Analgesic effects of intrathecal neostigmine in perianal surgery.
OBJECTIVE
In recent human and animal studies, intrathecal administration of various doses of neostigmine produces analgesia without neurotoxicity. The aim was to examine the effects of intrathecal neostigmine and bupivacaine in patients undergoing perianal surgery under spinal anaesthesia.


METHODS
The patients were randomly allocated into three groups of 15: Group 1 (controls) received hyperbaric bupivacaine 10 mg + dextrose 5%, 1 mL, to a total volume of 3 mL; Group 2 received hyperbaric bupivacaine 10 mg + neostigmine 25 microg in dextrose 5%, 1 mL, to a total volume of 3 mL; and Group 3 received hyperbaric bupivacaine 10 mg + neostigmine 50 microg in dextrose 5%, 1 mL, to a total volume of 3 mL.


RESULTS
The onset of sensory block was significantly earlier for Group 2 and 3 patients compared with Group 1 patients (P < 0.05). The full time to recovery of motor block and sensory block was significantly longer in Group 3 compared with Group 1 (P < 0.05). In Group 3, the average time until the first dose of tramadol was longer than Group 1 (P < 0.05). The incidence rate of nausea and vomiting was significantly higher in Groups 2 and 3 than in Group 1 (P < 0.05).


CONCLUSIONS
The use of intrathecal neostigmine as an analgesic drug in perianal surgery is unsatisfactory because of prolonged motor blockade and nausea.
Yegin
A
A
Akdeniz University Faculty of Medicine, Department of Anaesthesiology, Antalya, Turkey. ayegin@ixir.com
Yilmaz
M
M
Karsli
B
B
Erman
M
M
D001003:Anal Canal / Q000601:surgery; D000772:Anesthesia, Local; D019162:Anesthetics, Combined; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects; D001919:Bradycardia / Q000209:etiology; D002045:Bupivacaine / Q000008:administration & dosage / Q000009:adverse effects; D002800:Cholinesterase Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D004311:Double-Blind Method; D004357:Drug Synergism; D006484:Hemorrhoids / Q000601:surgery; D006801:Humans; D007278:Injections, Spinal; D009325:Nausea / Q000209:etiology; D009388:Neostigmine / Q000008:administration & dosage* / Q000009:adverse effects; D016896:Treatment Outcome
D019162:Anesthetics, Combined; D000779:Anesthetics, Local; D002800:Cholinesterase Inhibitors; D009388:Neostigmine; D002045:Bupivacaine