title: Pre-emptive analgesic and haemodynamic efficacy of combined spinal-epidural neostigmine delivery.
abstract: OBJECTIVE
  To determine the effect of pre-emptive epidurally administered 4 or 8 mcg/kg neostigmine on analgesia, mean arterial pressure, heart rate and side effects in intra and postoperative period.
  
  
  METHODS
  Randomized, double blinded, controlled clinical trial.
  
  
  METHODS
  Ankara Numune Training and Research Hospital, Turkey, from January to December 2008.
  
  
  METHODS
  Forty-five patients scheduled for lower extremity surgery were included in the study following the approval of the ethics committee and the patients. The study group was split into three groups and received combined spinalepidural anaesthesia. Diluting with 10 ml normal saline, group N4 and group N8 were delivered 4 mcg/kg and 8 mcg/kg epidural neostigmine, respectively, whereas group SF received 10 ml epidural saline. Lidocaine (2%) at 1.2 mg/kg dose was preferred for spinal anaesthesia. Analgesic efficacy, time to first analgesic requirement, Visual Analog Scale, Fentanyl consumption in the postoperative patient-controlled epidural analgesia, and delivered/required number of boluses, were evaluated. Haemodynamic data and side effects were noted.
  
  
  RESULTS
  Statistically, analgesic consumptions at 12 and 24 hours in the N8 group was lower than those in the SF group, the number of delivered boluses was lower in the N8 group compared with the SF and N4 groups, number of required boluses was lower in the N8 group than in the SF group. In terms of haemodynamics and side effects, no difference was found between the groups regarding the entire intraoperative and postoperative parameters.
  
  
  CONCLUSIONS
  Epidural Neostigmine administration at 8 mcg/kg was found to be a viable additional agent against analgesia, with the postoperative period depending on the dosage.
authors.affiliation: Department of Anaesthesiology and Reanimation, Ankara Numune Training and Research Hospital, Samanpazarı, Ankara, Turkey.
authors.forename: Vildan
authors.initials: V
authors.lastname: Taspinar
authors.forename: Yasar
authors.initials: Y
authors.lastname: Pala
authors.forename: Serap
authors.initials: S
authors.lastname: Diker
authors.forename: H Dilsen
authors.initials: HD
authors.lastname: Ornek
authors.forename: Levent
authors.initials: L
authors.lastname: Ozdogan
authors.forename: Murat
authors.initials: M
authors.lastname: Akcay
authors.forename: Bayazit
authors.initials: B
authors.lastname: Dikmen
authors.forename: Nermin
authors.initials: N
authors.lastname: Gogus
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural / Q000379:methods*; D016058:Analgesia, Patient-Controlled; D000765:Anesthesia, Conduction / Q000379:methods; D000775:Anesthesia, Spinal / Q000379:methods*; D002800:Cholinesterase Inhibitors / Q000008:administration & dosage*; D004311:Double-Blind Method; D005500:Follow-Up Studies; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007268:Injections, Epidural; D007869:Leg Injuries / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D009388:Neostigmine / Q000008:administration & dosage*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D011446:Prospective Studies
chemical_list: D002800:Cholinesterase Inhibitors; D009388:Neostigmine