Publication: Midazolam for caudal analgesia in children: Comparison with caudal bupivacaine
Date
2008
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Kathmandu University
Abstract
Abstract
Background: Caudal analgesia is the most popular and commonly used regional anaesthesia technique for post operative
analgesia in children undergoing lower limb, anoperineal and abdominal surgical procedures. It is commonly applied
in all the paediatric patients undergoing the above mentioned surgery, as the goal of balanced anaesthesia is not only
limited to intraoperative period but also good analgesia in post operative period. Many drugs like morphine, Pethidine,
Neostigmine etc have been used as analgesic agent via the caudal route but not without their side effects. So Midazolam
was used as an alternative drug as it may not be associated with the side effects encountered with the other drugs.
Aims and objectives: The objective of the study was to see the analgesic efficacy of caudal administration of Midazolam
with comparison to Bupivacaine for post operative analgesia, and to observe for side effects if any.
Materials and methods: This was a single blinded prospective observational study in children of age 1 to 6 years of
ASA grade I undergoing elective hernia or hydrocoele surgery. The patients were allocated randomly into two groups
(n=25) to receive caudal injection of either 0.25% Bupivacaine 1ml/kg (group A) or Midazolam 50μg/kg with normal
saline 1ml/kg (group B). In the post operative period heart rate, blood pressure, pain score, recovery to first analgesic
time, total number of analgesics required in 24 hours and side effects if any were noted and analysed.
Results: There were no significant differences in quality of pain relief, postoperative behaviour or analgesic requirements
between the Midazolam group and the Bupivacaine group. Recovery to first analgesic time though was longer in the
Bupivacaine group (9.65 hr) than Midazolam group (7.32 hr); it was statistically not significant (P= 0.9). Any of the
side effects such as motor weakness, urinary retention, and respiratory depression were not observed in both the groups.
However in both the groups, few of the patients had post operative vomiting.
Conclusion: We conclude that caudal Midazolam in a dose of 50μg/kg provides equivalent analgesia to Bupivacaine
0.25%, when administered in a volume of 1ml/kg for children undergoing unilateral inguinal herniotomy for hernia or
high ligation of processus vaginalis for hydrocoele.
Key words: analgesia, caudal, Midazolam, Bupivacaine, paediatric
Description
Pradhan B 1, Bajracharya GR2
1Asst. Professor, Department of Anesthesiology, Institute of Medicine, Kathmandu, Nepal, 2Professor, Department of Anesthesiology & Intensive Care, National Academy of Medical Science, Kathmandu, Nepal