Intrathecal Neostigmine and Postoperative Analgesia in Cesarean Section

الملخص

Spinal anesthesia has become so commonly used in cesarean section (SC) that if there was no medical contraindication or
patients refusal, it will be the anesthetist’s first choice.
In an attempt to improve and prolong the spinal block and pain free time after cesarean section which is usually 1.5-2 hr,
with the use of Bupivacaine intrathecally led scientists to think of adding other drugs to Bupivacaine.
By adding drugs to Bupivacaine before injecting it intrathecally prolongs the pain free time after SC which decreases the
need for intravenous and intramuscular analgesics which in return decreases its side effects, toxicity, and expenses.
This study is aimed to compare between the intrathecal injection of Neostigmine and Bupivacaine and Bupivacaine alone
in cesarean section and time of onset of pain after and duration of spinal block.
A randomized controlled study of 40 pregnant women of ASA 1 physical status undergoing cesarean section in the
Maternity department of Tripoli Medical Center.
After obtaining consent from patients they were divided into two groups; Group A: consisting of 20 patients where
intrathecal Bupivacaine alone injected. Group B: consisting of 20 patients where Neostigmine 30 ug prepared immediately
and under aseptic technique with the use of insulin syringe and mixed with Bupivacaine prior to injecting it intrathecally.
Also this group is further subdivided into 2 groups each of ten patients and given Dexamethasone intravenously while
performing spinal block one subgroup given 4 mg and the other 8 mg as an attempt to minimize the nausea and vomiting
caused by Neostigmine.
In both groups aseptic technique used to perform the spinal anesthesia with the use of 27 G spinal needle and 12 mg (2.2
ml) of heavy 0.5% Bupivacaine at L3-L4 level of spinal cord. Blood pressure before and after spinal anesthesia obtained.
Bromage Scale and, Visual Analogue Pain Scale (VAS) of ten centimeters long starting with 0-no pain and ending with
10-most painful, are obtained from patients after operation and time recorded in each scale.
The study revealed that, Neostigmine as an adjunct to intrathecal anesthesia exhibits analgesic effects resulting in
prolongation of sensory blockade of up to 10+ hr and motor blockade of up to 4.5 hr with no other side effects besides
nausea and vomiting which still occurred in 40% of patients who received 8 mg I.V. Dexamethasone as an attempt to
minimize these side effects.