Özet:

Objective: This study was designed to evaluate the analgesic efficacy, duration of analgesia, and side effects of three different doses of caudal neostigmine used with bupivacaine in unilateral inguinal hernia repair. Design: This is a prospective randomized double blinded study. Setting: This study was carried out over one year at a single tertiary care centre.Participants: Eighty children, ASA I, between 2 years and 7 years, undergoing elective unilateral inguinal hernia repair were recruited for this study. Intervention: The 80 subjects were randomly allocated to 4 groups(n=20) to receive the following drugs by caudal route at 1ml.kg-1: Group B – 0.25% plain bupivacaine; Group BN2 – 0.25% plain bupivacaine with neostigmine 2 µg•kg–1; Group BN3 – 0.25% plain bupivacaine with neostigmine 3 µg•kg–1 and Group BN4 – 0.25% plain bupivacaine with neostigmine 4 µg•kg–1.Postoperative pain was assessed for 24 h using AIIMS pain score. The time taken for first administration of rescue analgesia and the total amount of analgesic consumed was studied. The following adverse effects were documented: hemodynamics, PONV, sedation, prolongation of motor block or delay in micturition. Observation and main results: The neostigmine bupivacaine groups showed a statistically significant prolongation in the time taken to first administration of rescue analgesia: ( 6.10±1.55 h) in Group B, (15.70 ± 1.81 h) in Group BN2, (15.85±3.44 h) hours in Group BN3, (16.45±1.15 h) in Group BN4; p<0.01 ). From the 4th postoperative hour, the average pain score in group I 0.7(0.8) was statistically higher than group II (0.05), III (0.1) IV (0.15) p<0.01. Total number of doses of rescue analgesia in group B (1.95±0.69) was more than in group BN2 (1.20±0.41), BN3(1.15±0.37), BN4(1.10±0.31) , and this was statistically significant (p<0.01) (table 2). There was no statistically significant difference in time to first administration of rescue analgesia and also in the total analgesic consumption between groups BN2, BN3 and BN4 (p>0.05).Adverse effects were not different between the four groups.Conclusion:  Caudal neostigmine (2, 3 and 4 µ.kg-1) with bupivacaine 0.25% administered at 1ml.kg-1 body weight produces a dose independent prolongation of analgesic effect (16 h) in children as compared to those receiving caudal bupivacaine alone (6 h) and a reduction in number of postoperative rescue analgesia without increasing the incidence of adverse effects

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