Intrathecal neostigmine for postoperative analgesia after orthopedic surgery

Lauretti, Gabriela Rocha; Mattos, Anita Leocádia de; Reis, Marlene Paulino dos; Prado, Wiliam A.

doi:10.1016/s0952-8180(97)00103-7

Cited by 51 publications

(38 citation statements)

References 3 publications

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“…[8] Also, the fact that IT neostigmine enhances the analgesic action of opioid has been recognized. [4] These properties of IT neostigmine were best demonstrated in a study by Almeida et al .…”

Section: Discussionmentioning

confidence: 99%

“…In patients undergoing below knee surgery, Lauretti et al [8] showed a dose-independent reduction of postoperative analgesia requirement, but a dose-dependent increase in the incidence of PONV following addition of various doses of IT neostigmine (ranging from 25 to 100 mcg) to 15 mg of hyperbaric bupivacaine 0.5%. Even the dose as low as 6.25 mcg has been associated with high incidence of PONV.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Analgesic efficacy of low-dose intrathecal neostigmine in combination with fentanyl and bupivacaine for total knee replacement surgery

Jain

Bhardawaj

2012

J Anaesthesiol Clin Pharmacol

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Background and Aim:Intrathecal (IT) neostigmine has been used as an adjunct to spinal anesthesia. The purpose of this study was to determine whether a combination of low-dose neostigmine IT would enhance analgesia of a fixed dose of fentanyl IT, in patients undergoing unilateral total knee replacement (TKR) surgery with spinal anesthesia.Settings and Design:Forty-five patients scheduled for unilateral TKR were randomized to one of the three groups (n = 15) and prospectively studied using placebo-controlled, double-blinded design.Materials and Methods:A 19-G epidural catheter was introduced through the L3–L4 interspace with patient in the sitting position, followed by spinal anesthesia administration through the L3–L4 interspace. Fifteen milligrams of hyperbaric bupivacaine (3 ml) plus the test drug (0.5 ml) was administered IT. The test drug was normal saline (0.5 ml) in group I; fentanyl 20 mcg (0.4 ml) and normal saline (0.1 ml) in group II; and fentanyl 20 mcg (0.4 ml) and neostigmine 1 mcg (0.1 ml) in group III. Characteristics of sensory and motor block, heart rate, and blood pressure were recorded intraoperatively. Postoperatively, pain scores, postoperative nausea and vomiting (PONV) scores, and sedation scores, and postoperative analgesic dose were recorded.Results:Forty-five patients were enrolled in this study and 43 patients were subjected to statistical analysis. Overall 24-h visual analog score in group III was significantly less than in those who received fentanyl alone (P = 0.00). The durations of complete analgesia and effective analgesia were longer for all patients in group III compared with group II (P < 0.05) and group I (P < 0.005) patients. The total number of epidural top ups (rescue analgesia) required was less in group II (P < 0.05) and group III (P < 0.005) patients, compared with the control group. The incidence of nausea and vomiting was not increased in group III patients.Conclusions:The addition of 1 mcg neostigmine IT increased the duration of analgesia and decreased the analgesic consumption in 24 h in TKR. There was no increase in the incidence of adverse effects.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Analgesic efficacy of low-dose intrathecal neostigmine in combination with fentanyl and bupivacaine for total knee replacement surgery

Jain

Bhardawaj

2012

J Anaesthesiol Clin Pharmacol

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“…The drug can be used at low doses without any severe cholinomimetic side effects. Mainly post-operative pain can be relieved by neostigmine which is administered only as hospital treatment [41-45]. Cholinesterase inhibitors endowed with lower intrinsic activity such as donepezil can also be used to relieve other painful conditions such as migraine [38].…”

Section: Analgesia Induced By Cholinesterase Inhibitorsmentioning

confidence: 99%

Analgesic and Antineuropathic Drugs Acting Through Central Cholinergic Mechanisms

Bartolini¹,

Mannelli²,

Ghelardini

2011

RPCN

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The role of muscarinic and nicotinic cholinergic receptors in analgesia and neuropathic pain relief is relatively unknown. This review describes how such drugs induce analgesia or alleviate neuropathic pain by acting on the central cholinergic system. Several pharmacological strategies are discussed which increase synthesis and release of acetylcholine (ACh) from cholinergic neurons. The effects of their acute and chronic administration are described. The pharmacological strategies which facilitate the physiological functions of the cholinergic system without altering the normal modulation of cholinergic signals are highlighted. It is proposed that full agonists of muscarinic or nicotinic receptors should be avoided. Their activation is too intense and un-physiological because neuronal signals are distorted when these receptors are constantly activated. Good results can be achieved by using agents that are able to a) increase ACh synthesis, b) partially inhibit cholinesterase activity c) selectively block the autoreceptor or heteroreceptor feedback mechanisms. Activation of M1 subtype muscarinic receptors induces analgesia. Chronic stimulation of nicotinic (N1) receptors has neuronal protective effects. Recent experimental results indicate a relationship between repeated cholinergic stimulation and neurotrophic activation of the glial derived neurotrophic factor (GDNF) family. At least 9 patents covering novel chemicals for cholinergic system modulation and pain control are discussed.

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“…[24] Similarly, intrathecal high-dose neostigmine (200 mg) was previously described to result in analgesia, with peculiar adverse effects including bradycardia not responding to intravenous atropine. [25] Subsequently, bradycardia reversible by atropine was described following smaller intrathecal doses such as 25-100 mg.[2627] Nevertheless, such vagotonic effects were described only after intrathecal administration, but not after epidural administration, even when high epidural dose of 30 μg/kg was administered in pediatric patients undergoing genitourinary surgery. [28] Therefore, one would not expect any vagotonic action after epidural neostigmine, and therefore, the profound anesthesia was not a direct action on cardiovascular system, but rather analgesic contemplation of caudal neostigmine in the intraoperative setting, observed by the lower isoflurane consumption in all patients receiving caudal neostigmine as the adjuvant.…”

Section: Discussionmentioning

confidence: 99%

Comparison between the intravenous and caudal routes of sufentanil in children undergoing orchidopexy and further evaluation of the association of caudal adrenaline and neostigmine

et al. 2014

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Background:The aim of this study was to compare the intravenous (IV) and caudal routes of administration of sufentanil for children undergoing orchidopexy and also to evaluate the effects on addition of caudal adrenaline and neostigmine.Materials and Methods:Sixty patients scheduled for orchidopexy were divided into the following groups: 1) Group IVSu received IV 0.5 μg/kg sufentanil and caudal saline; 2) Group CSu received caudal 0.5 μg/kg sufentanil and IV saline; 3) Group CSuAdr received caudal sufentanil plus adrenaline 5 μg/ml (1:200,000) and IV saline; 4) Group CSuNeo received caudal sufentanil plus neostigmine, and IV saline; and 5) Group CSuNeoAdr received caudal sufentanil plus neostigmine plus adrenaline, and IV saline. Heart rate and mean blood pressure >15% was treated with increasing isoflurane concentration. Consumption of isoflurane, side effects, quality of sleep, time to first administration of analgesic, and number of doses of 24-h rescue analgesic were recorded.Results:Groups were demographically similar. Isoflurane consumption showed the following association: Group IVSu = Group CSuNeo = Group CSuNeoAdr < Group CSu = Group CSuAdr (P < 0.02). VAS for sedation on reversal of anesthesia showed the following association: Group CSuNeo = Group CSuNeoAdr < Group CSu = Group CSuAdr = Group IVSu (P < 0.005). Time to the first administration of dipyrone showed the following association: Group IVSu = Group CSu = Group CSuAdr (3-4 h) < Group CSuNeo = Group CSuNeoAdr (10-11 h) (P < 0.05). Number of doses of rescue analgesic showed the following association: Group IVSu = Group CSu = Group CSuAdr > Group CSuNeo = Group CSuNeoAdr (P < 0.005). Incidence of adverse effects was similar among groups.Conclusion:Caudal sufentanil alone was no better than when administered in the IV route, and would just be justified by the association of neostigmine, but not adrenaline. Neostigmine association resulted in better perioperative analgesia.

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Intrathecal neostigmine for postoperative analgesia after orthopedic surgery

Cited by 51 publications

References 3 publications

Analgesic efficacy of low-dose intrathecal neostigmine in combination with fentanyl and bupivacaine for total knee replacement surgery

Analgesic efficacy of low-dose intrathecal neostigmine in combination with fentanyl and bupivacaine for total knee replacement surgery

Analgesic and Antineuropathic Drugs Acting Through Central Cholinergic Mechanisms

Comparison between the intravenous and caudal routes of sufentanil in children undergoing orchidopexy and further evaluation of the association of caudal adrenaline and neostigmine

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