Postoperative Analgesic Effect of Intrathecal Neostgmine Added to Bupivacaine In Comparison With Bupivacaine Alone for Adult Patients Undergoing Lower Limb Orthopaedic Surgery at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia, 2017

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Addis Abeba University


Background: Several additives have been suggested to enhance analgesic effect of local anesthetic agents to decrease the adverse effects and increase the degree of satisfaction. Objective: - To assess postoperative analgesic effect of intrathecal neostigmine added to bupivacaine in comparison with bupivacaine alone for adult patients undergoing Lower limb Orthopedic Surgery at Tikur Anbessa specialized Hospital, Addis Ababa, Ethiopia, from January 1 to February 30, 2017 G.C. Methods: -This institutional based prospective observational cohort study was conducted among 60 adult patients scheduled for elective lower limb orthopedic surgery under spinal anesthesia and grouped in to bupivacaine group based on independent decision of responsible anesthetist. Patient‟s vital signs were taken intraoperativley. Postoperatively duration & consumption of analgesia, first analgesia request as well as severity of pain using 100mm visual analogue scale score were assessed over 24hrs. Normality of the data was checked using Shapiro-Wilk test and analyzed using student t test for normal distributed data and chi-square test for categorical data. Non- parametric data was analyzed using Mann –Whitney U test with 95% CI and p- value less than 0.05 is considered as statistically significant. Results: - Bupivacaine neostigmine group (BN, n=30) compared with bupivacaine only group (BS, n=30) which was presented by mean ±standard deviation, time of the first analgesic request in neostigmine and bupivacaine group was (377.60 ± 9.14) and (230.07 ± 17.11) in minute respectively, p < 0.001.Morever total amount of tramadol consumption was also significantly different between the two groups that was presented by median (inter quartile range),which was 50(50) mg in neostigmine group vs. 100 (50) mg in bupivacaine group. The visual analogue scale score also reduced at1hr, 2hrs, 3hrs, 4hrs, 5hrs and 6hrs in neostigmine group. Conclusion and recommendation: -Addition of 25mcg intrathecal neostigmine as an adjuvant to 15 mg bupivacaine for elective lower limb orthopedic surgery increased first analgesia request time, reduced postoperative analgesia consumption and with minimal hemodynamic changes and side effects. We recommend that the use of intrathecal neostigmine combined with bupivacaine for lower limb surgery in our setup. Key words: - Spinal Anesthesia, lower limb orthopedic surgery, intrathecal neostigmine, postop analgesia.



Spinal Anesthesia; Lower limb orthopedic surgery; Intrathecal neostigmine; Postop analgesia