Comparative study between (Dexamethasone – levobupivacaine) versus (Neostigmine - levobupivacaine) for postoperative analgesia in Patient Undergoing Perianal Surgeries

Abstract

Aim: This work aims to compare the postoperative analgesic effects and side effects of Dexamethasone or Neostigmine that added to levobupivacaine. Patient and Methods: Eighty patients aged between 20-80 years with ASA I-II who were scheduled for perianal surgeries under spinal anesthesia were enrolled in our study after written informed consent and approval of ethical committee; This Study was conducted in Sohag University Hospitals from August 2016 to March 2017. Patients Were divided into 2 equal groups:-(Group A) 40 patients received 100μg Neostigmine in 0.5 ml normal saline added to2.5ml volume of levobupivacaine.-(Group B) 40 patients received 4mg dexamethasone added to 2.5ml volume of levobupivacaine. Under complete aseptic conditions, spinal anesthesia was carried out in the sitting position, at level (L3-4 or L4-5). After a free flow of cerebrospinal fluid was confirmed, each patient received one of the coded spinal solutions (GA or GB). After administration; the patients stilled in sitting potion for 10 minutes then patients were turned into the supine position. Patients were monitored for: Heart rate; NIBP and Oxygen Saturation. Patients were observed for onset, duration of sensory block and motor block; In the post-anesthesia care unit (PACU), the patients were asked to assess their level of pain based on a visual analog scale (VAS). Complications also were observed. Results: Dexamethasone had a faster Onset of sensory block onset than Neostigmine; Dexamethasone had a longer duration of regard Duration of motor block than Neostigmine; Neostigmine group had a longer analgesic effect stayed longer than Dexamethasone group .No Significant difference Between Two groups in rate of Complications ; Hypotension and Bradycardia were the most frequent complications in the two groups .Conclusion: the addition of Dexamethasone 4mg Neostigmine 100μg to intrathecally injected Levobupivacaine improved the effect of Levobupivacaine and the postoperative analgesic effect and duration