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Dose response study of caudal neostigmine for postoperative analgesia in paediatric patients undergoing genitourinary surgery
Author(s) -
Batra Y.K.,
Arya V.K.,
Mahajan R.,
Chari P.
Publication year - 2003
Publication title -
pediatric anesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.704
H-Index - 82
eISSN - 1460-9592
pISSN - 1155-5645
DOI - 10.1046/j.1460-9592.2003.01066.x
Subject(s) - medicine , neostigmine , anesthesia , analgesic , hypospadias , vomiting , surgery , nausea , incidence (geometry) , bupivacaine , postoperative nausea and vomiting , tramadol , physics , optics
Summary Background: Neostigmine given through the neuraxial route has been found to have analgesic properties. In this clinical trial, we evaluated for the first time the efficacy of a varying dose of caudal neostigmine for postoperative analgesia in children undergoing genitourinary surgery. Method: In this double blind prospective study, we studied 120 children ASA physical status I in age group of 2–8 years scheduled for surgical repair of hypospadias under general anaesthesia. Children were randomly allocated to one of the six groups ( n = 20 each) and received either no caudal block (group C) or neostigmine (groups I‐V) in doses of 10, 20, 30, 40 and 50 μg·kg −1 respectively at the end of the surgery. Postoperatively pain was assessed using an objective pain score for 24 h. Blood pressure, heart rate, SpO 2 , total amount of analgesic consumed and adverse effects, if any, were also recorded. Result: The duration of postoperative analgesia did not differ significantly between group C and I ( P > 0.05). There was significant prolongation in the duration of analgesia in rest of the groups (group II‐3.52 ± 1.37 h; group III‐6.50 ± 1.93 h; group IV‐10.45 ± 3.41 h; group V‐13.70 ± 5.52 h) ( P < 0.05). A dose dependent increase in the incidence of nausea and vomiting was also observed with highest incidence in group IV and V (group C‐15%; group I‐20%; group II and III‐30%; group IV‐45% and group V‐60%) ( P < 0.05). No significant alteration in vital signs and other adverse effects were noticed. Conclusion: Caudal neostigmine in the dose range of 20–50 μg·kg −1 provides dose dependent analgesia. However, dose exceeding 30 μg·kg −1 is associated with a higher incidence of nausea and vomiting.