Caudal ropivacaine and Neostigmine in pediatric surgery

Neostigmine has been added to local anesthetics for different nerve blocks. This study was conducted to evaluate effects of neostigmine when added to ropivacaine for caudal anesthesia. We studied children, aged 1-5 yr, undergoing inguinal hernia and hypospadias surgery. After standard induction of a...

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Bibliographic Details
Published in:Anesthesiology (Philadelphia) 2003-03, Vol.98 (3), p.719-722
Main Authors: TURAN, Alparslan, MEMIS, Dilek, BASARAN, Omit N, KARAMANLIOZLU, Beyhan, SÜT, Necdet
Format: Article
Language:English
Subjects:
Amides - administration & dosage
Anesthesia
Anesthesia, Caudal
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Biological and medical sciences
Child
Child, Preschool
Humans
Infant
Local anesthesia. Pain (treatment)
Medical sciences
Neostigmine - administration & dosage
Pain, Postoperative - drug therapy
Ropivacaine
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Summary:Neostigmine has been added to local anesthetics for different nerve blocks. This study was conducted to evaluate effects of neostigmine when added to ropivacaine for caudal anesthesia. We studied children, aged 1-5 yr, undergoing inguinal hernia and hypospadias surgery. After standard induction of anesthesia, Group I received 0.2% ropivacaine 0.5 ml/kg and Group II received 0.2% ropivacaine 0.5 ml/kg with 2 microg/kg neostigmine via the caudal route. Heart rate, mean arterial pressure, and pulse oximetry were recorded before induction, after induction, and then every 10 min after caudal anesthesia. Hemodynamic, Toddler-Preschooler Postoperative Pain Scale pain score, and sedation score values were recorded 30 min after extubation and at hours 2, 4, 6, 12, and 24. A pain score greater than 3/10 resulted in administration of rectal paracetamol. There were no differences between the groups in demographic and hemodynamic data, duration of surgery and anesthesia, time to extubation, or sedation scores. The pain scores were significantly lower in Group II at 6 and 12 h (P < 0.05). Time to first analgesic requirement was statistically prolonged in Group II (19.2 +/- 5.5h) when compared with Group I (7.1 +/- 5.7 h) (P < 0.05). Total analgesic consumption was statistically larger in Group I (174 +/- 96 mg) when compared with Group II (80 +/- 85.5 mg) (P < 0.05). The incidence of vomiting (3 patients in Group II and 1 patient in Group I) was not statistically significantly different. The authors found that a single caudal injection of neostigmine when added to ropivacaine offers an advantage over ropivacaine alone for postoperative pain relief in children undergoing genitourinary surgery.
ISSN:0003-3022
1528-1175
DOI:10.1097/00000542-200303000-00021