Postoperative analgesic effect of epidural neostigmine following caesarean section

The aim of this study was to evaluate the analgesic effects of postoperative epidural administration of neostigmine and morphine in patients scheduled for caesarean section under epidural anaesthesia.

Sixty ASA I-II patients, scheduled for caesarean section under epidural anaesthesia, were randomly allocated into three groups. Neostigmine (10 μg/kg), morphine (3 mg), and saline (6 mL) were administered to the neostigmine, morphine, and control groups, respectively, 30 minutes after the surgery via the epidural catheter. Afterwards, postoperative pain treatment was administered to all patients with a patient-controlled epidural analgesia (PCEA) device, using 0.125% bupivacaine. The patients were followed up for 24 hours. The total volume of local anaesthetics used, the time to first analgesic requirement, analgesic requirements, VAS scores, analgesia quality, first passage of bowel gas, ambulation times, haemodynamic parameters and side effects were evaluated.

The time to first analgesic requirement was significantly longer in the morphine group than in the neostigmine and control groups (p<0.01), and in the neostigmine group compared to the control group (p<0.05). The total local anaesthetic consumption and the number of bolus injections were significantly higher in the control group than in the other groups (p<0.01). The first passage of bowel gas occurred significantly sooner in the neostigmine group than in the morphine (p<0.01) and the control (p<0.05) groups. Itching frequency was significantly higher in the morphine group than in the other two groups (p<0.05). VAS scores were similar in the morphine and neostigmine groups.

Postoperative single-dose epidural neostigmine reduced the 24-hour analgesic requirements but in the chosen doses presented an analgesic effect significantly lower than morphine. Hippokratia 2014; 18 (1): 44-48.