A Comparative Study of Intrathecal Neostigmine and Dexmedetomidine as Adjuvant to Bupivacaine Spinal Analgesia in Sub Umbilical Regional Surgeries

Abstract

Background: Spinal anesthesia is the most commonly used technique for lower abdominal surgeries as it is very economical and easy to administer. This study aims to determine the effect of intrathecal administration of Neostigmine and Dexmedetomidine as adjuvants on the onset and duration of sensory and motor block and postoperative analgesia produced by spinal Bupivacaine. Subjects and Methods: prospective randomized clinical study was carried out on 100 patients belonging to ASA grade I and II, posted for elective Sub umbilical surgeries under spinal anaesthesia, The study was designed to compare neostigmine 50mcg and Dexmedetomidine 10mcg along with 15mg 0.5% bupivacaine, in subarachnoid block. 100 patients were divided into two groups using randomized double blind method with 50 patients in each group. Results: The time of onset of peak sensory block is higher in Group D as compared to Group N. Mean Time for onset of peak sensory block in Group N was 5.48 ± 0.43 min and Group D was 7.31 ± 0.44 min. p value is < 0.01(statistically significant). Time for two segment regression was significantly higher in Dexmedetomidine group as compared to Neostigmine group. The onset of motor block in group N is earlier as compared to group D. The duration of analgesia is significantly higher in group D as compared to group N. Conclusion: Our study concludes that the use of intrathecal Neostigmine 50 mcg added to 15mg hyperbaric bupivacaine significantly hastens the onset of sensory and motor block. Dexmedetomidine(10mcg) when used intrathecally along with Bupivacaine significantly prolongs the duration of motor blockade, two segment regression and duration of effective post-operative analgesia.

Comparison Between Intrathecal Neostigmine and Fentanyl as Adjuvant to Hyperbaric Bupivacaine in Spinal Anaesthesia for Post-Operative Pain Relief

“…The mean time to onset of sensory block in Group N was 01 minute 33 seconds approximately (approx.) in the present study and it was in concurrence with the previous studies on intrathecal Neogstimine by Ruparel DH et al [7], Bhaskar HU et al [11] and Yoganarashima N et al [15]. Also, the mean time to onset of sensory block in Group F was 01 minute 36 seconds (approx.)…”

“…and in Group F was 01 hour 33 minutes (approx.) which correlated to the study conducted by Bhaskar HU et al (11) and Seewal R et al (14), respectively. Previous studies reported that both intrathecal Neostigmine and Fentanyl delay spinal block regression more than Bupivacaine alone [18,19].…”

“…On the other hand, the mean time to onset of peak sensory block (T6) in Group N was 04 min 10 seconds (approx.) and it correlated to the study on intrathecal Neostigmine done by Shakya ML et al [10] and Bhaskar HU et al [11]. Similarly, the mean time to onset of peak sensory block (T6) in Group F was 04 min 12 seconds (approx.)…”

“…Local anaesthetics in combination with adjuvants enhance the onset, improve the quality and prolong the duration of subarachnoid block: so, better pain relief in the immediate postoperative period. In the present study, it has been shown that intrathecal use of either 50 µg of Neostigmine [5,10,11] or 30 µg of Fentanyl [12][13][14] in combination with 0.5% hyperbaric Bupivacaine produces effective analgesia and anaesthesia. The outcomes like the time to both motor and sensory block did not differ between the groups (p-value>0.05).…”