
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Date
2020-06
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Addis Abeba University
Abstract
Background: Caudal epidural block is one of the most commonly used, popular, safe and easy
regional anesthetic techniques to be performed in children undergoing infra-umbilical surgeries.
The main disadvantage of single-shot caudal anesthesia is the short duration of
action. Neostigmine is one of adjuvant with local anesthetic agents to improve the efficiency and
quality to prolong the duration of analgesia after surgery.
Objective: To assess the effect of adding neostigmine to bupivacaine on post-operative analgesia
in pediatric patient during infra umbilical surgery at Tikur Anbesa specialized hospital from
November1, 2019 to January 30, 2020 G.C.
Methodology: Hospital based Prospective cohort study was conducted among 68 children’s,
whose aged is between 1-12 years, American Association of Anesthesiologists I & II undergoing
elective infra umbilical surgery received caudal bupivacaine alone or bupivacaine with
neostigmine. A systemic random sampling technique was used to select study
participants. Postoperative severity of pain, time to request and total analgesic consumption was
evaluated up to 24 hours after the operation. Based on the normality assumption, the analysis was
done by independent sample t- test, a chi-square test and Mann–Whitney U-test. A p-value <0.05
was considered as statistically significant.
Result: In this study the median duration of postoperative analgesia in neostigmine group was 644
min while it was 322.5 min in bupivacaine alone group with statistically significant difference.
With p-value <0.0001. Median postoperative pain severity was being statistically significant
difference at 4
th
, 8
th
, 12
th
and 24
th
hour with p-value of <0.05 but it was statistically insignificant
at arrival, 1
st
and 2
nd
hour. Median post-operative analgesic consumption in mg within 24
h neostigmine group was 250 and bupivacaine alone group was 750 statistically significant with
p-value of <0.0001.
Conclusion and Recommendation: Caudal neostigmine with bupivacaine provides effective
post-operative analgesia in pediatrics undergoing infra-umbilical surgeries. Based on this we
recommend that neostigmine in the dose of 2µg/kg added to caudal bupivacaine is safe and with
less or no side effect statistically significant.
Description
Keywords
Caudal block, bupivacaine, neostigmine, analgesic effect, infra umbilical surgery.