Effectiveness of intramuscular neostigmine to accelerate bladder emptying after spinal anesthesia

Senapathi, Tjokorda Gde Agung; Wiryana, Made; Subagiartha, I Made; Suarjaya, I Putu Pramana; Widnyana, I Made Gede; Sutawan, Ida Bagus Krisna Jaya; Jaya, A A Gde Putra Semara; Thewidya, Andri

doi:10.2147/tcrm.s176281

Cited by 6 publications

(9 citation statements)

References 12 publications

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“…When it comes to the primary outcomes of the current study, the times to first voiding after treatment and after catheter removal showed significant reduction with IM administration of neostigmine (P = 0.027 and 0.036, respectively). In agreement with our findings, Senapathi and colleagues reported that times to first voiding after spinal anesthesia and after treatment were significantly reduced with neostigmine administration [9] .…”

Section: Discussionsupporting

confidence: 93%

“…Transmission of efferent and afferent action potentials on the nerve fibers of S2-S4 spinal cord segments to and from the UB is inhibited by spinal injection of anesthetic medication [9] . Inhibiting the transmission of afferent nerve fibers from the UB to the micturition center in the brain results in analgesia of the UB.…”

Section: Discussionmentioning

confidence: 99%

“…A sample size of at least 42 women (21 per group) was needed to detect difference of at least 85 minutes in the mean time to first voiding after treatment. The estimation of the sample size was based on the previously reported mean time to first voiding after spinal anesthesia of 280.8 ± 66.6 minutes with neostigmine and 364.2 ± 77.3 minutes with placebo [9] . We planned to enroll 100 women (50 per group) in our study.…”

Section: Sample Size Calculationmentioning

confidence: 99%

“…Contraction of the UB is reliant on acetylcholine-induced activation of the contractile muscarinic receptors on the UB smooth muscle (detrusor) [8] . In patients undergoing surgery under spinal anesthesia, the intramuscular (IM) administration of neostigmine was evaluated for its efficacy in preventing POUR, however, the results were inconclusive [9] . Moreover, to the best of our knowledge, and based on intensive literature research, there are no studies handling the role of neostigmine in the prevention of this problem after CS.…”

Section: Introductionmentioning

confidence: 99%

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Intramuscular Neostigmine for Accelerating Bladder Emptying after Cesarean Section by Spinal Anesthesia

Aljaml,

Elnegery,

Shams-Eldien

et al. 2023

Evidence Based Women's Health Journal

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Objective: To assess the efficacy of intramuscular (IM) neostigmine administration for acceleration of urinary bladder (UB) emptying and prevention of postoperative urine retention (POUR) following cesarean section (CS) performed under spinal anesthesia. Patients and Methods: Randomized controlled trial conducted on pregnant women who were planned to undergo elective CS under spinal anesthesia. All participants were randomly allocated after surgery into 2 groups; neostigmine group who received 0.5 mg IM neostigmine, and placebo group who received IM NaCl 0.9%. The primary outcome measures were time to first voiding after treatment and time to first voiding after catheter removal, and the secondary outcome measures were volume of excreted urine, postvoid residual bladder volume (PVRBV) and catheterization rate. Results: A total of 100 women (50 women in each group) were subjected to final analysis. Time to first voiding after treatment was significantly lower in neostigmine group than in placebo group (266.94 ± 77.53 vs 303.72 ± 64.07 min; P = 0.027). Also, time to first voiding after catheter removal was significantly lower in neostigmine group than in placebo group (214.90 ± 66.53 vs 241.60 ± 61.73 min; P = 0.036). However, there were no significant difference between both groups in volume of excreted urine, PVRBV and catheterization rate. Conclusion: IM injection of neostigmine can effectively accelerate UB emptying following CS under spinal anesthesia but it does not appear to decrease PVRBV or catheterization rate.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Sample Size Calculationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Intramuscular Neostigmine for Accelerating Bladder Emptying after Cesarean Section by Spinal Anesthesia

Aljaml,

Elnegery,

Shams-Eldien

et al. 2023

Evidence Based Women's Health Journal

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“…Secondly, one can consider a chance for new indication areas for formulations with standardized and sufficiently high alkaloid content. Peripheral reduction of AChE activity was suggested for treatment of urinary retention or myasthenia gravis [28,29]. In case of sufficient delivery across the blood-brain barrier, the alkaloids might extend the spectrum of drugs used for therapy of central dysfunction of the cholinergic system, e.g., early stages of Alzheimerʼs disease or other forms of cognitive decline.…”

Section: Contraction Force (%)mentioning

confidence: 99%

Alkaloids from Lime Flower (Tiliae flos) Exert Spasmodic Activity on Murine Airway Smooth Muscle Involving Acetylcholinesterase

et al. 2021

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Lime flower (Tiliae flos) is traditionally used either for treatment of the common cold or to relieve symptoms of mental stress. Recently, the presence of a new class of piperidine and dihydro-pyrrole alkaloids from lime flower has been described. The present study aimed to investigate the pharmacological activity of hydroacetonic lime flower extracts, alkaloid-enriched lime flower fractions, and isolated alkaloids on the murine airway smooth muscle and the cholinergic system. While a hydroacetonic lime flower extract did not show any pharmacological activity, enriched Tilia alkaloid fractions potentiated acetylcholine-induced contractions of the trachea by ~ 30%, showing characteristics comparable to galanthamine. Effects were abrogated by atropine, indicating an involvement of muscarinic receptors. The dihydro-pyrrole alkaloid tiliine A, the piperidine alkaloid tiliamine B, and the acetylated piperidine alkaloid tilacetine A were characterized as acetylcholinesterase inhibitors. The positive control galanthamine (IC50 = 2.0 µM, 95% CI 1.7 to 2.2 µM) was approximately 100 times more potent compared to tiliine A (IC50 = 237 µM, 95% CI 207 to 258 µM) and tiliamine B (IC50 = 172 µM, 95% CI 158 to 187 µM). Neither DNA synthesis of HepG2 liver cells, HaCaT keratinocytes, and Caco-2 intestinal epithelial cells nor cell viability of primary human fibroblasts was reduced by the alkaloids. The indirect cholinergic activity of the alkaloids might explain some aspects of the traditional use of lime flowers and may extend the portfolio of compounds with regard to diseases involving parasympathetic malfunction or central cholinergic imbalance.

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The effectiveness of parasympathomimetics for treating underactive bladder: A systematic review and meta‐analysis

Moro

Phelps

Veer

et al. 2021

Neurourology and Urodynamics

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Aims: Biological rationale suggests that parasympathomimetics (cholinergic receptor stimulating agents) could be beneficial for patients with underactive bladder. However, no systematic review with meta-analysis addressing potential benefits or adverse effects exists. The aim of this review was to assess the effectiveness, both benefits and harms, of using parasympathomimetics for the treatment of underactive bladder. Methods: The protocol was registered in PROSPERO, and searches undertaken in PubMed, Embase, and CENTRAL, including randomized and nonrandomized controlled trials of patients with underactive bladder, comparing parasympathomimetic to placebo, no treatment, or other pharmaceuticals.Risk ratios, odds ratios, and mean differences were calculated. Results: Twelve trials with 3024 participants were included. There was a significant difference between parasympathomimetics and comparators (favoring parasympathomimetics) in the number of patients with urinary retention (risk ratio 0.55, 95% confidence interval [CI] 0.3-0.98, p = 0.04, low quality of evidence). There was no difference in mean postvoid volume overall (MD −41.4 ml, 95% CI −92.0 to 9.1, p = 0.11, low quality of evidence). There was a significant difference at up to 1 week post-intervention, favoring parasympathomimetics (MD −77.5 ml, 95% CI −90.9 to −64.1, p < 0.001, low quality of evidence), but no difference at 1 month post-intervention. There was no difference in adverse events (odds ratio 1.19, 95% CI 0.62-2.28, p = 0.6, moderate quality of evidence). Conclusions:The evidence supporting the use of parasympathomimetics is of low quality, with relatively short follow-up durations. Overall, it is not possible to draw clear evidence-based conclusions from the current literature, presenting the use of parasympathomimetics for treating underactive bladder as a key area that requires future well-controlled clinical trials.

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Effectiveness of intramuscular neostigmine to accelerate bladder emptying after spinal anesthesia

Cited by 6 publications

References 12 publications

Intramuscular Neostigmine for Accelerating Bladder Emptying after Cesarean Section by Spinal Anesthesia

Intramuscular Neostigmine for Accelerating Bladder Emptying after Cesarean Section by Spinal Anesthesia

Alkaloids from Lime Flower (Tiliae flos) Exert Spasmodic Activity on Murine Airway Smooth Muscle Involving Acetylcholinesterase

The effectiveness of parasympathomimetics for treating underactive bladder: A systematic review and meta‐analysis

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