Efficacy of bupivacaine-neostigmine and bupivacaine-tramadol in caudal block in pediatric inguinal herniorrhaphy.
BACKGROUND
Limited duration of analgesia is among the limitations of single caudal injection with local anesthetics. Therefore, the purpose of this study was to evaluate the effectiveness and safety of bupivacaine in combination with either neostigmine or tramadol for caudal block in children undergoing inguinal herniorrhaphy.


METHODS
In a double-blinded randomized trial, sixty children undergoing inguinal herniorrhaphy were enrolled to receive a caudal block with either 0.25% bupivacaine (1 ml x kg(-1)) with neostigmine (2 microg x kg(-1)) (group BN) or tramadol (1 mg x kg(-1)) (group BT). Hemodynamic variables, pain and sedation scores, additional analgesic requirements, and side effects were compared between two groups.


RESULTS
Duration of analgesia was longer in group BT (17.30 +/- 8.24 h) compared with group BN (13.98 +/- 10.03 h) (P = 0.03). Total consumption of rescue analgesic was significantly lower in group BT compared with group BN (P = 0.04). There were no significant differences in heart rate, mean arterial pressure, and oxygen saturation between groups. Adverse effects excluding the vomiting were not observed in any patients.


CONCLUSIONS
In conclusion, tramadol (1 mg x kg(-1)) compared with neostigmine (2 microg x kg(-1)) might provide both prolonged duration of analgesia and extended time to first analgesic in caudal block.
Taheri
Reza
R
Department of Anesthesiology, Children's Hospital, Tabriz University of Medical Sciences, Tabriz, Iran.
Shayeghi
Shahnaz
S
Razavi
Seyed S
SS
Sadeghi
Afsaneh
A
Ghabili
Kamyar
K
Ghojazadeh
Morteza
M
Rouzrokh
Mohsen
M
D000763:Anesthesia, Caudal / Q000379:methods*; D000779:Anesthetics, Local / Q000009:adverse effects; D002045:Bupivacaine / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D016292:Procedural Sedation; D004311:Double-Blind Method; D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D008297:Male; D009388:Neostigmine / Q000009:adverse effects; D010147:Pain Measurement / Q000187:drug effects; D010149:Postoperative Pain / Q000188:drug therapy; D010277:Parasympathomimetics / Q000009:adverse effects; D018401:Sample Size; D014147:Tramadol / Q000009:adverse effects; D016896:Treatment Outcome
D000779:Anesthetics, Local; D010277:Parasympathomimetics; D009388:Neostigmine; D014147:Tramadol; D002045:Bupivacaine