Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Sep;19(9):801-6.

Low-dose spinal neostigmine further enhances the analgesic effect of spinal bupivacaine combined with epidural dexamethasone, following orthopedic surgery

Gabriela Rocha Lauretti  1 , Fabricio S Veloso  1 , Antonio T Kitayama  1 , Anita Leocadia Mattos  2
Affiliations

Low-dose spinal neostigmine further enhances the analgesic effect of spinal bupivacaine combined with epidural dexamethasone, following orthopedic surgery

Gabriela Rocha Lauretti et al. J Res Med Sci. 2014 Sep.

Abstract

Background: Opioids are considered mainstream for combined spinal-epidural anesthesia, but frequently limited by adverse effects. The aim of this study was to examine whether low-dose spinal neostigmine, epidural dexamethasone or their combination enhances analgesia from spinal bupivacaine without adverse effects.

Materials and methods: A total of 60 patients undergoing orthopedic surgery were randomized to one of four groups and evaluated for 24-h after surgery for analgesia (time to first rescue analgesic) and rescue analgesic consumption. Patients received 15 mg bupivacaine plus the test drug intrathecally (saline or 1 microgram (μg) neostigmine). The epidural test drug was either saline or 10 mg dexamethasone. The Control group (CG) received spinal and epidural saline. The Neostigmine group (NG), spinal neostigmine and epidural saline; the Dexamethasone group (DG), spinal saline and epidural dexamethasone; and the Neostigmine-dexamethasone group (NDG), spinal neostigmine and epidural dexamethasone.

Results: The CG (282 ± 163 min) and NG (524 ± 142 min) were similar in their times to first rescue analgesic and analgesic consumption. The time to first rescue analgesic was longer for the DG (966 ± 397 min) compared with CG and NG (P < 0.0002), and the DG had less ketoprofen consumption and lower overall visual analogue scale-pain sores compared with CG and NG (P < 0.0005). Addition of 1 mg-neostigmine (NDG) resulted in longer time to rescue analgesic (1205 ± 303 min; P < 0.02) and lower ketoprofen consumption (P < 0.05) compared to DG. Sporadic cases of vesical catheterization and emesis were observed, however adverse effects were similar among groups.

Conclusion: Spinal 1 microgram (μg) neostigmine further enhanced analgesia from spinal bupivacaine combined with epidural dexamethasone, without increasing the incidence of adverse effects.

Keywords: Epidural dexamethasone; postoperative analgesia; spinal neostigmine.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Flow diagram of progress through the phases enrolment, allocation, follow-up and analysis
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Owen MD, Ozsaraç O, Sahin S, Uçkunkaya N, Kaplan N, Magunaci I. Low-dose clonidine and neostigmine prolong the duration of intrathecal bupivacaine-fentanyl for labor analgesia. Anesthesiology. 2000;92:361–6. - PubMed
    1. D’Angelo R, Dean LS, Meister GC, Nelson KE. Neostigmine combined with bupivacaine, clonidine, and sufentanil for spinal labor analgesia. Anesth Analg. 2001;93:1560–4. - PubMed
    1. Chang FL, Ho ST, Sheen MJ. Efficacy of mirtazapine in preventing intrathecal morphine-induced nausea and vomiting after orthopaedic surgery*. Anaesthesia. 2010;65:1206–11. - PubMed
    1. Düger C, Gürsoy S, Karadağ O, Kol IÖ, Kaygusuz K, Özal H, et al. Anesthetic and analgesic effects in patients undergoing a lumbar laminectomy of spinal, epidural or a combined spinal-epidural block with the addition of morphine. J Clin Neurosci. 2012;19:406–10. - PubMed
    1. Black AS, Newcombe GN, Plummer JL, McLeod DH, Martin DK. Spinal anaesthesia for ambulatory arthroscopic surgery of the knee: A comparison of low-dose prilocaine and fentanyl with bupivacaine and fentanyl. Br J Anaesth. 2011;106:183–8. - PubMed

LinkOut - more resources