17 EFFECT OF TRANSDERMAL NITROGLYCERIN PATCH ON INTRATHECAL NEOSTIGMINE WITH BUPIVACAINE FOR POST OPERATIVE ANALGESIA
Journal Title: Indian journal of applied basic medical sciences - Year 2017, Vol 19, Issue 29
Abstract
Background: Spinal anesthesia is preferred over general anesthesia for various surgeries as it is simple to perform and economical. And produces rapid onset of anesthesia, analgesia with good muscle relaxation. Concept of post operative analgesia is gaining importance . Intrathecal neostigmine causes dose dependent post operative analgesia by inhibiting breakdown of acetylcholine in dorsal horn and spinal meninges. Acetylcholine produces analgesia indirectly through stimulation of release of nitric oxide in spinal cord. The transdermal nitroglycerine patch has been related to nitric oxide formation during degradation of organic nitrate and enhances the antinociception produced by low dose neostigmine intrathecally Objective: to evaluate efficacy and potency of intrathecally administered bupivacaine with neostigmine (source of Acetylcholine) and bupivacaine and neostigmine with nitroglycerine patch (source of exogenous NO) on onset and duration of sensory and motor blockade, hemodynamic stability, duration of post operative analgesia and side effects in various surgeries. Material &method: The study was conducted by taking 50 randomly selected patients for various surgeries. Patients belonged to ASA Grade I/II aged 18 to 60 years after excluding them according to exclusion criteria.Patient were divided into 2 groups. Group-A : 0.5% heavy bupivacaine 3 ml (15 mg) + preservative free neostigmine 5 mcg. Group-B : 0.5% heavy bupivacaine 3 ml (15 mg) + preservative free neostigmine 5 mcg + transdermal nitroglycerine patch (5 mg/24 hours), applied on a non anaesthetized area after 20 minutes. Results: There was no statistically significant difference present regarding time of onset of sensory as well as motor blockade and hemodynamic parameters. There was highly significant difference between total duration of analgesia in both groups(p<0.01)which was more in group B as compared to group A. Event of more hypotention noted in group B than group A and incidence of bradycardia was same in both groups. Conclusion: From this study it can be concluded that transdermal nitroglycerine patch increases post-operative analgesia of low dose intrathecal neostigmine with bupivacaine in spinal anesthesia with less side effects.
Authors and Affiliations
Dr. Shweta S. Mehta, Dr. Athar Danish Khan
Keywords
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