A study of the effect of caudal epidural neostigmine for post operative pain relief in children undergoing lower abdominal surgery

Providing adequate pain relief has always been part of anaesthesiologist's role in the perioperative period beyond post anaesthesia care unit. Among the many adjuvants studied neostigmine was also found to be effective in acute post-operative and chronic pain. We have studied the analgesic efficacy of caudal bupivacaine with and without neostigmine in children.

In this randomized double blind study, sixty children belonging to ASA I and II, aged 2–8 years undergoing lower abdominal surgeries were randomly allocated into two groups to receive a caudal injection of 0.25% bupivacaine alone or a mixture of 0.25% bupivacaine 0.5ml/kg with 2μg/kg neostigmine. Monitoring of scores for pain, postoperative nausea and vomiting was performed by an Anaesthesiologist blinded to the study allocations.

Time to the first analgesic administration of syrup Paracetamol was longer (P<0.05) with mean duration of analgesia of 14.6 hrs in the bupivacaine-neostigmine than in the bupivacaine only group with a mean duration of 4.3 hrs. Side effect such as emesis was not significantly different between the two groups.

Caudal co-administration of bupivacaine with neostigmine produces significant prolongation of the duration of postoperative analgesia when compared to caudal bupivacaine alone.