Comparative Study of Spinal Anesthesia by Bupivacaine Heavy (0.5%), Bupivacaine Heavy (0.5%) with Ketamin or Midzolam in Paediatric Patients

Various anatomical and physiological differences make neural blockade in paediatric surgery different from that in adults. Recent availability of preservative free midazolam and ketamine used as adjuvants, prompted us to take up this study to explore the advantages to be gained by the use of these adjuvant drugs in spinal anaesthesia. The aim of this study was to evaluate spinal anaesthesia in children by using 0.5% bupivacaine which and either preservative free ketamine of preservative free midazolam adjuvants to 0.5% bupivacaine.

In 60 patients of 7–12 age group years posted for routine surgeries below the level of umbilicus were included after fitness according to ASA grading I and II. Group I received spinal anaesthesia using bupivacaine heavy 0.5%, Group II received spinal anaesthesia using bupivacaine heavy 0.5% with preservative free ketamine, Group III received spinal anaesthesia using bupivacaine heavy 0.5% with preservative free midazolam.

There was statistically no significant (p>0.05) difference between mean values of onset of sensory blockade (min) and height of sensory blockade in the three groups. While statistically highly significant (p<0.01) difference of mean duration of motor blockade, time of two segment regression and duration of post operative analgesia was found. The commonest adverse effects were shivering, nausea and vomiting. Only in group I, 4 cases require supplementation of general anaesthesia as surgical procedures outlasted the duration of sensory blockade of bupivacaine.

The time of onset of sensory block of bupivacaine was not significantly affected by the addition of adjuvants namely ketamine and midazolam. The duration of postoperative analgesia was significantly prolonged by addition of ketamine and midazolam. The addition of ketamine and midazolam to bupivacaine did not produce significant complications attributable to them.