Ketamine Versus Neostigmine as an Adjuvant To Bupivacaine In Caudal Block For Pediatric Patients Undergoing inguinal hernia repair

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Mohamed Mosaad,, Lobna Taha El Dorgham, Hala Ibrahim Zanfaly, Marwa Mahmoud Zakzouk

Abstract

Background Postoperative pain is one of the most common problems in surgical patients that can influence their physical and mental health. So, effective pain management is an essential component of postoperative care. Therefore pediatric surgeons, anesthetists and pharmacologists had been in a continuous search to locate a safe and effective analgesic for children. The purpose of the study was to Comparison between the analgesic effect of adding neostigmine or ketamine to bupivacaine in caudal block for pediatric patients undergoing lower abdominal surgeries. Materials and Methods: Comparative Prospective randomized double blind controlled clinical study. A total of 45 pediatric patients in age 1 - 3 years ASA I-II, scheduled for lower abdominal surgeries were equally divided into three groups (15 patients each): the study was carried out at the department of anesthesia in Zagazig University Hospitals. Group (C) 15 patients received GA and CEB using 0.25% bupivacaine 1ml/kg only. Group (K) 15 patients received GA and CEB using 0.25% bupivacaine 1 ml/kg plus 0.5 mg/kg ketamine. Group (N): 15 patients received GA and CEB using 0.25% bupivacaine 1ml/kg plus neostigmine 2µg/kg. HR, MAP and Spo2 were recorded before (baseline) and then every 10 min till end of operation and at 1, 2, 4, 6, 8, 12 hr. postoperatively. Pain scores were evaluated by the “Face, Leg, Activity, Cry, Console ability ‘FLACC’ pain scale. Time of 1st analgesic rescue and Total doses of rescue analgesic that administered in the postoperative period (12 hr) were recorded. Results: The results showed no significant difference between the studied groups as regarding different MAP, HR readings during the operation at before induction, 20 min, 50 min, 60 min and 70 min after induction. While there were highly significant difference between them as regarding intra-operative MAP and HR which was found to be significantly higher among group C compared to K and N groups at 10, 30 and 40 min after induction ( ⃰p <0.001). As regard SpO₂, the result of the current study is there was no significant difference between the studied groups. there were highly significant differences between the studied groups as regarding first time for rescue analgesia and the amount fentanyl intra operative needed of paracetamol postoperatively to be significantly higher among C group compared to other groups. As regard pain assessment a significant increase in FLACC scale of group C compared with that of group K and group N (p < 0.001) at 1 H, 2 H, 4 H, 6 H and 8 H. Conclusion: the addition of 2μg/kg neostigmine, or 0.5 mg/kg ketamine as an adjuvant to 1 ml/kg of 0.25% caudal bupivacaine could lengthen the duration of postoperative analgesia in children undergoing lower abdominal surgeries without increasing the incidence of side effects. However, neostigmine offered a significant advantage over ketamine in this regard.

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