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Lal, Sanjay
- A Pilot Study of the Efficacy of Intrathecal Neostigmine for Postoperative Analgesia in Lower Abdominal and Lower Limb Surgery at SIMS, Ghaziabad, Uttar Pradesh
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Authors
Affiliations
1 Department of Anaesthesia, Sarswathi Institute of Medical Sciences, NH-24 Anwarpur, Hapur, Ghaziabad 245304, IN
1 Department of Anaesthesia, Sarswathi Institute of Medical Sciences, NH-24 Anwarpur, Hapur, Ghaziabad 245304, IN
Source
Indian Journal of Public Health Research & Development, Vol 3, No 1 (2012), Pagination: 136-138Abstract
Intrathecal neostigmine had been used in various doses to produce analgesia without neurotoxicity in both animal and human studies. The present study was conducted using 50μg intrathecal neostigmine methylsulphate with 12.5mg bupivacaine (0.5% heavy) for optimum duration of post-operative analgesia with minimal side effects. In this study 100 patients belonging to ASA physical status I and II, age 20-70 years of either sex scheduled for elective lower abdominal and lower limb surgeries under spinal anaesthesia were included. Patients were randomly allocated in two groups: group I (n=50, control) received 2.5ml bupivacaine + 0.5ml of normal saline and group II (n=50, test) received 2.5ml bupivacaine +0.5ml of neostigmine (50μg). Time of onset of sensory and motor block, highest level of block, duration of analgesia and side effects like hypotension, bradycardia, nausea, vomiting, etc were recorded. Onset time of sensory and motor block was much faster In bupivacaine and neostigmine group as compared to bupivacaine group. Patients were pain free for average 6-7 hours with bupivacaine and neostigmine as compared to 3-4 hours with bupivacaine. It was concluded that intrathecal neostigmine in the dose of 50μg provide post-operative analgesia for a period of 6-8 hours with lesser incidence of side effects of nausea and vomiting.Keywords
Anaesthesia, Spinal Anaesthesia, Drugs, Bupivacaine, Neostigmine
References
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- Krukowski JA, Hood DD, Eisenach JC and et al. intrathecal neostigmine for post caesarean section analgesia: Dose response. Anesth Analg 1997; 84: 1269-75.
- Eisenach JC, Detweiler DJ, Tong Cy and et al. Cerebrospinal fluid norepinephrine and acetylcholine concentrations during acute pain. Anesth Analg 1996; 82: 621-6.
- Hood D.D., Eisenach J.C., Tong C., Tommasi E., Yaksh T.L.Cardio respiratory and spinal cord blood flows effects of intrathecal neostigmine methy1sulphate, clonidine and their combination in sheep. Anesthesiology 1995; 82: 428-435.
- Chung CJ, Kim JS, Park HS, Chin YJ. The efficacy of intrathecal neostigmine, intrathecal morphine and their combination for post cesarean section analgesia. Anesth Analg 1998; 87: 341-6.
- Mainvsky J.M., Renaud G., Le Corre P.Intrathecal bupivacaine in humans: effects of volume and baricity on spinal effects. Anesthesiology 1999; 91:1260-1266.
- Krukowski J.A., Hood D.D., Eisenach J.C. and et al. Intrathecal neostigmine for post cesarean section analgesia; dose response. Anesth Analg. 1997; 84: 1269-1275.
- Batra YK, Rajeev S, Panda NB and et al. Intrathecal neostigmine With bupivacaine for infants undergoing lower abdominal and urogenital Procedures dose response.Acta Anaesthesiol Scand 2009;Apr,53(4);470-5
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- Gupta S.Postoperative Analgesia With Intrathecal Neostigmine; Two Different doses Of 75 µgms And 50 µgms With Heavy Bupivacaine. The Internet journal of Anaesthesiology ISSN 1092-406X
- Lauretti GR, Hood DD, Eisenach JC. A multicenter study of intrathecal neostigmine for analgesia following vaginal hysterectomy. Anesthesiology 1998; 89: 913-8.
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- A Comparison of Post Operative Analgesia and Adverse Effects Produced by Neostigmine and Morphine when Given Intrathecally
Abstract Views :287 |
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Authors
Affiliations
1 Department of Anaesthesia, Saraswathi Institute of Medical Sciences, Hapur, Ghaziabad 245304, IN
1 Department of Anaesthesia, Saraswathi Institute of Medical Sciences, Hapur, Ghaziabad 245304, IN
Source
Indian Journal of Public Health Research & Development, Vol 3, No 2 (2012), Pagination: 154-157Abstract
Various modalities had been tried for optimum duration of post operative analgesia with minimal side effects. The present study was undertaken to evaluate the duration and quality of post operative analgesia by intrathecal bupivacaine alone, intrathecal bupivacaine12.5mg (0.5% heavy) with neostigmine (50μg) or intrathecal bupivacaine12.5mg (0.5% heavy) with morphine (100μg) in spinal block. 150 patients of ASA physical status 1&2, age 20-70 years of either sex, body weight 50- 100Kg were randomally assigned in three study groups. Group I - 0.5% bupivacaine (2.5ml bupivacaine+0.5ml normal saline), group II - 0.5% bupivacaine with 50μg neostigmine (2.5ml bupivacaine+0.5ml neostigmine) and group III - 0.5% bupivacaine with morphine100μg (2.5 ml bupivacaine+0.5 ml morphine). Onset of sensory and motor block of intrathecal neostigmine and intrathecal morphine group was much faster as compare to control group. Duration of post operative analgesia was also more in intrathecal neostigmine and intrathecal morphine group as compare to control group. Intrathecal neostigmine and intrathecal morphine groups were comparable in terms of onset of sensory and motor block and level of highest block. Nausea, vomiting and bradycardia were more in neostigmine group as compare to intrathecal morphine and control group. Patients in intrathecal morphine group had more incidence of pruritus. We concluded that intrathecal morphine 100μg is a better choice than intrathecal neostigmine during spinal block.Keywords
Anaesthesia, Spinal Anaesthesia, Drugs, Bupivacaine, Neostigmine, MorphineReferences
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- Casey WF, Wynands JE, Ralley FE. The role of intrathecal morphine in the anesthetic management of patients undergoing coronary bypass surgery. J Cardiothorac Anesth 1987;1:510–6.
- Hamber EA, Viscomi CM. Intratheal lipophilic opioids as adjuncts to surgical spinal anesthesia. Reg Anesth Pain Med 1999;24:255– 63.
- Murphy PM, Stack D, Kinirons B, and et al. Optimizing the Dose of Intrathecal Morphine in Older Patients Undergoing Hip Arthroplasty Anesth Analg 2003;97:1709 –15.
- Almeida RA, Lauretti GR, Mattos AL. Antinociceptive Effect of Low-dose Intrathecal Neostigmine Combined with Intrathecal Morphine following Gynecologic Surgery. Anesthesiology: 2003;(2);495-498.
- Motamed C, Bouaziz H, Franco Dand et al. Analgesic effect of low-dose intrathecal morphine and bupivacaine in laparoscopic cholecystectomy. Association of Anaesthetists of Great Britain & Ireland 2000;55:118-124.
- Krukowski JA, Hood DD, Eisenach JC and et al. intrathecal neostigmine for post caesarean section analgesia: Dose response. Anesth Analg 1997; 84: 1269-75.
- Eisenach JC, Detweiler DJ, Tong Cy and et al. Cerebrospinal fluid norepinephrine and acetylcholine concentrations during acute pain. Anesth Analg 1996; 82: 621-6.
- Chung CJ, Kim JS, Park HS and et al. The efficacy of Intrathecal neostigmine, intrathecal morphine and their combination for post cesarean section analgesia. Anesth Analg 1998; 87: 341-6.
- Mainvsky J.M., Renaud G., Le Corre P. Intrathecal bupivacaine in humans: effects of volume and baricity on spinal effects. Anesthesiology 1999; 91:1260-1266.
- Eisenach JC, Hood DD, Curry R. Phase I human safety assessment of intrathecal neostigmine containing methyl- and propylparabens. Anesth Analg 1997; 85:842–6.
- Lauretti GR, Hood DD, Eisenach JC. A multicenter study of intrathecal neostigmine for analgesia following vaginal hysterectomy. Anesthesiology 1998; 89: 913-8.
- Tan PH, Chia YY, Lo Y and et al: Intrathecal bupivacaine with Morphine or neostigmine for postoperative analgesia after total Knee replacement surgery. Can J Anaesth, 2001; 48: 6: 551–618.
- Ishaque M, Siddique R, Hashmi SN, Naseem A and et al;A study of post operative analgesia and adverse effects produced by intrathecal neostigmine, morphine and their combination in patients undergoing elective caessarian section under spinal anaesthesia. Pakistan Armed Force Medical Journal : 2005,(2).
- Klamt, J. G, Garcia, L. V, Prado W A. Analgesic and adverse effects of a low dose of intrathecally administered hyperbaric neostigmine alone or combined with morphine in patients submitted to spinal anesthesia: pilot studies. Anesth 1999; 54(1): 27-31.