A Prospective, Randomized Control Study Comparing Caudal Block using Bupivacaine with Bupivacaine and Midazolam for Post Operative Analgesia in Children Undergoing Elective Lower Abdominal Surgeries

BACKGROUND: Post operative discomfort that arises from pain is annoying for both child and parents. This resulted in the excessive use of Opioids and NSAIDS post operatively which have significant side effects. So adding an adjuvant like Midazolam to caudal bupivacaine prolongs post operative pain relief and avoids these side effects. AIM OF THE STUDY: To compare the efficacy and safety of using caudal epidural administration of preservative free Midazolam (50 Microgram per kg) with 0.25 % bupivacaine vs plain 0.25% bupivacaine for providing post op pain relief in children undergoing elective lower abdominal surgeries. MATERIALS AND METHODS: It was a prospective randomized case control study done on 60 patients age between 2 – 8 years of American society of Anaesthesiologist (ASA) Grade 1 & 2 posted for lower abdominal surgeries under standardized General Anaesthesia. After induction patients were allocated randomly into two groups. GROUP B received caudal block with inj. Bupivacaine (0.25%) 1 ml per kg & Group BM received caudal block with inj. Bupivacaine (0.25%) 1 ml per kg and 50 micro gram per kg of preservative free midazolam. All children were continuously observed in recovery room for two hours after which they are shifted to recovery room. The FLACC pain score, Ramsay sedation score and vitals recorded at regular intervals for upto 24 hrs after surgery. RESULT: Pain score were comparable in both the groups for 1st one hour post operatively. After that Group BM had low pain scores compared to Group B. The mean duration of post operative analgesia in group BM was 12.49 ± 1.19 hrs. and that of group b was 5.11 ± 0.50 hrs. it was statistically significant with a p value < 0.05. Sedation scores were higher in the Group BM for 1st one hour compared to group B with no adverse effects. There was no significant haemodynamic changes in both the groups. CONCLUSION: I conclude the that administration of preservative free midazolam with bupivacaine for caudal epidural block increases the duration of post operative analgesia without producing any adverse effects compared with bupivacaine alone. Thus low dose preservative free midazolam can be used as an adjuvant to local anesthetics in caudal epidural block for prolonging analgesic effects.