A systematic review of the effects of adding neostigmine to local anesthetics for neuraxial administration in obstetric anesthesia and analgesia

Cossu, Andrea; Giudici, L.M. De; Piras, Desiderio; Mura, Paolo; Scanu, Martina; Cossu, Marco; Saba, Marcello; Finco, Gabriele; Brazzi, Luca

doi:10.1016/j.ijoa.2015.05.002

Cited by 30 publications

(7 citation statements)

References 46 publications

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“…has concluded that use of epidural neostigmine for labor analgesia is associated with a decrease in the risk of pruritus with no increase in the incidence of hypotension, dizziness, or sedation and no effect on the incidence of abnormal FHR patterns or Apgar scores. [5]…”

Section: Discussionmentioning

confidence: 99%

“…While intrathecal administration is limited by a high incidence of nausea and vomiting in this patient population, the epidural route appears more promising and requires further investigation. [56] Epidural administration of neostigmine appears to be safe in the obstetric population, with no reported adverse effects in the mother or fetus. Neuraxial adjuvant drugs are used to improve analgesia and to decrease complications associated with a high dose of a single drug.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of epidural butorphanol with neostigmine and epidural sufentanyl with neostigmine for first stage of labor analgesia: A randomized controlled trial

2017

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Background:Epidural administration of neostigmine appears to be safe in the obstetric population. Recently, few studies have concluded 10 μg sufentanil to be an effective adjuvant with epidural neostigmine in providing labor analgesia. However, no study has evaluated the analgesic effect of epidural butorphanol with neostigmine for the same.Materials and Methods:The parturients were randomly allocated to one of the three study groups - Group A (n = 30) received butorphanol 1 mg and neostigmine 7 μg/kg. Group B (n = 30) received sufentanil 10 μg and neostigmine 7 μg/kg. Group C (n = 30) received neostigmine 7 μg/kg and 0.9% normal saline. Maternal hemodynamic parameters and fetal heart rate (FHR) were continuously monitored. The level of sensory and motor block, and visual analog scale (VAS) pain score were recorded at designated time points. In addition, the total duration of analgesia, duration of labor, mode of delivery, and any maternal or fetal adverse effects were also recorded.Statistical Analysis Used:A one-way analysis of variance (ANOVA) with post hoc Tukey's test was used to compare mean value among the three groups for age, height, weight, gestational age, and cervical dilatation. Repeated measure ANOVA was used to compare mean difference among the time points and also the trend among the various time points for hemodynamic parameters, VAS pain score, and FHR. For inter-group comparison among the groups, post hoc Tukey test was used.Results:There was a statistically significant longer effect of analgesic drug in Group B with respect to Group A and C (P < 0.001); however, the parturient in Group C had minimum duration of analgesia. Epidural neostigmine combined with sufentanil produces effective analgesia in early labor (VAS <30 within 10 min in 63.3% of parturient and within 15 min in 83.3% parturient) with average duration of 111.67 ± 24.51 min without motor block or other side effect in mother and fetus. No significant effect was observed in the duration of labor and mode of delivery in-between the two groups, and none of the patients in any group had any maternal or fetal side effects.Conclusion:Epidural combination of sufentanil with neostigmine provided better pain relief in terms of the total duration of analgesia and the reduction in VAS pain scores at various time points in the initial 30 min of epidural administration of drugs during the first stage of labor in parturient when compared to the epidural combination of butorphanol with neostigmine.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparison of epidural butorphanol with neostigmine and epidural sufentanyl with neostigmine for first stage of labor analgesia: A randomized controlled trial

2017

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“…To decrease the onset time of the motor and sensory block and decrease the postoperative analgesic consumption, several agents have been tried such as opioid,[ 6 ] neostigmine,[ 7 ] clonidine,[ 8 ] and n-methyl d-aspartic acid (NMDA) receptor antagonist. The analgesic effect of epidural magnesium sulfate (MgSO 4 ) is because of its noncompetitive antagonism of NMDA receptor and blocking calcium influx.…”

Section: Introductionmentioning

confidence: 99%

Analgesic effect of adding magnesium sulfate to epidural levobupivacaine in patients with pre-eclampsia undergoing elective cesarean section

Elsharkawy

Farahat

Abdelhafez

2018

J Anaesthesiol Clin Pharmacol

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“…A systematic review regarding the use of neostigmine as an adjuvant in neuraxial anesthesia reported postoperative analgesia following cesarean section. The risk of nausea was found with the intrathecal but not with the epidural neostigmine administration [9]. Furthermore, intrathecal 50 µg neostigmine did not enhance the onset of sensory block, but prolonged the sensory and motor blockade of bupivacaine, together with effective postoperative analgesia in patients admitted for lower abdominal and lower limb surgeries.…”

Section: Discussionmentioning

confidence: 87%

Safety and efficacy of adding different doses of neostigmine as an adjuvant in peribulbar block for cataract surgery: A randomized controlled trial

Fetouh

Sherif

Osama

et al. 2021

Egyptian Journal of Anaesthesia

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Background: This study aimed to evaluate safety and efficacy of adding two different doses of neostigmine to the local anesthetic lidocaine in peribulbar block anesthesia for cataract surgery. Methods: This randomized, double blind, parallel group, controlled trial (Trial registration number: IRCT20210106049952N1) included 60 patients (30-70 years-old), ASA physical status I, II, or III who were scheduled for cataract surgery. Patients received standard peribulbar block (Group C) or standard block plus 0.25 mg neostigmine (Group N25) or 0.5 mg neostigmine (Group N50). All patients were assessed for primary outcomes including hemodynamics and onsets of motor and sensory blocks. Secondary outcomes included duration of block, patient's and surgeon's satisfaction, postoperative pain, and time to first analgesic dose. Results: Mean onset of motor block was significantly shorter in N25 and N50 groups (72.25 ± 20.3 and 44.3 ± 10.4 sec, respectively) than in control group (110.25 ± 35.6 sec). Onset of sensory block was significantly shorter in N50 group compared to control group as well as N25 group (P < 0.001). A significantly longer mean duration of block was observed in N50 group (173.55 ± 31.09 min) in comparison to control group (79.75 ± 12.51 min) and N25 group (81.25 ± 6.25 min). Mean time till first analgesic dose showed significant differences between the three groups C, N25, and N50 (2.85 ± 0.47, 3.45 ± 1.28, and 7.1 ± 1.25 h, respectively, P < 0.001). Only two patients belonging to N50 group developed postoperative nausea and vomiting. Conclusion: Neostigmine in 0.5 mg was superior to 0.25 mg dose when added to the local anesthetic lidocaine in peribulbar anesthesia for cataract surgery regarding both sensory and motor block as well as postoperative analgesia.

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A systematic review of the effects of adding neostigmine to local anesthetics for neuraxial administration in obstetric anesthesia and analgesia

Cited by 30 publications

References 46 publications

Comparison of epidural butorphanol with neostigmine and epidural sufentanyl with neostigmine for first stage of labor analgesia: A randomized controlled trial

Comparison of epidural butorphanol with neostigmine and epidural sufentanyl with neostigmine for first stage of labor analgesia: A randomized controlled trial

Analgesic effect of adding magnesium sulfate to epidural levobupivacaine in patients with pre-eclampsia undergoing elective cesarean section

Safety and efficacy of adding different doses of neostigmine as an adjuvant in peribulbar block for cataract surgery: A randomized controlled trial

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