Effectiveness of Caudal Bupivacaine with Neostigmine for Postoperative Pain Management after Hypospadias Surgery in Children: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

LAN Yunping , HUANG Zhenhua ,  ZUO Yunxia

Department of Anaesthesia, West China Hospital, Sichuan University, Chengdu 610041, China;

Corresponding author：

ZUO Yunxia, Email: zuoyunxiahxa@yahoo.com.cn

Keywords：

Bupivacaine; Neostigmine; Hypospadias; Systematic review

DOI：

10.7507/1672-2531.20090119

Video：

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Objective 　To assess the analgesic effect of caudal bupivacaine with neostigmine for hypospadias surgery in children.
Methods 　We searched The Cochrane Library (Issue 2, 2008), MEDLINE (1966-2008), EMbase (1980-2008), CBMdisc (1978-2008), CNKI (1989-2008) and Wanfang Database using the keywords “bupivacaine”, “neostigmine” and “hypospadias” to identify randomized control trials (RCTs) of caudal bupivacaine with neostigmine versus bupivacaine alone for hypospadias surgery in children. The methodological quality of included RCTs was evaluated by two reviewers independently, and Meta-analysis was conducted using RevMan 5.0.13 software.
Results 　We identified 3 RCTs including 160 patients which had an uncertain risk of bias. The results of meta-analysis showed no significant difference found between bupivacine alone and bupivacine plus 1 µg/kg neostigmine (WMD= 0.05, 95%CI – 6.76 to 6.86, P= 0.99), but a difference was found between bupivacine alone and bupivacine plus 1 µg/ kg, 2 µg/kg, or 3 µg/ kg neostigmine (WMD= 12.79, 95%CI 10.96 to 14.62, P lt; 0.000 01; WMD= 12.10, 95%CI – 6.76 to 6.86, P lt; 0.000 01; WMD= 11.90, 95%CI 9.17 to 14.63, P lt;0.000 01). The duration of postoperative analgesia of the bupivacaine with neostigmine group was longer than that of bupivacine alone.
Conclusions 　Because of the small sample size and the unclear risk of bias in the included RCTs, the effectiveness of caudal bupivacaine with neostigmine for postoperative pain management after hypospadias surgery in children is not completely confirmed. So more large sample size, double-blind RCTs are needed.

Citation： LAN Yunping,HUANG Zhenhua,ZUO Yunxia. Effectiveness of Caudal Bupivacaine with Neostigmine for Postoperative Pain Management after Hypospadias Surgery in Children: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2009, 09(6): 670-673. doi: 10.7507/1672-2531.20090119 Copy

1.	Dalens BJ. Regional anesthesia in children. Miller RD, Ed.. Anesthesia, 5th ed. Philadelphia: Churchill Livingstone, 2000. 1549-1585.
2.	Cook B, Grubb DJ, Aldridge LA, et al. Comparison of the effects of adrenaline, clonidine and ketamine on the duration of caudal analgesic produced by bupivacaine in children. Br J Anaesth, 1995, 75(6): 698-701.
3.	Wolf AR, Hughes D, Wade A, et al. Postoperative analgesia after paediatric orchidopexy: evaluation of a bupivacaine morphine mixture. Br J Anaesth, 1990, 64(4): 430-435.
4.	Senel AC, Akyol A, Dohman D, et al. Caudal bupivacaine-tramadol combination for postoperative analgesia in pediatric hernioraphy. Acta Anaesthesiol Scand, 2001, 45(6): 786-789.
5.	Lauretti GR, Reis MP, Prado WA, et al. Dose-response study of intrathecal morphine versus intrathecal neostigmine, their combination or placebo for postoperative analgesia in patients undergoing anterior and posterior vaginoplasty. Anesth Analg, 1996, 82(6): 1182-1187.
6.	Lauretti GR, de Oliveira R, Reis MP, et al. Study of three different doses of epidural neostigmine co administered with lidocaine for postoperative analgesia. Anesthesiology, 1999, 90(6): 1534-1538.
7.	Lauretti GR, Gomes JM, Reis MP, et al. Low doses of epidural ketamine or neostigmine, but not midazolam improves morphine analgesia in epidural terminal cancer pain therapy. J Clin Anesth, 1999, 11(8): 663-668.
8.	Iwamoto ET, Marion L. Characterization of the antinociception produced by intrathecally administered muscarinic agonists in rats. J Pharmacol Exp Ther, 1993, 266(1): 329-338.
9.	Yaksh TL, Dirksen R, Harty GJ. Antinociceptive effects of intrathecally injected cholinomimetic drugs in the rat and cat. Eur J Pharmacol, 1985, 117(1): 81-88.
10.	Turan A, Memis D, Basaran UN, et al. Caudal ropivacaine and neostigmine in pediatric surgery. Anesthesiology, 2003, 98(3): 719-722.
11.	Kumar P, Rudra A, Pan AK, et al. Caudal additives in pediatrics: A comparison among midazolam, ketamine and neostigmine coadministered with bupivacaine. Anesth Analg, 2005, 101(1): 69-73.
12.	李静, 李幼平. 不断完善与发展的Cochrane系统评价. 中国循证医学杂志, 2008, 8(9): 742-743.
13.	Abdulatif M, El-Sanabary M. Caudal neostigmine, bupivacaine, and their combination for postoperative pain management after hypospadias surgery in children. Anesth Analg, 2002, 95(5): 1215-1218.
14.	Mahajan R, Grover VK, Chari P. Caudal neostigmine with bupivacaine produces a dose-independent analgesic effect in children. Can J Anaesth, 2004, 51(7): 702-706.
15.	Batra YK, Arya VK, Mahajan R, et al. Dose response study of caudal neostigmine for postoperative analgesia in paediatric patients undergoing genitourinary surgery. Paediatr Anaesth, 2003, 13(6): 515-521.
16.	Naguib M, Yaksh TL. Antinociceptive effects of spinal cholinesterase inhibition and isobolographic analysis of the interaction with μ and α2 receptor systems. Anesthesiology, 1994, 80(6): 1338-1348.
17.	Roelants F, Rizzo M, Lavand’homme P. The effect of epidural neostigmine combined with ropivacaine and sufentanil on neuraxial analgesia during labor. Anesth Analg, 2003, 96(4): 1161-1166.
18.	Lauretti GR, Hood DD, Eisenach JC, et al. A multi-center study of intrathecal neostigmine for analgesia following vaginal hysterectomy. Anesthesiology, 1998, 89(4): 913-918.
19.	Gaitini LA, Somri M, Vaida SJ, et al. Does the addition of fentanyl to bupivacaine in caudal epidural block have an effect on plasma level of catecholamines in children? Anesth Analg, 2000, 90(5): 1029-1033.
20.	Krukowski JA, Hood DD, Eisenach JC, et al. Intrathecal neostigmine for postcesarean section analgesia: dose response. Anesth Analg, 1997, 84(6): 1269-1275.

1. Dalens BJ. Regional anesthesia in children. Miller RD, Ed.. Anesthesia, 5th ed. Philadelphia: Churchill Livingstone, 2000. 1549-1585.
2. Cook B, Grubb DJ, Aldridge LA, et al. Comparison of the effects of adrenaline, clonidine and ketamine on the duration of caudal analgesic produced by bupivacaine in children. Br J Anaesth, 1995, 75(6): 698-701.
3. Wolf AR, Hughes D, Wade A, et al. Postoperative analgesia after paediatric orchidopexy: evaluation of a bupivacaine morphine mixture. Br J Anaesth, 1990, 64(4): 430-435.
4. Senel AC, Akyol A, Dohman D, et al. Caudal bupivacaine-tramadol combination for postoperative analgesia in pediatric hernioraphy. Acta Anaesthesiol Scand, 2001, 45(6): 786-789.
5. Lauretti GR, Reis MP, Prado WA, et al. Dose-response study of intrathecal morphine versus intrathecal neostigmine, their combination or placebo for postoperative analgesia in patients undergoing anterior and posterior vaginoplasty. Anesth Analg, 1996, 82(6): 1182-1187.
6. Lauretti GR, de Oliveira R, Reis MP, et al. Study of three different doses of epidural neostigmine co administered with lidocaine for postoperative analgesia. Anesthesiology, 1999, 90(6): 1534-1538.
7. Lauretti GR, Gomes JM, Reis MP, et al. Low doses of epidural ketamine or neostigmine, but not midazolam improves morphine analgesia in epidural terminal cancer pain therapy. J Clin Anesth, 1999, 11(8): 663-668.
8. Iwamoto ET, Marion L. Characterization of the antinociception produced by intrathecally administered muscarinic agonists in rats. J Pharmacol Exp Ther, 1993, 266(1): 329-338.
9. Yaksh TL, Dirksen R, Harty GJ. Antinociceptive effects of intrathecally injected cholinomimetic drugs in the rat and cat. Eur J Pharmacol, 1985, 117(1): 81-88.
10. Turan A, Memis D, Basaran UN, et al. Caudal ropivacaine and neostigmine in pediatric surgery. Anesthesiology, 2003, 98(3): 719-722.
11. Kumar P, Rudra A, Pan AK, et al. Caudal additives in pediatrics: A comparison among midazolam, ketamine and neostigmine coadministered with bupivacaine. Anesth Analg, 2005, 101(1): 69-73.
12. 李静, 李幼平. 不断完善与发展的Cochrane系统评价. 中国循证医学杂志, 2008, 8(9): 742-743.
13. Abdulatif M, El-Sanabary M. Caudal neostigmine, bupivacaine, and their combination for postoperative pain management after hypospadias surgery in children. Anesth Analg, 2002, 95(5): 1215-1218.
14. Mahajan R, Grover VK, Chari P. Caudal neostigmine with bupivacaine produces a dose-independent analgesic effect in children. Can J Anaesth, 2004, 51(7): 702-706.
15. Batra YK, Arya VK, Mahajan R, et al. Dose response study of caudal neostigmine for postoperative analgesia in paediatric patients undergoing genitourinary surgery. Paediatr Anaesth, 2003, 13(6): 515-521.
16. Naguib M, Yaksh TL. Antinociceptive effects of spinal cholinesterase inhibition and isobolographic analysis of the interaction with μ and α2 receptor systems. Anesthesiology, 1994, 80(6): 1338-1348.
17. Roelants F, Rizzo M, Lavand’homme P. The effect of epidural neostigmine combined with ropivacaine and sufentanil on neuraxial analgesia during labor. Anesth Analg, 2003, 96(4): 1161-1166.
18. Lauretti GR, Hood DD, Eisenach JC, et al. A multi-center study of intrathecal neostigmine for analgesia following vaginal hysterectomy. Anesthesiology, 1998, 89(4): 913-918.
19. Gaitini LA, Somri M, Vaida SJ, et al. Does the addition of fentanyl to bupivacaine in caudal epidural block have an effect on plasma level of catecholamines in children? Anesth Analg, 2000, 90(5): 1029-1033.
20. Krukowski JA, Hood DD, Eisenach JC, et al. Intrathecal neostigmine for postcesarean section analgesia: dose response. Anesth Analg, 1997, 84(6): 1269-1275.

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Effectiveness of Caudal Bupivacaine with Neostigmine for Postoperative Pain Management after Hypospadias Surgery in Children: A Systematic Review

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