Background: Pain control by various methods, in children is of great concern for the anaesthesiologists. we coadminstered neostigmine with ropivacaine  to prolong duration of block due to its synergistic effect. We compared the analgesic efficacy and safety of Neostigmine -Ropivacaine mixture to that of ropivacaine with saline following caudal administration in children undergoing infra umbilical surgeries.

Methods: In a prospective, randomized, double blind study, 100 children aged 1-5years of ASA class 1 of either sex, were randomly allocated to one of the groups of 50 patients each to receive caudal injection of either 1ml/kg of 0.25% ropivacaine hydrochloride with saline 0.2ml/kg in group R (Control group) or 2µg/Kg(10 µg/m) of neostigmine added to 1ml/kg of 0.25% ropivacaine hydrochloride in Group RN(Study group). The perioperative hemodynamic effects, post operative pain score, supplementary analgesic requirement and side effects were assessed by a blind observer in all patients during 24 hour post operative period.

Results: Both the groups were homogenous with reference to age, sex, weight and duration of anesthesia and duration of surgery. No significant differences with respect to mean heart rate, blood pressure (systolic and diastolic) and oxygen saturation were noted during perioperative period between the two groups. The mean duration of analgesia in group R was8.25±2.229hours while in group RN mean duration of analgesia was 18.00±4.93 hours. The duration of analgesia in group RN was longer and the difference was statistically significant (p< 0.05). In the postoperative period rescue analgesia in the form of paracetamol I/V (15mg/kg) was required in 13 patients (26%) in the study group and 28(56%) patients in the control group. Statistically a significant difference (p<0.001) was observed between the two groups. In our study 2 patients in study group had nausea and vomiting (4%), while in control group 4patients had nausea and vomiting (4%). The total number of patients who had side effects was less in study group compared to control group. However, the difference was statistically insignificant (p>0.05) between the two groups. None of our patient developed any other complication. In our study there was very low incidence of nausea and vomiting which was probably due to i/v ondansetron given intraoperatively.

Conclusion: Caudal neostigmine is an effective and prolonged intra and postoperative analgesia in children undergoing infra-umbilical surgeries. Neostigmine in the dose of 2µg/kg body weight when added to caudal ropivacaine is safe and without any significant side effects.

KEYWORDS: caudal anesthesia, neostigmine, post operative pain, children, ropivacaine.

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Dr Tahira Akhter

Senior Resident SKIMS Soura, Pin Code 190011

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