Midazolam for caudal analgesia in children: comparison with caudal bupivacaine. 2008

B Pradhan, and G R Bajracharya
Department of Anesthesiology, Institute of Medicine, Kathmandu, Nepal. biswaspradhan@yahoo.com

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. OBJECTIVE 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. 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 1 ml/kg (group A) or Midazolam 50 microg/kg with normal saline 1 ml/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. CONCLUSIONS We conclude that caudal Midazolam in a dose of 50 microg/kg provides equivalent analgesia to Bupivacaine 0.25%, when administered in a volume of 1 ml/kg for children undergoing unilateral inguinal herniotomy for hernia or high ligation of processus vaginalis for hydrocoele.

UI MeSH Term Description Entries
D007223 Infant A child between 1 and 23 months of age. Infants
D008297 Male Males
D008874 Midazolam A short-acting hypnotic-sedative drug with anxiolytic and amnestic properties. It is used in dentistry, cardiac surgery, endoscopic procedures, as preanesthetic medication, and as an adjunct to local anesthesia. The short duration and cardiorespiratory stability makes it useful in poor-risk, elderly, and cardiac patients. It is water-soluble at pH less than 4 and lipid-soluble at physiological pH. Dormicum,Midazolam Hydrochloride,Midazolam Maleate,Ro 21-3981,Versed,Hydrochloride, Midazolam,Maleate, Midazolam,Ro 21 3981,Ro 213981
D010146 Pain An unpleasant sensation induced by noxious stimuli which are detected by NERVE ENDINGS of NOCICEPTIVE NEURONS. Suffering, Physical,Ache,Pain, Burning,Pain, Crushing,Pain, Migratory,Pain, Radiating,Pain, Splitting,Aches,Burning Pain,Burning Pains,Crushing Pain,Crushing Pains,Migratory Pain,Migratory Pains,Pains, Burning,Pains, Crushing,Pains, Migratory,Pains, Radiating,Pains, Splitting,Physical Suffering,Physical Sufferings,Radiating Pain,Radiating Pains,Splitting Pain,Splitting Pains,Sufferings, Physical
D010149 Pain, Postoperative Pain during the period after surgery. Acute Post-operative Pain,Acute Postoperative Pain,Chronic Post-operative Pain,Chronic Post-surgical Pain,Chronic Postoperative Pain,Chronic Postsurgical Pain,Pain, Post-operative,Persistent Postsurgical Pain,Post-operative Pain,Post-operative Pain, Acute,Post-operative Pain, Chronic,Post-surgical Pain,Postoperative Pain, Acute,Postoperative Pain, Chronic,Postsurgical Pain,Postoperative Pain,Acute Post operative Pain,Chronic Post operative Pain,Chronic Post surgical Pain,Chronic Postsurgical Pains,Pain, Acute Post-operative,Pain, Acute Postoperative,Pain, Chronic Post-operative,Pain, Chronic Post-surgical,Pain, Chronic Postoperative,Pain, Chronic Postsurgical,Pain, Persistent Postsurgical,Pain, Post operative,Pain, Post-surgical,Pain, Postsurgical,Post operative Pain,Post operative Pain, Acute,Post operative Pain, Chronic,Post surgical Pain,Post-operative Pains,Post-surgical Pain, Chronic,Postsurgical Pain, Chronic,Postsurgical Pain, Persistent
D011446 Prospective Studies Observation of a population for a sufficient number of persons over a sufficient number of years to generate incidence or mortality rates subsequent to the selection of the study group. Prospective Study,Studies, Prospective,Study, Prospective
D002045 Bupivacaine A widely used local anesthetic agent. 1-Butyl-N-(2,6-dimethylphenyl)-2-piperidinecarboxamide,Bupivacain Janapharm,Bupivacain-RPR,Bupivacaina Braun,Bupivacaine Anhydrous,Bupivacaine Carbonate,Bupivacaine Hydrochloride,Bupivacaine Monohydrochloride, Monohydrate,Buvacaina,Carbostesin,Dolanaest,Marcain,Marcaine,Sensorcaine,Svedocain Sin Vasoconstr,Bupivacain RPR
D002648 Child A person 6 to 12 years of age. An individual 2 to 5 years old is CHILD, PRESCHOOL. Children
D002675 Child, Preschool A child between the ages of 2 and 5. Children, Preschool,Preschool Child,Preschool Children
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man

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