| Summary: | Background: Co-administration of dexamethasone or neostigmine with local anesthetic solution for caudal block (CB) can prolong postoperative analgesia duration. We aimed to evaluate and compare the effectiveness of dexamethasone (0.1 mg/kg) versus neostigmine (2 μg/kg) when used as adjuvant to 0.25% bupivacaine for CB in children undergoing unilateral open inguinal hernia repair on the quality of postoperative analgesia.
Methods: 105 children aged 1–6 years scheduled for unilateral open inguinal hernia repair were randomly allocated into three groups. Ultrasound guided CB was performed with 0.25% bupivacaine (0.75 ml/kg). 1 ml saline, dexamethasone (0.1 mg/kg) in 1 ml saline and neostigmine (2 μg/kg) in 1 ml saline were added in bupivacaine, bupivacaine-dexamethasone and bupivacaine-neostigmine respectively. Duration of postoperative analgesia, postoperative consumption of analgesic, the modified objective pain score, postoperative sedation and side effects were recorded.
Results: Duration of postoperative analgesia was prolonged in bupivacaine-dexamethasone and bupivacaine-neostigmine groups as compared to the bupivacaine group (P < 0.05). Bupivacaine-neostigmine provided the longest duration of postoperative analgesia. Postoperative analgesic consumption was lower in bupivacaine-dexamethasone and bupivacaine-neostigmine groups as compared to the bupivacaine group (P < 0.05). Bupivacaine-neostigmine provided lowest postoperative analgesic consumption. Postoperative nausea and vomiting was insignificantly different among the three groups.
Conclusion: Co-administration of dexamethasone (0.1 mg/kg) or neostigmine (2 μg/kg) with 0.25% bupivacaine for CB in pediatric patients undergoing unilateral open inguinal hernia repair prolonged postoperative analgesia duration and decreased postoperative analgesic utilization as compared to bupivacaine alone. Caudal bupivacaine-neostigmine provided more pronounced analgesic effect as compared to bupivacaine-dexamethasone.
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