R. D'Angelo et al., Neostigmine combined with bupivacaine, clonidine, and sufentanil for spinal labor analgesia, ANESTH ANAL, 93(6), 2001, pp. 1560-1564
Citations number
26
Categorie Soggetti
Aneshtesia & Intensive Care","Medical Research Diagnosis & Treatment
We previously found that spinal clonidine prolongs labor analgesia when com
bined with spinal bupivacaine and sufentanil. We sought to determine whethe
r the addition of spinal neostigmine to these drugs would further enhance l
abor analgesia. By use of a combined spinal/epidural technique, 36 patients
were randomized to receive a hyperbaric spinal injection of bupivacaine 2.
5 mg plus clonidine 50 mug and sufentanil 10 mug with or without neostigmin
e 10 mug. Pain, maternal hemodynamics, fetal heart rate, nausea, pruritus,
sedation, motor block, sensory levels to pinprick, and maternal oxygen satu
ration were assessed at regularly specified intervals after spinal injectio
n until additional analgesia was requested. The duration of spinal analgesi
a was similar between groups (215 +/- 60 min in the Control group versus 20
5 +/- 62 min in the Neostigmine group). Likewise, pain scores, the duration
of labor, Apgar scores, and side effects were similar between groups excep
t that patients administered neostigmine experienced significantly more nau
sea and vomiting (53% vs 7%, P = 0.01). We conclude that spinal neostigmine
10 mug produces severe nausea and does not potentiate the duration of spin
al analgesia in laboring women from spinal bupivacaine, clonidine, and sufe
ntanil.