title: Caudal ropivacaine and neostigmine in pediatric surgery.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Anesthesiology, Trakya University Medical Faculty, Edirne, Turkey. alparslanturan@yahoo.com
authors.forename: Alparslan
authors.initials: A
authors.lastname: Turan
authors.forename: Dilek
authors.initials: D
authors.lastname: Memiş
authors.forename: Umit N
authors.initials: UN
authors.lastname: Başaran
authors.forename: Beyhan
authors.initials: B
authors.lastname: Karamanlioğlu
authors.forename: Necdet
authors.initials: N
authors.lastname: Süt
mesh_terms: D000577:Amides / Q000008:administration & dosage*; D000763:Anesthesia, Caudal; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D009388:Neostigmine / Q000008:administration & dosage*; D010149:Postoperative Pain / Q000188:drug therapy*; D000077212:Ropivacaine
chemical_list: D000577:Amides; D009388:Neostigmine; D000077212:Ropivacaine