الفهرس 
ANATOMYOnly 14 pages are availabe for public view
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Abstract
Pain is one of the most misunderstood, underdiagnosed, and
untreated medical problems, particularly in children. New
Joint Commission on Accreditation of Health Care
Organization regards pain as fifth vital sign and requires care
givers to regularly assess pain. Inadequate pain relief during
childhood may have long-term negative effects including
harmful neuroendocrine responses, disrupted eating and sleep
cycles and increased pain perception during subsequent painful
experiences. Postoperative pain can result in an uncooperative
and restless child. Hence, it is preferable to prevent the onset
of pain rather than to relieve its existence.
Caudal analgesia remains the most popular and
commonly used regional block in paediatric anaesthesia.
Bupivacaine is the most widely used local anaesthetic for this
technique and provides postoperative analgesia lasting 4-8 h. It
is clear that the extended duration of analgesia that can be
achieved by using caudal additives is significant.
Local anesthetics alone for caudal epidural block provide
good operative conditions, but they have short duration of
postoperative analgesia. Therefore, various adjuvants such as
opioids, neostigmine and midazolam were added to local
anesthetics in caudal epidural block to achieve quick, dense and
prolonged block.this study showed that caudal anesthesia supplemented
with a dose of neostigmine was beneficial in the postoperative
pain control compared with patients who received a routine
caudal block. The patients from caudal neostigmine group
required significantly less rescue analgesia.
Neostigmine was one of the additives. Several studies
have been performed to test its efficacy and safety. The
addition of neostigmine to caudal bupivacaine prolonged the
duration of postoperative analgesia after lower abdominal
surgery. The dose of neostigmine selected in the current study
(2μg/kg) was previously reported to provide effective analgesia
with minimal side effects and reduce additional analgesics.
In conclusion, caudal bupivacaine plus 2μg/kg
neostigmine provided excellent analgesia lasting up to 24 hours
post-operative, without serious side effects and minimal
additional analgesics thus providing a safe, simple and effective
postoperative analgesia for children undergoing lower
abdominal surgery.