Two different doses of caudal neostigmine co-administered with levobupivacaine produces analgesia in children.
BACKGROUND
This study was aimed to evaluate the analgesic efficacy duration of analgesia, and side effects of two different doses of caudal neostigmine used with levobupivacaine in children.


METHODS
Sixty boys, between 5 months and 5 years, undergoing genitourinary surgery were allocated randomly to one of three groups (n =20 each). Group I patients received caudal 0.25% levobupivacaine (1 ml.kg(-1)) alone. Groups II and III patients received neostigmine (2 and 4 microg.kg(-1) respectively) together with levobupivacaine used in the same does as Group I. Pain scores were assessed using Children's and Infant's Postoperative Pain Scale (CHIPPS) at 15th (t(1)) min after arrival to postanesthetic care unit, and 1st (t(2)), 2nd (t(3)), 3rd (t(4)), 4th (t(5)), 8th (t(6)), 16th (t(7)), and 24th (t(8)) hour postoperatively. Duration of analgesia, amount of additional analgesic (paracetamol), score of motor blockade and complications were recorded for 24 h postoperatively, and compared between groups.


RESULTS
CHIPPS scores were higher during t(2), t(3), t(6), t(7), and t(8) periods, duration of analgesia was shorter, and total analgesic consumption was higher in Group I compare to neostigmine groups (P < 0.05). Duration of postoperative analgesia and total analgesic consumption were similar in Groups II and III (P > 0.05). Adverse effects were not different between three groups.


CONCLUSIONS
Caudal neostigmine in doses of 2 and 4 microg.kg(-1) with levobupivacaine extends the duration of analgesia without increasing the incidence of adverse effects, and 2 microg.kg(-1) seems to be the optimal dose, as higher dose has no further advantages.
Karaaslan
Kazim
K
Department of Anesthesiology, Abant Izzet Baysal University, Faculty of Medicine, Bolu, Turkey.
Gulcu
Nebahat
N
Ozturk
Hayrettin
H
Sarpkaya
Ali
A
Colak
Cemil
C
Kocoglu
Hasan
H
D000698:Analgesia / Q000009:adverse effects / Q000379:methods*; D000763:Anesthesia, Caudal / Q000009:adverse effects / Q000379:methods*; D019162:Anesthetics, Combined / Q000008:administration & dosage* / Q000009:adverse effects; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects; D002045:Bupivacaine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives; D002675:Child, Preschool; D002800:Cholinesterase Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D006801:Humans; D007223:Infant; D000077554:Levobupivacaine; D008297:Male; D009388:Neostigmine / Q000008:administration & dosage* / Q000009:adverse effects; D010147:Pain Measurement / Q000379:methods / Q000706:statistics & numerical data; D010149:Postoperative Pain / Q000517:prevention & control; D020250:Postoperative Nausea and Vomiting / Q000139:chemically induced; D013997:Time Factors; D016896:Treatment Outcome; D014566:Urogenital System / Q000601:surgery
D019162:Anesthetics, Combined; D000779:Anesthetics, Local; D002800:Cholinesterase Inhibitors; D009388:Neostigmine; D000077554:Levobupivacaine; D002045:Bupivacaine