Postoperative analgesic effect of epidural neostigmine and plasma cortisol and IL-6 responses.
OBJECTIVE
To examine whether epidural administration of neostigmine reduces the stress and inflammatory responses thereby improving postoperative pain status.


METHODS
Randomized, double-blinded clinical study.


METHODS
Operating rooms and wards of a university hospital.


METHODS
40 ASA physical status I patients undergoing lower open abdominal surgery for benign gynecological disease.


METHODS
Patients were randomly divided into four groups to receive different doses of epidural neostigmine (0, 0.05, 0.1, or 0.15 mg) with mepivacaine (100 mg) before general anesthesia induction.


METHODS
The plasma levels of cortisol and interleukin-6 (IL-6) were determined perioperatively. The patients' pain rating was assessed by visual analog scale (VAS) in the postoperative period.


RESULTS
Epidural neostigmine at all doses significantly reduced the plasma levels of cortisol in the early surgical period; however, IL-6 levels were not affected by the neostigmine. The VAS scores were significantly decreased at 2 hours after the end of surgery by all doses of epidural neostigmine used in this study.


CONCLUSIONS
The preincisional epidural neostigmine transiently suppresses the stress responses during surgery and improves postoperative analgesia in patients undergoing lower open abdominal surgery.
Masaki
Eiji
E
Department of Anesthesiology and Division of Clinical Research and Development, Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-ku Tokyo 105-8461, Japan. ejmasaki@jikei.ac.jp
Saito
Hirokazu
H
Shoji
Kazuhiro
K
Matsushima
Masato
M
D000328:Adult; D015360:Analgesia, Epidural; D002800:Cholinesterase Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D007249:Inflammation / Q000209:etiology / Q000517:prevention & control; D015850:Interleukin-6 / Q000097:blood*; D009388:Neostigmine / Q000008:administration & dosage / Q000627:therapeutic use*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D013312:Stress, Physiological / Q000209:etiology / Q000517:prevention & control
D002800:Cholinesterase Inhibitors; D015850:Interleukin-6; D009388:Neostigmine; D006854:Hydrocortisone