Background: Caudal block is widely in children, mostly in conjunction with general anaesthesia and it significantly improves patient comfort in the post -operative period. Bupivacaine is the most widely used local anaesthetic for caudal block in children but has numerous side effects. Midazolam in appropriate doses has been found to be effective in providing post- operative analgesia and is devoid of side effects. We in our study compared the efficacy of Bupivacaine and Midazolam as analgesics and studied their side effects. Methods: This randomized, double blind study was conducted on 56 children scheduled for infra-umbilical surgery in a tertiary care hospital. All the patient were given general anaesthesia as per standard protocol and caudal block was administered postoperatively either using 0.25% bupivacaine 01ml/Kg or midazolam 50 g Kg-1 in 0.9% saline 01 ml/Kg. Post-operative assessment of pain was done for 24 hours and pain scoring was done with reference to a six point modification of pain and discomfort scale. Demeanor was observed as cheerful and calm, restless and tense. Total number of analgesic doses required in first 24 hours were noted. Side effects like nausea, vomiting, urinary retention, respiratory depression, convulsions and any cardiovascular abnormality were looked for and noted. Results: The analgesic requirements in both the groups were similar. 13 patients in M group and 11 patients in B group did not require any supplemental analgesics in first 24 hours, 7 patients in both the groups received one supplemental dose of analgesics, 8 patients in M group and 9 in B group received two supplemental doses of analgesics. Only 1 patient in B group received 3 supplemental doses of analgesics. More children in the M group were cheerful and calm in the immediate postoperative period (26 Vs 22). 04 children in B group were tense or restless in the immediate post operative period compared to 02 in the M group. At the end of six hours 02 children in the B group and none of children in M group were tense/restless. 08 patients in B group had nausea and vomiting compared to 02 patients in M group. 04 patients in the B group had urinary retention and 02 patients had to be catheterized. Conclusion: Caudal midazolam provides equivalent analgesia to bupivacaine in children undergoing infra umbilical surgeries with lesser side effects.
Keywords: Caudal block, Midazolam, Bupivacaine