Epidural Morphine and Neostigmine for Postoperative Analgesia After Orthopedic Surgery

Omais, Maruan; Lauretti, Gabriela Rocha; Paccola, Cleber Antônio Jansen

doi:10.1097/00000539-200212000-00042

Cited by 53 publications

(39 citation statements)

References 12 publications

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“…Approximately 10% of epidurally administered neostigmine crosses the dura mater [41], so it may be expected that 500 µg of epidural neostigmine would produce the same amount of emesis as 50 µg of IT neostigmine; however, this does not appear to be the case. This finding is consistent with early studies that noted an 8-hour, dose-independent analgesia from 1, 2, or 4 µg/kg of epidural neostigmine combined with 85 mg of IT lidocaine in patients undergoing minor orthopedic procedures [41] and that epidural neostigmine potentiates epidural morphine without adverse side effects [42]. Several additional studies have failed to demonstrate an increased rate of nausea or vomiting when neostigmine is delivered epidurally [43][44][45][46].…”

Section: Acetylcholinesterase Inhibitorssupporting

confidence: 88%

The evolving role of spinal agents in acute pain

Heitz

Viscusi²

2005

Current Science Inc

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Section: Acetylcholinesterase Inhibitorssupporting

confidence: 88%

The evolving role of spinal agents in acute pain

Heitz

Viscusi²

2005

Current Science Inc

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“…These results indicate that postoperative epidural neostigmine in combination with epidural bupivacaine and fentanyl provides an approximately 13.5% postoperative bupivacaine-and fentanyl-sparing effect. Previous studies evaluating coadministration of epidural neostigmine/morphine or neostigmine/lidocaine for postoperative pain in patients after orthopedic surgery produced similar results, with demonstration of an analgesic-sparing effect (8,21). However, pain intensity between our post-neo and control groups was not statistically significant.…”

Section: Discussionsupporting

confidence: 76%

The Efficacy of Thoracic Epidural Neostigmine Infusion After Thoracotomy

Chia¹,

Chang²,

Liu³

et al. 2006

Anesthesia &Amp; Analgesia

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Few anesthesia studies have explored perioperative continuous epidural infusion of neostigmine. We examined such a regimen in thoracotomy patients. Ninety patients were randomized to one of three groups in this double-blind trial. Before anesthesia induction, an epidural catheter was inserted in all patients at T5-8 levels under local anesthesia. Pre-neo patients received bolus 500-microg epidural neostigmine before anesthesia induction followed by infusion of 125 microg/h until the end of surgery. Post-neo patients received epidural saline during the same time periods plus bolus 500-microg epidural neostigmine at end of surgery. Patients in the control group received saline placebo during all three periods. Patients in the neostigmine groups postoperatively received patient-controlled epidural analgesia with morphine 0.02 mg/mL, bupivacaine 0.08 mg/mL, and neostigmine 7 microg/mL. Control patient-controlled epidural analgesia excluded neostigmine. Data were recorded for 6 postoperative days. Daily patient-controlled epidural analgesia consumption (mL) for Pre-neo patients was significantly less than that of post-neo and control group patients for postoperative days 1-6 (at least 10% and 16% less, respectively; P < 0.05). There was a modest decrease in pain intensity on postoperative days 3-6 for pre-neo patients versus other groups (P < 0.05). These results suggest that continuous thoracic epidural neostigmine started before anesthesia provided preemptive, preventive analgesia and an analgesic-sparing effect that improved postoperative analgesia for these patients without increasing the incidence of adverse effects.

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“…74 Studies of neostigmine via the epidural route have been inconsistent but suggest that it may decrease pain scores and analgesic use, with fewer studies reporting adverse events. [75][76][77][78][79] However, the results remain inconsistent, and an optimal dose has yet to be determined. There is no consistent evidence for its usefulness as an adjunct in IV regional anesthesia or brachial plexus blocks.…”

Section: Analgesia Opioid Requirements and Adverse Effectsmentioning

confidence: 99%