Pandey Vandana, Mohindra B K, Sodhi Gurdip Singh
Department of Anaesthesia and Critical Care, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India.
Department of Anaesthesia and Critical Care, Mohan Dai Oswal Cancer Hospital, Ludhiana, Punjab, India.
Anesth Essays Res. 2016 Sep-Dec;10(3):538-545. doi: 10.4103/0259-1162.180779.
To study the efficacy and safety of intrathecal neostigmine at dose of 50 μg and 150 μg as an adjuvant to bupivacaine for postoperative analgesia under spinal anesthesia.
75 patients of either sex, belonging to American Society of Anesthesiologists (ASA) physical status I and II in the age group of 30-65 years scheduled to undergo lower abdominal and lower limb surgeries were allocated randomly into 3 groups of 25 each. Spinal anesthesia was administered in Group I (control group) with 12.5 mg (2.5 ml) of 0.5% hyperbaric bupivacaine, in Group II (50 μg group) with 12.5 mg (2.5 ml) of 0.5% hyperbaric bupivacaine and 50 μg (0.1 ml) of neostigmine methylsulphate and in Group III (150 μg group) with 12.5 mg (2.5 ml) of 0.5% hyperbaric bupivacaine and 150 μg (0.3 ml) of neostigmine methylsulphate. Hemodynamic parameters, onset and level of sensory block were recorded. Postoperative analgesic assessment was made in terms of total Visual Analogue Scale-Pain (VAS-P) scores in 24 hrs, duration of analgesia (time to requirement of first analgesic) and total number of rescue analgesic (diclofenac sodium 75 mg intramuscularly) consumption in 24 hours. Side effects were recorded.
The total VAS-P score in group I was 23.12 ± 3.21, which was higher than the VAS-P score in group II (18.4 ± 2.92) and group III (16.24 ± 1.85). The total duration of analgesia was significantly prolonged in neostigmine groups (224.40 ± 23.28 min in group I, 367.60 ± 42.15 min in group II and 625.60 ± 87.70 min in group III). In group I, the patients required 2.48 ± 0.51 number of analgesics in 24 hours, which was much higher than required in group II (1.92 ± 0.64) and group III (1.32 ± 0.47). The incidence of nausea and vomiting was more with 150 μg neostigmine group compared to 50 μg neostigmine.
The administration of intrathecal neostigmine in dose of 50 μg as an adjuvant to bupivacaine produces hemodynamically stable analgesia with minimal side effects.
研究鞘内注射50μg和150μg新斯的明作为布比卡因辅助药物用于脊麻术后镇痛的有效性和安全性。
将75例年龄在30 - 65岁、美国麻醉医师协会（ASA）身体状况分级为I级和II级、计划接受下腹部和下肢手术的患者随机分为3组，每组25例。I组（对照组）给予12.5mg（2.5ml）0.5%的高压布比卡因行脊麻；II组（50μg组）给予12.5mg（2.5ml）0.5%的高压布比卡因和50μg（0.1ml）甲硫酸新斯的明；III组（150μg组）给予12.5mg（2.5ml）0.5%的高压布比卡因和150μg（0.3ml）甲硫酸新斯的明。记录血流动力学参数、感觉阻滞的起效时间和平面。根据术后24小时视觉模拟评分法疼痛（VAS-P）总分、镇痛持续时间（首次需要镇痛的时间）以及24小时内补救镇痛药（75mg双氯芬酸钠肌内注射）的总消耗量进行术后镇痛评估。记录副作用。
I组的VAS-P总分是23.12±3.21，高于II组（18.4±2.92）和III组（16.24±1.85）。新斯的明组的镇痛总持续时间显著延长（I组为224.40±23.28分钟，II组为367.60±42.15分钟，III组为625.60±87.70分钟）。I组患者24小时内需要2.48±0.51次镇痛药，远高于II组（1.92±0.64）和III组（1.32±0.47）。与50μg新斯的明组相比，150μg新斯的明组恶心呕吐的发生率更高。
鞘内注射50μg新斯的明作为布比卡因的辅助药物可产生血流动力学稳定的镇痛效果，且副作用最小。
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