Enhancement of axillary brachial plexus block anesthesia by coadministration of neostigmine.
OBJECTIVE
The acetylcholinesterase inhibitor neostigmine has shown peripherally mediated analgesic action in recent preclinical and clinical studies. The present study investigates the effectiveness of adding neostigmine to a local anesthetic, mepivacaine, in patients receiving axillary brachial plexus block for upper extremity surgery.


METHODS
In a double-blind, randomized study 34 patients were assigned to the treatment group: Neostigmine (NM) (500 microg) + mepivacaine (M) (500 mg) (NM, n = 17) as drugs for the plexus block, or to control group: mepivacaine (500 mg) + saline (0.9%, 1 mL) (M, n = 17).


RESULTS
The onset and duration of sensory and motor block was similar in both groups. Patients receiving NM had significantly lower pain ratings [visual analogue scores (VAS): 14.7 +/- 9.9 vs 32.4 +/-23.5; P < .05] 24 hours after surgery, and a lower number of patients in the NM group needed supplemental analgesics during the first 24 hours postoperatively. No adverse events were recorded for either group.


CONCLUSIONS
Peripherally administered neostigmine improves postoperative analgesia in axillary brachial plexus block.
Bone
H G
HG
Department of Anesthesiology and Operative Intensive Care Medicine, Westfälische Wilhelms-Universität Münster, Germany.
Van Aken
H
H
Booke
M
M
Bürkle
H
H
D000759:Adjuvants, Anesthesia; D000328:Adult; D000368:Aged; D000779:Anesthetics, Local / Q000009:adverse effects; D001917:Brachial Plexus; D002800:Cholinesterase Inhibitors / Q000009:adverse effects; D004311:Double-Blind Method; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D008297:Male; D008619:Mepivacaine / Q000009:adverse effects; D008875:Middle Aged; D009388:Neostigmine / Q000009:adverse effects; D009407:Nerve Block / Q000009:adverse effects; D010147:Pain Measurement
D000759:Adjuvants, Anesthesia; D000779:Anesthetics, Local; D002800:Cholinesterase Inhibitors; D009388:Neostigmine; D008619:Mepivacaine