Combined intrathecal fentanyl and neostigmine: therapy for postoperative abdominal hysterectomy pain relief.
OBJECTIVE
To evaluate the analgesic action of spinal neostigmine as part of a multimodal analgesic therapy approach including spinal neostigmine and spinal fentanyl for postoperative pain relief


METHODS
Randomized, prospective study.


METHODS
Teaching hospital.


METHODS
50 ASA physical status I and II patients undergoing abdominal hysterectomy.


METHODS
Patients were assigned to one of five groups (n = 10) to receive 15 mg bupivacaine plus 1 ml of the test drug intrathecally. The control group (CG) received saline as the test drug, the fentanyl group (FG) received 25 microg fentanyl; the neostigmine group (NG) received 25 microg neostigmine; the fentanyl-neostigmine 10 microg group (FNG10) was given 10 microg fentanyl plus 10 microg neostigmine; and the fentanyl-neostigmine 25 microg group (FNG25) received 25 microg fentanyl plus 25 microg neostigmine. Pain and nausea were evaluated using a 10-cm visual analog scale (VAS).


RESULTS
The analgesic consumption, in 24 hours was greatest in CG, next highest in NG, FG, and FNG10 where consumption was the same in the three groups; and least in FNG25 (p < 0.05). The time to first rescue analgesic medication was greatest for FNG25 compared with the other groups (>5 hours compared with 2 to 3 hours; p < 0.05). VAS showed no statistically significant differences for pain impression, intraoperative and postoperative nausea, or occurrence of vomiting (p > 0.05).


CONCLUSIONS
The combination of 25 microg neostigmine with 25 microg fentanyl given intrathecally with 15 mg of hyperbaric bupivacaine delayed postoperative pain and lowered the number of rescue analgesics. Because the better quality of analgesia was obtained with an increased (although not statistically significant difference) incidence of untoward side effects, larger samples should be studied before its routine use is recommended.
Department of Surgery, Orthopedics and Traumatology, Hospital das Clínicas, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Brazil.
G R
GR
Lauretti
A L
AL
Mattos
M P
MP
Reis
N L
NL
Pereira
D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D000704:Analysis of Variance; D004359:Drug Therapy, Combination; D005260:Female; D005283:Fentanyl / Q000627:therapeutic use*; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects* / Q000379:methods; D007278:Injections, Spinal; D008875:Middle Aged; D009388:Neostigmine / Q000627:therapeutic use*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D011446:Prospective Studies
D000701:Analgesics, Opioid; D009388:Neostigmine; D005283:Fentanyl