title: The effect of epidural neostigmine combined with ropivacaine and sufentanil on neuraxial analgesia during labor.
abstract: Spinal neostigmine produces analgesia without respiratory depression or hypotension but provokes major gastrointestinal side effects. Epidural injection of this drug, however, appears to induce analgesia devoid of such side effects. In this study, we evaluated the effect of a bolus of epidural neostigmine on the duration and magnitude of analgesia in early labor and assessed its eventual sparing effect on subsequent local anesthetic requirements. Epidural neostigmine methylsulfate (maximal dose 4 microg/kg) was added to 10 mL of ropivacaine 0.1%, with and without sufentanil 10 microg, to initiate analgesia. Twenty minutes after injection, pain score, sensory level, and motor block were assessed. Time until request for supplemental epidural medication was also recorded. Patient-controlled epidural analgesia with ropivacaine 0.1% was used for epidural supplementation. Maternal and fetal side effects were closely recorded. Neostigmine (4 microg/kg), when added to ropivacaine 10 mg, provided equivalent analgesia to ropivacaine 20 mg but was less effective than sufentanil 10 microg for the initiation of labor epidural analgesia. Further, neostigmine did not modify the subsequent patient-controlled epidural analgesia local anesthetic requirements during labor. No hemodynamic instability, additional motor block, or bothersome side effects were recorded.
  
  
  CONCLUSIONS
  The combination of epidural neostigmine (4 microg/kg) with the local anesthetic ropivacaine, with or without sufentanil, does not significantly enhance neuraxial analgesia during labor. Such a dose, however, has no bothersome side effects.
authors.affiliation: Department of Anesthesiology, Université Catholique de Louvain, St. Luc Hospital, Brussels, Belgium.
authors.forename: Fabienne
authors.initials: F
authors.lastname: Roelants
authors.forename: Michella
authors.initials: M
authors.lastname: Rizzo
authors.forename: Patricia
authors.initials: P
authors.lastname: Lavand'homme
mesh_terms: D000328:Adult; D000577:Amides / Q000009:adverse effects; D015360:Analgesia, Epidural / Q000009:adverse effects; D016362:Analgesia, Obstetrical / Q000009:adverse effects; D018686:Anesthetics, Intravenous / Q000009:adverse effects; D000779:Anesthetics, Local / Q000009:adverse effects; D001794:Blood Pressure / Q000187:drug effects; D002800:Cholinesterase Inhibitors / Q000009:adverse effects; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D009388:Neostigmine / Q000009:adverse effects; D010100:Oxygen / Q000097:blood; D010147:Pain Measurement; D011247:Pregnancy; D011446:Prospective Studies; D000077212:Ropivacaine; D017409:Sufentanil / Q000009:adverse effects
chemical_list: D000577:Amides; D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D002800:Cholinesterase Inhibitors; D009388:Neostigmine; D000077212:Ropivacaine; D017409:Sufentanil; D010100:Oxygen