COMPARATIVE STUDY OF INTRATHECAL BUPIVACAINE WITH OR WITHOUT NEOSTIGMINE FOR INFRAUMBILICAL SURGERIES
Journal Title: Journal of Evidence Based Medicine and Healthcare - Year 2017, Vol 4, Issue 49
Abstract
BACKGROUND Spinal anaesthesia requires a small volume of drug to produce profound sensory analgesia and motor blockade, but has limited duration of action. An adjuvant to local anaesthetic agent produces a better quality regional block. Intrathecal (IT) neostigmine has been used as an adjunct to Spinal Anaesthesia (SA) for the prevention of acute perioperative pain. It has been shown to potentiate opioid analgesia.1 According to recent literature, the inhibition of acetylcholine degradation by neostigmine enhances the descending control of afferent nociceptive stimuli and provides new approach for enhancement of desirable analgesia with few dose-related side effects.2 The use of neostigmine intrathecally does not cause any hypotension, sedation, respiratory depression or neurological dysfunction.2 Hence, we studied to compare the effect of intrathecal neostigmine 50 µg added to intrathecal hyperbaric bupivacaine with regard to sensory characteristics, motor characteristics and side effects. MATERIALS AND METHODS This was a prospective, randomised controlled double blinded study in 60 patients posted for infraumbilical surgeries belonging to ASA I and II status and aged between 18 to 60 years. One group received intrathecal 0.5% hyperbaric bupivacaine 3 mL (15 mg) group A and second group received preservative-free neostigmine 50 µg with 3 mL (15 mg) of intrathecal 0.5% hyperbaric bupivacaine group B and they were compared with regard to sensory characteristics, motor characteristics and side effects. RESULTS The addition of neostigmine 50 ug to hyperbaric bupivacaine prolonged mean duration of analgesia from the time of onset of complete sensory blockade to the time at which rescue analgesic was given using VAS score. It was 322.2 + 25.76 (SD) min. in the neostigmine group suggesting a statistically significant delay in onset of breakthrough pain between group A and group B. CONCLUSION Intrathecal neostigmine 50 ug with bupivacaine produces a good sensory and motor block for the surgical procedure with safe, durable and predictable postoperative analgesia. Administration of intrathecal neostigmine as an adjuvant to bupivacaine produces effective, prolonged and haemodynamically stable postoperative analgesia as compared to administration of intrathecal bupivacaine alone.2
Authors and Affiliations
Dadichiluka Veeragouri Sankararao, Kesava Vamsikrishna Bhairavabhatla
Keywords
Related Articles
- EP ID EP220167
- DOI 10.18410/jebmh/2017/592
- Views 82
- Downloads 0
A COMPARATIVE STUDY OF ONLAY AND RETRORECTUS MESH REPAIR IN INCISIONAL HERNIA
BACKGROUND Incisional hernia is a frequent complication of abdominal surgery constituting about 10% to 20% of laparotomy. There are various factors responsible, like the patient characteristics and the underlying patholo...
A STUDY ON CORRELATION OF DIABETIC RETINOPATHY IN RELATION TO DIABETIC NEPHROPATHY IN TYPE II DM PATIENTS
Diabetes mellitus is one of the most common metabolic disorders of multiple etiology. The multisystem effects of diabetes such as retinopathy, nephropathy, neuropathy and cardiovascular diseases have an important impingi...
COMPARISON OF LOW-DOSE BUPIVACAINE WITH FENTANYL AND BUPIVACAINE ALONE FOR SPINAL ANAESTHESIA FOR LOWER LIMB SURGERIES
BACKGROUND Bupivacaine is the widely used anaesthetic agent for spinal anaesthesia. Though, it has some advantages of producing good surgical anaesthesia and a longer half-life when compared to other local anaesthetics,t...
A STUDY OF BLOOD LEAD LEVELS IN YOUNG HYPERTENSIVE PATIENTS
BACKGROUND Lead is a normal constituent of the earth’s crust, with trace amounts found naturally in soil, plants and water. Over the years lead has become one of the most popular elements in the manufacturing of man-made...
A PROSPECTIVE STUDY OF THE COURSE AND OUTCOME OF NUCHAL CORD IDENTIFIED AT 34 WEEKS OF GESTATION
USS report at 34 weeks of gestation may mention presence of nuchal cord. This may cause anxiety and apprehension in the patient. After a detailed counseling, the scan is repeated at 39 weeks to identify those with persis...