Cj. Chung et al., THE EFFICACY OF INTRATHECAL NEOSTIGMINE, INTRATHECAL MORPHINE, AND THEIR COMBINATION FOR POSTCESAREAN SECTION ANALGESIA, Anesthesia and analgesia, 87(2), 1998, pp. 341-346
We designed this study to evaluate the postoperative analgesic efficac
y and safety of intrathecal Fl neostigmine, IT morphine, and their com
bination in patients undergoing cesarean section under spinal anesthes
ia. Seventy-nine term parturients were randomly divided into four grou
ps to receive isotonic sodium chloride solution 0.2 mL, neostigmine 25
mu g, morphine 100 mu g, or the combination of IT neostigmine 12.5 mu
g and morphine 50 mu g with IT 0.5% hyperbaric bupivacaine 12 mg. The
re were no significant differences among the four groups with regard t
o spinal anesthesia, maternal blood pressure and heart rate, or fetal
status. Postoperative analgesia was provided by IV patient-controlled
analgesia (PCA) using fentanyl and ketorolac. Compared with the saline
group, the time to first PCA use was significantly longer in the neos
tigmine group (P < 0.001), with lower 24-h analgesic consumption (P <
0.001). Nausea and vomiting were the most common side effects of IT ne
ostigmine (73.7%). Analgesic effectiveness was similar between the neo
stigmine and morphine groups. Compared with the neostigmine group, the
combination group had significantly prolonged analgesic effect and re
duced 24-h PCA consumption (P < 0.05) with less severity of nausea and
vomiting (P = 0.058). Compared with the morphine group, the combinati
on group tended to have prolonged times to first PCA use (P = 0.054) w
ith a lower incidence of pruritus (P < 0.03). Implications: Intratheca
l (IT) neostigmine 25 mu g produced postoperative analgesia for cesare
an section similar to that of IT morphine 100 mu g, but with a high in
cidence of nausea and vomiting. The combination of IT neostigmine 12.5
mu g and IT morphine 50 mu g may produce better postoperative analges
ia with fewer side effects than IT neostigmine 25 mu g or TT morphine
100 mu g alone.