[Neostigmine added to bupivacaine in axillary plexus block: which benefit?].
BACKGROUND
Recent study showed that neostigmine (500 microg) by intra-articular produces postoperative analgesia without adverse effect. The author's goal was to determine whether 500 microg of neostigmine added to bupivacaine in axillary plexus block could prolonged postoperative analgesia without increasing the incidence of side effects.


METHODS
Ninety patients scheduled for orthopedic or plastic surgery with axillary plexus block were randomly assigned to one of 3 groups : group 1 (TGr n = 30) received saline solution (1 ml) in the axillary plexus, group 2 (NAGr n = 30) received 500 microg (1 ml) neostigmine in the axillary plexus and group 3.500 microg neostigmine subcutaneously (NSGr n = 30). We evaluated visual analog pain scores (VAS), the consumption of the ketoprofene, nausea and vomiting incidence during the first 24 h. ANOVA, Kruskall Wallis and Fisher tests were used for statistical analysis. A p value of <0.05 was considered significant.


RESULTS
The VAS score was lower in NAGr (21 +/- 18) vs NSGr (31 +/- 14) and control group TGr (45 +/- 2) (p < 0.05). The consumption of the ketoprofene is 127 +/- 65 mg in NAGr vs 150 +/- 53 mg in NSGr and 200 +/- 50 mg in group TGr (p = 0.02). Incidence of nausea and vomiting was 3.5% in NAGr vs 6.8% in NSGr and 0% for TGr.


CONCLUSIONS
Neostigmine combined to a mixture of lidocaine and bupivacaine prolongs postoperative analgesia after axillary plexus block.
Bouderka
M A
MA
Département d'anesthésie-réanimation, CHU Ibn-Rochd, Casablanca, Maroc. mabouderka@yahoo.fr
Al-Harrar
R
R
Bouaggad
A
A
Harti
A
A
D000328:Adult; D000779:Anesthetics, Local / Q000009:adverse effects; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D002045:Bupivacaine / Q000009:adverse effects; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007660:Ketoprofen / Q000627:therapeutic use; D008012:Lidocaine; D008297:Male; D008875:Middle Aged; D009388:Neostigmine / Q000009:adverse effects; D009407:Nerve Block / Q000009:adverse effects; D019637:Orthopedic Procedures; D010147:Pain Measurement; D010149:Postoperative Pain / Q000453:epidemiology / Q000517:prevention & control*; D010277:Parasympathomimetics / Q000009:adverse effects; D020250:Postoperative Nausea and Vomiting / Q000188:drug therapy / Q000517:prevention & control; D013518:Surgery, Plastic
D000779:Anesthetics, Local; D000894:Anti-Inflammatory Agents, Non-Steroidal; D010277:Parasympathomimetics; D009388:Neostigmine; D007660:Ketoprofen; D008012:Lidocaine; D002045:Bupivacaine