Comparison of Caudal Analgesia Using Bupivacaine With or Without Midazolam in Children

Abstract

Introduction : Effective postoperative pain management aims to alleviate or eliminate pain with minimal side effects in a cost-effective manner. In pediatric anesthesia, caudal blocks are commonly administered alongside general anesthesia to ensure effective analgesia during and after surgery. The inclusion of adjuvant agents with local anesthetics has demonstrated an ability to extend the duration of caudal analgesic effects.

Objectives: This study evaluates the efficacy and safety of preservative-free Midazolam as an adjuvant to Bupivacaine for caudal analgesia in children to support its safe and routine clinical use.

Methodology: A prospective, randomized, double-blind study was conducted at Kanti Children’s Hospital in Kathmandu, Nepal. The study included 70 pediatric patients, aged 2 to 7 years, scheduled for elective unilateral hernia or hydrocele surgery. The study population was randomly divided into two equal groups. Group A (n = 35) received 1 ml/kg of 0.25% Bupivacaine alone, whereas Group B (n = 35) was administered 1 ml/kg of 0.25% Bupivacaine combined with Midazolam at a dose of 50 mcg/kg. The duration of analgesia was assessed using the FLACC (Face, Legs, Activity, Cry, Consolability) scale. Hemodynamic parameters and potential adverse effects were also monitored and recorded.

Results: The demographic characteristics and hemodynamic parameters were comparable between the two groups (P > 0.05). The incidence of postoperative vomiting was identical in both groups, observed in 5.71% of patients. No adverse events such as arrhythmias, hypotension, bradycardia, seizures, respiratory depression, or urinary retention were reported in either group.Group B demonstrated a significantly longer duration of analgesia (485.63 ± 78.05 minutes) compared to Group A (227 ± 55.96 minutes), with the difference being statistically significant (P < 0.001).

Conclusion : The addition of midazolam as an adjuvant to bupivacaine in caudal blocks has been shown to effectively prolong the duration of analgesia in pediatric patients without increasing the incidence of adverse effects.