Abstract:
Background: This study was aimed to evaluate the analgesic efficacy,
duration of analgesia, and side effects of two different doses of caudal
neostigmine used with levobupivacaine in children.
Methods: Sixty boys, between 5 months and 5 years, undergoing
genito-urinary surgery were allocated randomly to one of three
groups (n = 20 each). Group I patients received caudal 0.25%
levobupivacaine (1 mlÆkg)1
) alone. Groups II and III patients
received neostigmine (2 and 4 lgÆkg)1 respectively) together with
levobupivacaine used in the same dose as Group I. Pain scores were
assessed using Children’s and Infant’s Postoperative Pain Scale
(CHIPPS) at 15th (t1) min after arrival to postanesthetic care unit, and
1st (t2), 2nd (t3), 3rd (t4), 4th (t5), 8th (t6), 16th (t7), and 24th (t8) hour
postoperatively. Duration of analgesia, amount of additional analgesic
(paracetamol), score of motor blockade and complications were
recorded for 24 h postoperatively, and compared between groups.
Results: CHIPPS scores were higher during t2, t3, t6, t7 and t8 periods,
duration of analgesia was shorter, and total analgesic consumption
was higher in Group I compare to neostigmine groups (P < 0.05).
Duration of postoperative analgesia and total analgesic consumption
were similar in Groups II and III (P > 0.05). Adverse effects were not
different between three groups.
Conclusions: Caudal neostigmine in doses of 2 and 4 lgÆkg)1 with
levobupivacaine extends the duration of analgesia without increasing
the incidence of adverse effects, and 2 lgÆkg)1 seems to be the optimal
dose, as higher dose has no further advantages.
