Analgesic effect of epidural neostigmine after abdominal hysterectomy.
OBJECTIVE
To evaluate the effects of epidurally administered neostigmine on pain after abdominal hysterectomy.


METHODS
Prospective, randomized, double-blind study.


METHODS
Teaching hospital.


METHODS
45 ASA physical status I adult patients scheduled for abdominal hysterectomy.


METHODS
All patients received identical general and epidural anesthesia. At the end of the surgery, they received epidural bupivacaine (10 mg) with either saline (control group, n = 15), 5 micro g/kg (5-micro g group, n = 15), or 10 micro g/kg neostigmine (10-micro g group, n = 15). Postoperatively, 50 mg diclofenac suppository was given for pain relief on patient demand.


RESULTS
The time to first diclofenac administration and the number of times diclofenac was required during the first 24 postoperative hours were recorded. Pain was assessed using a 10-cm visual analog pain scale (VAS) at rest at the first diclofenac request, and at 15 and 24 hours after surgery. The time to first diclofenac administration was significantly longer (p < 0.05) in the 10-micro g group (223 +/- 15 min) than in the control (78 +/- 17 min) or 5-micro g groups (88 +/- 18 min). However, epidural neostigmine at both doses did not reduce the number of postoperative diclofenac administrations. There were no differences in VAS among the three groups.


CONCLUSIONS
Epidural neostigmine of 10 micro g/kg in bupivacaine provides a longer duration of analgesia than does bupivacaine alone or with 5 micro g/kg of neostigmine after abdominal hysterectomy.
Nakayama
M
M
Department of Anesthesiology, Obihiro Kosei Hospital, Obihiro, Japan. miyabi@zc4.so-net.jp
Ichinose
H
H
Nakabayashi
K
K
Satoh
O
O
Yamamoto
S
S
Namiki
A
A
D015360:Analgesia, Epidural; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D002800:Cholinesterase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D004008:Diclofenac / Q000627:therapeutic use; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008297:Male; D008875:Middle Aged; D009388:Neostigmine / Q000009:adverse effects / Q000627:therapeutic use*; D010147:Pain Measurement / Q000187:drug effects; D010149:Postoperative Pain / Q000188:drug therapy*; D011229:Preanesthetic Medication; D011446:Prospective Studies
D000894:Anti-Inflammatory Agents, Non-Steroidal; D002800:Cholinesterase Inhibitors; D004008:Diclofenac; D009388:Neostigmine