title: Optimal single-dose epidural neostigmine for postoperative analgesia after partial hepatectomy.
abstract: OBJECTIVE
  Neostigmine can produce analgesia by acting on the spinal cord. This study was to determine the optimal single-dose of epidural neostigmine for postoperative analgesia after partial hepatectomy.
  
  
  METHODS
  Twenty-six patients undergoing elective partial hepatectomy under general anesthesia combined with epidural block were studied. The dose of epidural neostigmine was determined using Dixon's up-and-down method, starting from neostigmine 100 μg with an interval of 25 μg. Thirty minutes after skin incision, a predetermined dose of neostigmine was injected via the epidural catheter. Each patient received 0.125% bupivacaine and fentanyl 2 μg/ml for patient controlled epidural analgesia (PCEA) after the operation. Assessment of analgesia quality was performed at 8 h and 24 h after the operation.
  
  
  RESULTS
  The ED50 of epidural neostigmine in combination with PCEA for satisfactory analgesia was 226.78 ± 33.20 μg. Probit analysis showed that the ED50 and ED95 of epidural neostigmine were 228.63 μg (95% CI = 197.95-299.77 μg) and 300.12 μg (95% CI = 259.44-741.65 μg), respectively.
  
  
  CONCLUSIONS
  The ED50 and ED95 of epidural neostigmine in combination with PCEA for satisfactory analgesia after partial hepatectomy were 228.63 μg (95% CI = 197.95-299.77 μg) and 300.12 μg (95% CI = 259.44-741.65 μg).
authors.affiliation: Department of Anaesthesia, Zhongshan Hospital, Department of Anesthesiology, Shanghai Medical College, Fudan University, Shanghai, China.
authors.forename: Qiao Sheng
authors.initials: QS
authors.lastname: Zhong
authors.affiliation: Department of Anaesthesia, Zhongshan Hospital, Department of Anesthesiology, Shanghai Medical College, Fudan University, Shanghai, China.
authors.forename: Sheng Jin
authors.initials: SJ
authors.lastname: Ge
authors.affiliation: Department of Anaesthesia, Zhongshan Hospital, Department of Anesthesiology, Shanghai Medical College, Fudan University, Shanghai, China.
authors.forename: Bei
authors.initials: B
authors.lastname: Wang
authors.affiliation: Department of Anaesthesia, Zhongshan Hospital, Department of Anesthesiology, Shanghai Medical College, Fudan University, Shanghai, China.
authors.forename: Zhang Gang
authors.initials: ZG
authors.lastname: Xue
mesh_terms: D000293:Adolescent; D000328:Adult; D015360:Analgesia, Epidural; D016058:Analgesia, Patient-Controlled; D000700:Analgesics / Q000008:administration & dosage* / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D005260:Female; D006498:Hepatectomy; D006801:Humans; D007268:Injections, Epidural; D008297:Male; D008875:Middle Aged; D009388:Neostigmine / Q000008:administration & dosage* / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000700:Analgesics; D009388:Neostigmine
keywords: Dixon's up-and-down method; neostigmine; optimal dose; patient controlled epidural analgesia; postoperative analgesia