Hostname: page-component-78c5997874-lj6df Total loading time: 0 Render date: 2024-11-10T20:53:00.645Z Has data issue: false hasContentIssue false
  • English
  • Français

Analgesic effects of intrathecal neostigmine in perianal surgery

Published online by Cambridge University Press:  30 June 2005

A. Yegin ,
M. Yilmaz ,
B. Karsli  and
M. Erman
A. Yegin
Affiliation:
Akdeniz University Faculty of Medicine, Department of Anaesthesiology, Antalya, Turkey
M. Yilmaz
Affiliation:
Akdeniz University Faculty of Medicine, Department of Anaesthesiology, Antalya, Turkey
B. Karsli
Affiliation:
Akdeniz University Faculty of Medicine, Department of Anaesthesiology, Antalya, Turkey
M. Erman
Affiliation:
Akdeniz University Faculty of Medicine, Department of Anaesthesiology, Antalya, Turkey
Get access

Extract

Summary

Background and objective: In recent human and animal studies, intrathecal administration of various doses of neostigmine produces analgesia without neurotoxicity. The aim was to examine the effects of intrathecal neostigmine and bupivacaine in patients undergoing perianal surgery under spinal anaesthesia.

Methods: The patients were randomly allocated into three groups of 15: Group 1 (controls) received hyperbaric bupivacaine 10 mg + dextrose 5%, 1 mL, to a total volume of 3 mL; Group 2 received hyperbaric bupivacaine 10 mg + neostigmine 25 μg in dextrose 5%, 1 mL, to a total volume of 3 mL; and Group 3 received hyperbaric bupivacaine 10 mg + neostigmine 50 μg in dextrose 5%, 1 mL, to a total volume of 3 mL.

Results: The onset of sensory block was significantly earlier for Group 2 and 3 patients compared with Group 1 patients (P < 0.05). The full time to recovery of motor block and sensory block was significantly longer in Group 3 compared with Group 1 (P < 0.05). In Group 3, the average time until the first dose of tramadol was longer than Group 1 (P < 0.05). The incidence rate of nausea and vomiting was significantly higher in Groups 2 and 3 than in Group 1 (P < 0.05).

Conclusions: The use of intrathecal neostigmine as an analgesic drug in perianal surgery is unsatisfactory because of prolonged motor blockade and nausea.

Keywords

ANAESTHESIA, CONDUCTION, anaesthesia spinal, CHOLINESTERASE INHIBITORS, neostigminePOSTOPERATIVE COMPLICATIONS, pain postoperativePOSTOPERATIVE NAUSEA AND VOMITING
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 20 , Issue 5 , May 2003 , pp. 404 - 408
Copyright
2003 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Liu SS, Hodgson PS, Moore JM, Trautman WJ, Burkhead DL. Dose–response effects of spinal neostigmine added to bupivacaine spinal anesthesia in volunteers. Anesthesiology 1999; 90: 710–717.Google Scholar
Wamsley JK, Lewis MS, Young WS III, Kuhar MJ. Autoradiographic localisation of muscarinic cholinergic receptors in rat brainstem. J Neurosci 1981; 1: 176–191.Google Scholar
Naguib M, Yaksh TL. Antinociceptive effects of spinal cholinesterase inhibition and isobolographic analysis of the interaction with mu and alpha2 receptor systems. Anesthesiology 1994; 80: 1338–1348.Google Scholar
Bouaziz H, Tong C, Eisenach JC. Postoperative analgesia from intrathecal neostigmine in sheep. Anesth Analg 1995; 80: 1–5.Google Scholar
Hood DD, Eisenach JC, Tuttle R. Phase I safety assessment of intrathecal neostigmine methylsulfate in humans. Anesthesiology 1995; 82: 331–343.Google Scholar
Ben-David B, Soloman E, Levin H, Admoni H, Goldik Z. Intrathecal fentanyl with small dose dilute bupivacaine: better anesthesia without prolonging recovery. Anesth Analg 1997; 85: 560–565.Google Scholar
Chaney MA. Side effects of intrathecal and epidural opioids. Can J Anaesth 1995; 42: 891–903.Google Scholar
Eisenach JC, De Kock M, Klimscha W. Alpha 2-adrenergic agonists for regional anesthesia. A clinical review of clonidine (1984–1995). Anesthesiology 1996; 85: 655–674.Google Scholar
Liu SS. Optimizing spinal anesthesia for ambulatory surgery. Reg Anesth 1997; 22: 500–510.Google Scholar
Skura S, Sumi M, Sakaguchi Y, et al. The addition of phenylephrine contributes to the development of transient neurologic symptoms after spinal anesthesia with 0.5% tetracaine. Anesthesiology 1997; 87: 771–778.Google Scholar
Buerkle H, Boschin M, Marcus MAE, et al. Central and peripheral analgesia mediated by the acetylcholisterase-inhibitor neostigmine in the rat inflamed knee joint model. Anesth Analg 1998; 86: 1027–1032.Google Scholar
Pan PM, Huang CT, Wei TT, Mok MS. Enhancement of analgesic effect of intrathecal neostigmine and clonidine on bupivacaine spinal anesthesia. Reg Anesth 1998; 23: 49–56.Google Scholar
Lauretti GR, Hood DD, Eisenach JC, Pfeifer BL. A multicenter study of intrathecal neostigmine for analgesia following vaginal hysterectomy. Anesthesiology 1998; 89: 913–918.Google Scholar
Lauretti GR, Mattos AL, Reis MP, Prado WA. Intrathecal neostigmine for postoperative analgesia after orthopedic surgery. J Clin Anesth 1997; 9: 473–477.Google Scholar
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: 341–346.Google Scholar
Lauretti GR, Mattos AL, Reis MP, Prado WA. Intrathecal neostigmine for postoperative analgesia after orthopedic surgery. J Clin Anesth 1997; 9: 473–477.Google Scholar
Tan PH, Kuo JH, Liu K, et al. Efficacy of intrathecal neostigmine for the relief of postinguinal herniorraphy pain. Acta Anaesthesiol Scand 2000; 44: 1056–1060.Google Scholar
Hood DD, Eisenach JC, Tuttle R. Phase I safety assessment of intrathecal neostigmine methylsulfate in humans. Anesthesiology 1995; 82: 331–343.Google Scholar
Krukowski JA, Hood DD, Eisenach JC, Mallak KA, Parker RL. Intrathecal neostigmine for post-Cesarean section analgesia: dose response. Anesth Analg 1997; 84: 1269–1275.Google Scholar
Pan H-L, Song H-K, Eisenach JC. Effects of intrathecal neostigmine, bupivacaine, and their combination on sympathetic nerve activity in rats. Anesthesiology 1998; 88: 481–486.Google Scholar
Carp H, Jayaram A, Morrow D. Intrathecal cholinergic agonists lessen bupivacaine spinal-block-induced hypotension in rats. Anesth Analg 1994; 79: 112–116.Google Scholar