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
No Thumbnail Available
Date
2017-06
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Addis Abeba University
Abstract
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.
Description
Keywords
Spinal Anesthesia; Lower limb orthopedic surgery; Intrathecal neostigmine; Postop analgesia