Comparison of postoperative analgesic effects of preemptively used epidural ketamine and neostigmine

Study Objective: To compare the analgesic and side effects of preemptively used epidural ketamine +bupivacaine, neostigmine +bupivacaine, and bupivaca ine alone on postoperative analgesia after major abdominal surgery. Design: Randomized, controlled study. Setting: Inpatient anesthesia at the department of surgery of a metropolita n hospital. Patients: 30 ASA physical status I, II, and III patients scheduled for abdo minal surgery. Interventions: Group K received 1 mL (50 mg) ketamine and 5 mL (25 mg) bupi vacaine epidurally, Group N received 1 mL (0.5 mg) neostigmine and 5 mL (25 mg) bupivacaine epidurally, and Group B received 1 mL saline and 5 mL (25 mg) bupivacaine epidurally 30 minutes before operation. All patients underw ent anesthesia induction with thiopental and vecuronium; anesthesia was mai ntained with isoflorane and vecuronium. For postoperative analgesia, all pa tients received epidural morphine for 48 hours postoperatively. Measurements and Main Results: Standard monitoring included: 48 hours of an algesic requirement, visual analog scale (VAS), mean arterial pressure (MAP ), and heart rate (HR) in the 1st, 2nd, 6th, 12th, 24th, and 48th hours. Da ta were analyzed using Kruskall-Wallis and Mann Whitney U tests, with a p < 0.05 considered statistically significant. No significant differences were observed regarding MAP and HR among the groups during the study period. In Group N, VAS was significantly lower than Group K and Group B. The total o pioid consumption in Group N was significantly lower than in Groups K and B in the first 48 hours after the operation. Conclusions: Preemptive neostigmine can be a good choice for postoperative analgesia. (C) 2000 by Elsevier Science Inc.