title: Caudal neostigmine for postoperative analgesia in paediatric surgery.
abstract: BACKGROUND
  This study was conducted to evaluate analgesia and side-effects of caudal neostigmine coadministered with bupivacaine in paediatric surgery.
  
  
  METHODS
  We studied children, aged 1-5 years, undergoing elective surgery (inguinal hernia and hypospadias). After standard induction of anaesthesia, caudal anaesthesia was performed. Group 1 received 0.25% bupivacaine 0.5 ml.kg-1 and Group 2 received 0.25% bupivacaine 0.5 ml x kg-1 with 1 microg x kg-1 neostigmine via the caudal route. Heart rate, mean arterial pressure, peripheral oxygen saturation were recorded before induction, after induction but before caudal anaesthesia, and then every 5 min after caudal anaesthesia. Haemodynamic, Toddler, Preschooler, Postoperative Pain Scale (TPPPS) pain score and sedation score values were recorded 30 min after extubation and at hours 2, 4, 6, 12 and 24. A pain score >3/10 resulted in administration of rectal paracetamol. The duration of postoperative analgesia was defined as the time between caudal drug injection and the first rectal paracetamol administration.
  
  
  RESULTS
  There were no differences between the groups in demographic and haemodynamic date, duration of surgery and anaesthesia, time to extubation or sedation scores. The duration of postoperative pain relief did not differ between the two groups; 15.40 +/- 10.97 h for group 1 vs. 15.45 +/- 10.99 h for group 2 (P > 0.05). The incidence of nausea (three patients in group 2 and one patient in group 1) was not statistically significant. No other side-effects were seen.
  
  
  CONCLUSIONS
  We found that a single caudal injection of 1 microg x kg-1 neostigmine mixed with bupivacaine offers no significant advantage over bupivacaine alone for postoperative pain relief in children undergoing genitourinary surgery.
authors.affiliation: Department of Anaesthesiology, Trakya University Medical Faculty, Edirne, Turkey. dilmemis@mynet.com
authors.forename: Dilek
authors.initials: D
authors.lastname: Memiş
authors.forename: Alparslan
authors.initials: A
authors.lastname: Turan
authors.forename: Beyhan
authors.initials: B
authors.lastname: Karamanlioğlu
authors.forename: Gaye
authors.initials: G
authors.lastname: Kaya
authors.forename: Necdet
authors.initials: N
authors.lastname: Süt
authors.forename: Zafer
authors.initials: Z
authors.lastname: Pamukçu
mesh_terms: D000763:Anesthesia, Caudal / Q000706:statistics & numerical data*; D019162:Anesthetics, Combined / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000627:therapeutic use; D002045:Bupivacaine / Q000627:therapeutic use; D002675:Child, Preschool; D004311:Double-Blind Method; D017558:Elective Surgical Procedures; D006552:Hernia, Inguinal / Q000601:surgery; D006801:Humans; D007223:Infant; D009388:Neostigmine / Q000009:adverse effects / Q000627:therapeutic use*; D010147:Pain Measurement / Q000706:statistics & numerical data; D010149:Postoperative Pain / Q000517:prevention & control*; D010277:Parasympathomimetics / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D019162:Anesthetics, Combined; D000779:Anesthetics, Local; D010277:Parasympathomimetics; D009388:Neostigmine; D002045:Bupivacaine