Evaluation of Bupivacaine Co-administration with Midazolam or Neostigmine in Pediatric Inguinal Hernia Surgery-A Randomized Clinical Trial Study

Aims: The aim of this study was to evaluate the analgesic effects of midazolam and neostigmine co-administration with bupivacaine in pediatric inguinal hernia surgery.

Study Design: Randomized, double-blinded clinical study.

Place and Duration of Study: Departments of Anesthesiology, Head and Neck Surgery, Shahid Sadoughi University of Medical Sciences, Yazd, Iran, between 2012 and 2014.

Methodology: In this double blinded randomized clinical trial study, 90 pediatric patients aged 1-5 years undergoing inguinal hernia surgery were randomly assigned in to 3 groups. Group A received bupivacaine with placebo. Group B received caudal block with bupivacaine co-administrated with 50 µgr/kg midazolam. Group C received bupivacaine co-administered with neostigmine 2 µgr/kg. The hemodynamic variables were recorded at the baseline and interoperation. The pain score, sedation score, nausea/vomiting and analgesic use were recorded in the recovery phase and after 24 hours too.

Results: Baseline and intraoperative hemodynamic variables such as heart rate and blood pressure were compared between three groups. After 24 hours the pain score and sedation were not different. The anesthesia side effects like nausea and vomiting were the same between the three groups. In recovery room pain and sedation were significantly better in midazolam group (B). Also the analgesic use between group A and B, was different during 24 hours after operation. The most analgesic dose were used in Bupivacaine with Placebo (A) and the least in midazolam group (B).

Our findings demonstrated that pain score in midazolam and neostigmine group was less than bupivacaine group and sedation score was higher in midazolam and neostigmine group. After 24 hours the pain score and sedation were not different. The anesthesia side effects like nausea and vomiting were the same in three groups. Analgesic use was significantly higher in bupivacaine group compare with other two groups.

Conclusion: From the results, midazolam and neostigmine would be appropriate adjuncts to bupivacaine in caudal block during pediatric surgeries.