title: The efficacy of thoracic epidural neostigmine infusion after thoracotomy.
abstract: Few anesthesia studies have explored perioperative continuous epidural infusion of neostigmine. We examined such a regimen in thoracotomy patients. Ninety patients were randomized to one of three groups in this double-blind trial. Before anesthesia induction, an epidural catheter was inserted in all patients at T5-8 levels under local anesthesia. Pre-neo patients received bolus 500-microg epidural neostigmine before anesthesia induction followed by infusion of 125 microg/h until the end of surgery. Post-neo patients received epidural saline during the same time periods plus bolus 500-microg epidural neostigmine at end of surgery. Patients in the control group received saline placebo during all three periods. Patients in the neostigmine groups postoperatively received patient-controlled epidural analgesia with morphine 0.02 mg/mL, bupivacaine 0.08 mg/mL, and neostigmine 7 microg/mL. Control patient-controlled epidural analgesia excluded neostigmine. Data were recorded for 6 postoperative days. Daily patient-controlled epidural analgesia consumption (mL) for Pre-neo patients was significantly less than that of post-neo and control group patients for postoperative days 1-6 (at least 10% and 16% less, respectively; P < 0.05). There was a modest decrease in pain intensity on postoperative days 3-6 for pre-neo patients versus other groups (P < 0.05). These results suggest that continuous thoracic epidural neostigmine started before anesthesia provided preemptive, preventive analgesia and an analgesic-sparing effect that improved postoperative analgesia for these patients without increasing the incidence of adverse effects.
authors.affiliation: Department of Anesthesiology, Kaohsiung Veterans General Hospital and School of Medicine, National Yang-Ming University, Taiwan.
authors.forename: Yuan-Yi
authors.initials: YY
authors.lastname: Chia
authors.forename: Ting-Hang
authors.initials: TH
authors.lastname: Chang
authors.forename: Kang
authors.initials: K
authors.lastname: Liu
authors.forename: Huang-Chou
authors.initials: HC
authors.lastname: Chang
authors.forename: Nai-Hua
authors.initials: NH
authors.lastname: Ko
authors.forename: Ying-Ming
authors.initials: YM
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D015360:Analgesia, Epidural / Q000009:adverse effects / Q000379:methods; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009388:Neostigmine / Q000008:administration & dosage* / Q000009:adverse effects; D010149:Postoperative Pain / Q000188:drug therapy* / Q000453:epidemiology; D011446:Prospective Studies; D013908:Thoracotomy / Q000009:adverse effects; D013909:Thorax / Q000187:drug effects
chemical_list: D009388:Neostigmine