Evaluation and comparison of clinical efficacy, post-operative analgesia and hemodynamic effect of intrathecal hyperbaric bupivicaine versus intrathecal hyperbaric bupivicaine plus neostigmine during lower abdominal and lower limb surgeries.

Irfan Rasool Bhat; Hilal Ahmad

Volume : VII, Issue : XI, November - 2017

Evaluation and comparison of clinical efficacy, post-operative analgesia and hemodynamic effect of intrathecal hyperbaric bupivicaine versus intrathecal hyperbaric bupivicaine plus neostigmine during lower abdominal and lower limb surgeries.

Irfan Rasool Bhat, Hilal Ahmad

Abstract :

Background and Aims

Pain management especially in the post–operative period is an essential practice in the field of anaesthesiology. Providing purposeful and proper post–operative analgesia has become a popular practice for the sake of patient comfort. Neural blockade is commonly used to control post–operative pain.Additives like systemic benzodiazepines, synthetic and semi– synthetic opiods are simple, effective and commonly adopted way of post–operative pain relief.In this study we evaluated & compared clinical efficacy, post–operative analgesia and hemodynamic effect of intrathecal hyperbaric bupivicaine versus intrathecal hyperbaric bupivicaine plus neostigmine during lower abdominal and lower limb surgeries.

Methods: This was a Randomised Control trial.The patients were randomly assigned to one of the two groups with 30 patients each. Allocation into groups was done by using sealed envelopes.

Group C received intrathecally 2.5 ml of 0.5% of hyperbaric bupivacaine plus 1ml of normal saline.Group N received intrathecally 2.5ml of 0.5% hyperbaric bupivacaine plus 50 mcg of neostigmine (1ml) – Study Group. and they were compared with regards to clinical efficacy, post–operative analgesia , haemodynamic stability and side effects .

Results Addition of 50 μg neostigmine significantly decreased the onset time of sensory analgesia (Group N 1.48±0.425 , Group C 2.85±0.671, P value as <0.05 ) & the Mean Time taken to achieve maximum level of sensory block(Group N 6.40±1.029 , Group C 7.53±1.167 , P value as <0.05).Duration of sensory regression to S1 level was 215.13±26.23 in Control group as compared to 272.87±59.52 in study group, p value = 0.001 . The mean duration of analgesia for control group was 223.80±42.302 min and for study group 462.70± 38.587 min.Side effects such as nausea & vomiting , shivering ,Vasopressor & anti–emetic requirement were comparable in both group & insignificant statistically.

Conclusions

50mcg neostigmine seems to be an attractive alternative as an adjuvant to spinal bupivacaine in surgical procedures.Significant prolongation of analgesia & adequate motor relaxation without any side effects gives a safe edge in situations where there is unexpected prolongation of surgical procedure.