The effect of addition of neostigmine to epidural levobupivacaine fentanyl mixture on return of intestinal motility in postoperative ICU

Abstract EN

Background Postoperative ileus is a major cause of morbidity and mortality.

It has a direct correlation with pain and the use of narcotic analgesics.

Neostigmine is an anticholine esterase.

It acts as an adjuvant analgesic in the epidural space.

This study aimed to demonstrate the effect of epidural neostigmine addition to levobupivacaine / fentanyl mixture on postoperative analgesia following abdominal hysterectomy.

Materials and methods A total of 40 patients were divided into group N (the neostigmine group) and group C (the control group).

In group N, neostigmine 1 μg / kg was added to the epidural infusion of levobupivacaine and fentanyl.

Results Both groups were comparable in demographic data, surgical time, and hemodynamic data.

Group N had signifi cantly lower visual analogue scale (P < 0.05).

In addition, time to fi rst analgesic request was signifi cantly longer in group N (9.5+ or −1.3 vs.

8.1+ or −0.9 in group C).

The number of patients requiring analgesia in group N was two (10%), whereas in group C the number was nine (45%), which was statistically signifi cant.

Total narcotic consumption was signifi cantly less in group N (104 ± 21.6 vs.

218 ± 35.2 mg in group C) and return of intestinal sounds was signifi cantly faster in group N (8.1 ± 0.7 vs.

10.5 ± 1.8 h in group C).

Group N had less nausea and vomiting.

However, the difference was nonsignifi cant.

Conclusion Neostigmine addition to levobupivacaine and fentanyl in lumbar epidural analgesia reduces pain scores and helps early return of intestinal motility during the postoperative period following abdominal hysterectomy.