| Study of three different doses of epidural neostigmine coadministered with lidocaine for postoperative analgesia. | |
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MedLine Citation:
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PMID: 10360848 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Intrathecal neostigmine produces analgesia in volunteers and patients. However, the use of epidural neostigmine has not been investigated. The purpose of the current study was to define the analgesic effectiveness of epidural neostigmine coadministered with lidocaine and side effects in patients after minor orthopedic procedures. METHODS: After Institutional Review Board approval and informed consent, 48 patients (n = 12) undergoing knee surgery were randomly allocated to one of four groups and studied in a prospective way. After 0.05-0.1 mg/kg intravenous midazolam premedication, patients were randomized to receive 20 mg intrathecal bupivacaine plus epidural lidocaine (85 mg) with saline (control group); 1 microg/kg epidural neostigmine (1 microg group); 2 microg/kg epidural neostigmine (2 microg group); or 4 microg/kg epidural neostigmine (4 microg group). The concept of the visual analog scale, which consisted of a 10-cm line with 0 equaling "no pain at all" and 10 equaling "the worst possible pain" was introduced. Postoperatively, pain was assessed using the visual analog scale, and intramuscular 75 mg diclofenac was available at patient request. RESULTS: Groups were demographically the same and did not differ in intraoperative characteristics (blood pressure, heart rate, ephedrine consumption, oxyhemoglobin saturation, sensory loss before start of surgery, or duration of sensory motor block). The visual analog scale score at first rescue analgesic and the incidence of adverse effects were similar among groups (P > 0.05). The time (min +/- SD) to first rescue analgesic was as follows: control group: 205+/-48; 1-microg group: 529+/-314; 2-microg group: 504+/-284; 4-microg group: 547+/-263 (P < 0.05). The analgesic consumption (number of intramuscular diclofenac injections [mean, 25th-75th percentile]) in 24 h was as follows: control group: 3 [3 or 4]; 1-microg group: 1 [1 or 2]; 2-microg group: 2 [1 or 2]; 4-microg group: 2 [1-3] (P < 0.05). The 24-h-pain visual analog scale score (cm +/- SD) that represents the overall impression for the last 24 h was as follows: control group: 5+/-1.6; 1-microg group: 1.6+/-1.8; 2-microg group: 1.4+/-1.6; 4-microg group: 2.2+/-1.9 (P < 0.005). The incidence of adverse effects was similar among groups (P > 0.05). CONCLUSION: Epidural neostigmine (1, 2, or 4 microg/kg) in lidocaine produced a dose-independent analgesic effect (approximately 8 h) compared to the control group (approximately 3.5 h), and a reduction in postoperative rescue analgesic consumption without increasing the incidence of adverse effects. |
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Authors:
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G R Lauretti; R de Oliveira; M P Reis; M C Juliâo; N L Pereira |
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Publication Detail:
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Type: Clinical Trial; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Anesthesiology Volume: 90 ISSN: 0003-3022 ISO Abbreviation: Anesthesiology Publication Date: 1999 Jun |
Date Detail:
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Created Date: 1999-06-17 Completed Date: 1999-06-17 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 1300217 Medline TA: Anesthesiology Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 1534-8 Citation Subset: AIM; IM |
Affiliation:
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Department of Surgery, Center for Pain of the Hospital das Clínicas, Faculty of Medicine of Ribeirâo Preto, University of Sâo Paulo, Brazil. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Analgesia, Epidural* Dose-Response Relationship, Drug Double-Blind Method Drug Therapy, Combination Female Humans Knee / surgery Lidocaine / administration & dosage* Male Middle Aged Neostigmine / administration & dosage* Pain, Postoperative / drug therapy* Prospective Studies |
| Chemical | |
Reg. No./Substance:
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137-58-6/Lidocaine; 59-99-4/Neostigmine |
| Comments/Corrections | |
Comment In:
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Anesthesiology. 2000 Apr;92(4):1207-8
[PMID:
10754652
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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