In the present study, we have observed that Addition of either Neostigmine or ketamine to caudal bupivacaine significantly prolonged its analgesic effect but bupivacaine-neostigmine mixture had longer effect than bupivacaine or bupivacaine-ketamine mixture.
In patients receiving neostigmine added to caudal bupivacaine, we noticed hemodynamic stability, pain scores showing no or minimal pain, normal hormonal levels and no major complications were noticed. This analgesic effect of both drugs extends from 16 to 20 hours postoperatively.
By this thesis, epidural neostigmine has proved to be safe in the concentration used and proved to prolong the local anesthetic analgesic duration by a period that reached up to 20 hours postoperatively