Study of three different doses of epidural neostigmine coadministered with lidocaine for postoperative analgesia

Background Intrathecal neostigmine produces analgesia In volunteers and patients. However, the use of epidural neostigmine has not been investigated. The purpose of the current study was to define the analgesic effectiveness of epidural neostigmine coadministered with lidocaine and side effects in patients after minor orthopedic procedures. Methods: After Institutional Review Board approval and informed consent, 48 patients (n = 12) undergoing knee surgery were randomly allocated to one of four groups and studied in a prospective way. After 0.05-0.1 mg/kg intravenous midazolam premedication, patients were randomized to receive 20 rug Intrathecal bupivacaine plus epidural lidocaine (85 mg) with saline (control group): 1 mu g/kg epidural neostigmine (1 mu g group); 2 mu g/kg epidural neostigmine (2 pg group); or 4 mu g/kg epidural neostigmine (4 mu g group). The concept of the visual analog scale, which consisted of a 10-cm line with 0 equaling "no pain at all" and 10 equaling "the worst possible pain" was Introduced Postoperatively, pain was assessed using the visual analog scale, and Intramuscular 75 mg diclofenac was available at patient request. Results: Groups were demographically the same and did not differ in intraoperative characteristics (blood pressure, heart rate, ephedrine consumption oxyhemoglobin saturation, sensory loss before start of surgery, or duration of sensory motor block). The visual analog scale score at first rescue analgesic and die incidence of adverse effects were similar among groups CP > 0.05. The time (min a SD) to first rescue analgesic was as follows: control group: 205 a 48; I-Gig group: 529 +/- 314; 2-mu g group: 504 +/- 284; 4 mu g group: 547 +/- 263 (P < 0.05). The analgesic consumption (number of intramuscular diclofenac injections mean, 25th-75th percentile) in 24 h was as follows: control group: 3 [3 or ii]; 1-mu g group: 1 [1 or 2]; 2-mu g group: 2 [1 or 2]; 4-mu g Bn,up: 2 [1-;3] (P < 0.05). The 24-h pain visual analog scale score (cm a SD) that represents the overall Impression for the I:last 24 h was as follows: control, group: 5 a 1.6; 1-mu g group: 1.6 +/- 1.8: 2-mu g group: l. 1.4 +/- 1.6; 4-Crg group: 2.2 +/- 1.9 (P < 0,005). The incidence of adverse effects was similar among groups (P > 0.05), Conclusions: Epidural neostigmine (1, 2, or 4 mu g/kg) in lidocaine produced a dose-independent analgesic effect (similar to 8 h) compared to the control group (similar to 3.5 h), and a reduction in postoperative rescue analgesic consumption without increasing the incidence of adverse effects.