Prospective Randomized Double Blind Study to Evaluate the Analgesic E?cacy of Low Dose of Intrathecal Neostigmine in Combination with Fentanyl and Bupivacaine for Lower Abdominal and Lower Limb Surgery

Analgesic Efficacy of Intrathecal drugs

Abstract

Background: More than 80% of patients undergoing surgical procedures under spinal anesthesia experience acute post-operative pain. The present study was conducted with aim to compare the analgesic efficacy and side effects of addition of neostigmine to fentanyl and bupivacaine. Subjects and Methodology: The study was conducted at Christian Medical College and Hospital, Ludhiana in the Department of Anaesthesia and Critical Care, from 15^th Oct 2015 to 14^th Oct 2016. 50 patients aged between 18 - 60 years belonging to the ASA grade I & II undergoing elective surgery for lower abdominal and limb region (likely to finish within 3 hours), were divided into 2 groups(25 each) . Group A was given Intrathecal Bupivacaine 12.5 mg (2.5 ml) + Fentanyl 20 g (0.4 ml)+0.1 ml Normal Saline (Total 3 ml) and Group B was given Intrathecal Bupivacaine 12.5 mg (2.5 ml) + Fentanyl 20 g (0.4 ml) + Neostigmine 1g (0.1 ml) (Total 3 ml). Various parameters such as sensory and motor block onset, point of maximum sensory level attainment, VAS pain score, rescue analgesia and adverse effects were recorded. Results: The results showed that both the groups showed statistically significant difference in terms of sensory blockade and recovery of sensory blockade was. It was observed that group B showed the early onset of sensory blockade and prlonged recovery time. No difference was seen in maximal sensory blockade. Conclusion: Intrathecal neostigmine precipitated the onset of motor and sensory blockade and prolongs the block significantly when used with bupivacaine and fentanyl in spinal anesthesia in a low dose. The duration of analgesia was also significantly prolonged when neostigmine is added. Although the addition of neostigmine produced side effects like nausea and hypo tension, they were not statistically significant and were cautiously managed.