| IntroductionRecently studies in animals and clinical studies have shown that spinal and epidural cholinesterase inhibitor, neostigmine ( NEO) produces antinociceptive effect and analgesia in dose - related way. The efficacy of intrathecal NEO in analgesia is similar to that of morphine ( MOR). MOR produces worrisome side effects, such as nausea, pruritus, urinary retention and respiratory depression, which could limit its use in clinical practice, especially for postoperative analgesia in children. The better the efficacy of their combination in analgesia, the fewer the side effects. As reducing each dose without decreasing spinal blood flow, it is nonpoisonous to nerval system and safe to use for postoperative analgesia. However, the efficacy and safety of MOR combined with NEO for postoperative analgesia in children is unclear.To evaluate the effect of MOR alone or in combination ( NEO + MOR) on postoperative analgesia and side effects in children undergoing caudal MOR or combined with different dose of NEO, this study observed visual analog scale ( VAS ) , objective pain scale ( OPS ) , heart rate (HR) , respiration (R) , mean arterial pressure (MAP) , pulse oxygen saturatio ( SpO2 ) , nausea, pruritus, urinary retention and respiratory depression.Methods45 children aged 4-12 years, ASA I - II, weight13 -47kg, undergoing elective lower abdominal surgery under general and caudal anesthesia ( caudal solution injected one of drugs numbered (1)/ (2)/ (3) 0. 6 ml/kg or 20 ml in maximal volume) , were included in this study. The children were known without respiratory and circulatory abnormalities and were randomly allocated into 3 groups of 15 children each in double -blind way. Group I (M) received MOR 0. 025 mg/ kg caudally. Group II (N0.015M) received NEO 0. 015mg/kg with MOR 0.025 mg/kg caudally. Group III(N0.02M) received NEO 0.02 mg/kg with MOR 0.025 mg/kg caudally.Atropin 0. 01 mg/kg was administrated intramuscularly as pre-medication. All chlidren were monitored and recorded basic Bp, HR, R and Sp02 after arriving in operating room. Anesthesia was inducted with intravenous Propofol 2.5 mg/kg slowly and respirable 1% -2% Enflurane/50%N2O. Caudal block was performed after conscious disappearance. Anus relaxation was considered the onset sign of caudal block. At mean time, both of intravenous and respirable drugs were reduced/stoped. The children were returned ward after wakening in stable condition. As measured using VAS and OPS, effective analgesi-a was evaluated at 2, 4, 8, 12, 24 hour after surgery. This study noted respiratory and circulatory signs, including MAP, HR, R , SpO2 and side effects (nausea, pruritus, urinary retention, et al. ).The results were analyzed using SPSS 10. 0 statistical software. The quantitave data were expressed as mean ?standard deviation (x + s) , and these vaiables were analyzed using one - way analysis of variance. The qualitative data were expressed as the percentage, andthese vaiables were analyzed within group or between groups using the X test. P <0.05 was considered statistically significant.ResultsThe children in three groups were similar in age, weight and duration of surgery and anesthesia. There were no differences within group and among groups on HR, R , MAP and Sp02. VAS pain scores were significandy lower in group III than group I at 2h, 4h and 8h after operation (P <0. 01, respectively). VAS pain scores were significandy lower in group IH than group I at 12h and 24h after operation (P <0. 05, respectively ). OPS were significandy lower at 8h than at 24h within group II ( P <0. 05). OPS were significandy lower in group III than group I at 2h, 4h, 8h and 12h after operation (P < 0.05, respectively) ; OPS were significandy lower in group III than group I at 24h (P <0.01) ; OPS were significandy lower in group III than group II at 12h and 24h after operation (P <0. 05, respectively ). The incidence of side effects in group III or in group II showed significandy lower than in group I(P <0.01). There was no difference between group I...
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