Clinical trial NCT02127489: The Effects of Single-dose Rectal Midazolam Application on Post-operative Recovery
Official title: The Effects of Single-dose Rectal Midazolam Application on Post-operative Recovery, Sedation, and Analgesia in Children Given Caudal Anesthesia Plus Bupivacaine
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: PHASE4
Conditions: Failed Moderate Sedation During Procedure
Keywords: Bupivacaine, caudal, rectal midazolam, children
Lead sponsor: Karadeniz Technical University
Sponsor class: OTHER
First posted: 2014-04-30
Enrollment: 40
Sex: ALL
Minimum age (years): 2
Maximum age (years): 10
Standard ages: CHILD
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: TREATMENT

Brief summary: This study aimed to compare the efficiency of rectal midazolam addition after applying bupivacaine and caudal anesthesia on postoperative analgesia time, the need for additional analgesics, postoperative recovery, sedation, and to find out its adverse effects in children having lower abdominal surgery.

Detailed description: Summary Background: This study aimed to compare the efficiency of rectal midazolam addition after applying bupivacaine and caudal anesthesia on postoperative analgesia time, the need for additional analgesics, postoperative recovery, sedation, and to find out its adverse effects in children having lower abdominal surgery.

Methods: 40 children between 2 and 10 years of American Society of Anesthesiologist (ASA) I-II stages were randomized and applied caudal anesthesia under general anesthesia. Patients were applied caudal block in addition with saline and 1milliliter/kilograms (mL/kg) bupivacaine 0.25%. In the postoperative period, Group C (n=20) was given 5 milliliter (mL) saline and Group M (n=20) was given 0.30 mg/kg rectal midazolam diluted with 5mL saline. Sedation scale and postoperative pain scale (CHIPPS) of the patients were evaluated. The patients were observed for their analgesic need, first analgesic time, and adverse effects for 24 hours.

Eligibility criteria: Inclusion Criteria:

* children having lower abdominal surgery

Exclusion Criteria:

* Children with significant respiratory system, circulatory system, liver, and kidney function disorder, history of allergy to the drugs to be studied, those who received analgesic medication before the operation, and those for whom caudal anesthesia is contraindicated

Primary outcomes:
measure: Sedation scale and postoperative pain scale (CHIPPS)
timeFrame: 24 hours
Secondary outcomes:
Other outcomes:
Locations:
city: Trabzon
country: Turkey
facility: Karadeniz Technical University Faculty of Medicine
Study officials:
affiliation: KANUNI EDUCATION AND RESEARCH HOSPITAL, TRABZON ,TURKEY
name: SEDAT SAYLAN, Med. doctor
role: PRINCIPAL_INVESTIGATOR
References:
citation: Mahajan R, Batra YK, Grover VK, Kajal J. A comparative study of caudal bupivacaine and midazolam-bupivacaine mixture for post-operative analgesia in children undergoing genitourinary surgery. Int J Clin Pharmacol Ther. 2001 Mar;39(3):116-20. doi: 10.5414/cpp39116.
citation: Breschan C, Schalk HV, Schaumberger F, Likar R. Experience with caudal blocks in children over a period of 3.5 years. Acta Anaesthesiol Scand Suppl. 1996;109:174-6. No abstract available.
citation: Sumpelmann R, Munte S. Postoperative analgesia in infants and children. Curr Opin Anaesthesiol. 2003 Jun;16(3):309-13. doi: 10.1097/00001503-200306000-00011.
citation: Lee HM, Sanders GM. Caudal ropivacaine and ketamine for postoperative analgesia in children. Anaesthesia. 2000 Aug;55(8):806-10. doi: 10.1046/j.1365-2044.2000.01330-2.x.
citation: Silvani P, Camporesi A, Agostino MR, Salvo I. Caudal anesthesia in pediatrics: an update. Minerva Anestesiol. 2006 Jun;72(6):453-9.
citation: Clausen TG, Wolff J, Hansen PB, Larsen F, Rasmussen SN, Dixon JS, Crevoisier C. Pharmacokinetics of midazolam and alpha-hydroxy-midazolam following rectal and intravenous administration. Br J Clin Pharmacol. 1988 Apr;25(4):457-63. doi: 10.1111/j.1365-2125.1988.tb03330.x.
citation: Kanegaye JT, Favela JL, Acosta M, Bank DE. High-dose rectal midazolam for pediatric procedures: a randomized trial of sedative efficacy and agitation. Pediatr Emerg Care. 2003 Oct;19(5):329-36. doi: 10.1097/01.pec.0000092578.40174.85.
citation: McGrath PJ, McAlpine L. Psychologic perspectives on pediatric pain. J Pediatr. 1993 May;122(5 Pt 2):S2-8. doi: 10.1016/s0022-3476(11)80002-8.
citation: Tyler DC, Tu A, Douthit J, Chapman RC. Toward validation of pain measurement tools for children: a pilot study. Pain. 1993 Mar;52(3):301-309. doi: 10.1016/0304-3959(93)90163-J.
citation: Shavit I, Keidan I, Augarten A. The practice of pediatric procedural sedation and analgesia in the emergency department. Eur J Emerg Med. 2006 Oct;13(5):270-5. doi: 10.1097/00063110-200610000-00005.
citation: Roy RC. Choosing general versus regional anesthesia for the elderly. Anesthesiol Clin North Am. 2000 Mar;18(1):91-104, vii. doi: 10.1016/s0889-8537(05)70151-6.
citation: Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975 Nov;12(3):189-98. doi: 10.1016/0022-3956(75)90026-6. No abstract available.
citation: Somri M, Gaitini LA, Vaida SJ, Yanovski B, Sabo E, Levy N, Greenberg A, Liscinsky S, Zinder O. Effect of ilioinguinal nerve block on the catecholamine plasma levels in orchidopexy: comparison with caudal epidural block. Paediatr Anaesth. 2002 Nov;12(9):791-7. doi: 10.1046/j.1460-9592.2002.00916.x.
citation: Solak M, Ulusoy H, Sarihan H. Effects of caudal block on cortisol and prolactin responses to postoperative pain in children. Eur J Pediatr Surg. 2000 Aug;10(4):219-23. doi: 10.1055/s-2008-1072362.
citation: Golianu B, Krane EJ, Galloway KS, Yaster M. Pediatric acute pain management. Pediatr Clin North Am. 2000 Jun;47(3):559-87. doi: 10.1016/s0031-3955(05)70226-1.
citation: Martinez-Telleria A, Cano Serrano ME, Martinez-Telleria MJ, Castejon Casado J. [Analysis of regional anesthetic efficacy in pediatric postop pain]. Cir Pediatr. 1997 Jan;10(1):18-20. Spanish.
citation: Da Conceicao MJ, Coelho L. Caudal anaesthesia with 0.375% ropivacaine or 0.375% bupivacaine in paediatric patients. Br J Anaesth. 1998 Apr;80(4):507-8. doi: 10.1093/bja/80.4.507.
citation: Gann DS, Lilly MP. The neuroendocrine response to multiple trauma. World J Surg. 1983 Jan;7(1):101-18. doi: 10.1007/BF01655918. No abstract available.
citation: Kehlet H. The stress response to surgery: release mechanisms and the modifying effect of pain relief. Acta Chir Scand Suppl. 1989;550:22-8.
citation: Reier CE, George JM, Kilman JW. Cortisol and growth hormone response to surgical stress during morphine anesthesia. Anesth Analg. 1973 Nov-Dec;52(6):1003-10. No abstract available.
citation: Saylan S, Eroglu A, Dohman D. The effects of single-dose rectal midazolam application on postoperative recovery, sedation, and analgesia in children given caudal anesthesia plus bupivacaine. Biomed Res Int. 2014;2014:127548. doi: 10.1155/2014/127548. Epub 2014 May 5.