Epidural Neostigmine versus Fentanyl to Decrease Bupivacaine Use in Patient-controlled Epidural Analgesia during...

Area of Science:

• Anesthesiology
• Obstetrics
• Pharmacology

Background:

• Opioids with epidural local anesthetics reduce consumption but cause side effects.
• Epidural neostigmine is also known to reduce local anesthetic use.
• The study aimed to compare neostigmine with fentanyl in epidural analgesia.

Purpose of the Study:

• To test if epidural bupivacaine with neostigmine decreases hourly bupivacaine use compared to epidural bupivacaine with fentanyl.
• To evaluate the efficacy of neostigmine as an adjunct to bupivacaine for labor analgesia.

Main Methods:

• 215 laboring parturients received 0.125% bupivacaine with either fentanyl (2 μg/ml) or neostigmine (2, 4, or 8 μg/ml).
• Primary outcome was total hourly local anesthetic consumption (bupivacaine use divided by infusion duration).
• Sample size was calculated for 80% power to detect a 20% difference.

Main Results:

• 151 patients were evaluable; demographics and outcomes were similar across groups.
• Total hourly bupivacaine consumption did not differ significantly among groups (P = 0.55).
• Median hourly bupivacaine consumption ranged from 14.6 to 16.2 ml/h across neostigmine and fentanyl groups.

Conclusions:

• The study data do not support a difference in bupivacaine requirements for labor analgesia.
• Epidural bupivacaine with neostigmine (2-8 μg/ml) showed similar efficacy to bupivacaine with fentanyl (2 μg/ml).
• Neostigmine is not superior to fentanyl in reducing bupivacaine consumption for patient-controlled epidural analgesia during labor.