Effectiveness of Neostigmine versus Dexamethasone as an Adjuvant to Bupivacaine for Caudal Epidural Analgesia Among Pediatrics Surgical Patients at Hospitals in Sodo Town: Cohort Study Design

Caudal epidural analgesia is one of the most commonly used analgesia techniques in pediatrics patients. The use of local anesthetics alone has short duration of action in caudal block. So adjuvants are usually added to prolong the duration of local anesthetics with minimum side effects. Neostigmine and dexamethasone are among commonly used adjuvants for caudal block. Objective: This study aimed to assess effectiveness of neostigmine and dexamethasone with Bupivacaine on post caudal block analgesia. Methods: A prospective cohort study design was employed. A consecutive sampling technique was used to select study participants. Data were collected from February 29, 2020 to May 30, 2020. Prior power analysis (G power version 3.1.9.4) statistical software was used to calculate the sample size. The data were entered into Epi info version 7 and transported to SPSS version 26 for analysis. For normally distributed data, an independent t-test was used to compare the mean between the groups. Skewed data were analyzed by the Mann-Whitney test. The difference in mean values was determined by considering a p-value less than 0.05 as a significant difference. Results: The average duration of analgesia in the Dexamethasone Bupivacaine Group (DBG) was 808.00 ± 148.674 minutes, whereas in the Neostigmine Bupivacaine Group (NBG), it was 716.58 ± 116.503 minutes (p=0.002). Notably, the mean cost expense was higher in NBG (160.29 ± 37.360) compared to DBG (139.87 ± 34.439), with a p-value of 0.008. Additionally, the incidence of postoperative Pediatric Opioid-Induced (PONY) was observed to be higher in NBG compared to DBG. These findings suggest that the incorporation of dexamethasone into bupivacaine proved more effective than neostigmine bupivacaine for caudal epidural analgesia in pediatric surgical patients. Conclusion: Our study concluded that the incorporation of dexamethasone with bupivacaine in caudal epidural analgesia for pediatric surgical patients offers superior pain relief compared to neostigmine bupivacaine. These findings suggest that dexamethasone bupivacaine may be a more effective and cost-efficient option for pain management in pediatric surgical procedures, emphasizing the need for further consideration and implementation in clinical practice.