Preemptive caudal epidural analgesia in adult patients undergoing lumbar disc surgery: a comparison between neostigmine, ropivacaine and their mixture

This prospective, randomized double blind study was designed to evaluate the analgesic characters and profile of ropivacaine/ neostigmine mixture in comparison with the analgesic characters of ropivacaine and neostigmine when used alone and injected caudally in cases subjected for elective lumbar disc surgery at Mansoura University Hospitals. Thirty adult patients ASA I-II subjected for elective lumbar disc surgery at Mansoura University Hospital were enrolled in this study. General anesthesia was induced with 5 mg /kg thiopental sodium and tracheal intubation was facilitated using atracurium 0.5 mg/kg. Patients were randomly assigned into three equal groups [n= 10] according to the regimen of caudal drug injection. The injectate was prepared by an anesthesiologist not involved in the evaluation of the patients. Patient's groups were as follows: Ropivacaine group [R], received ropivacaine 0.2% in saline with total volume 30 ml. Neostgmine group [N], received neostgmine 4 ug /kg in total volume 30 ml. Ropivacaine-Neostgmine group [RN], patients received ropivacaine 0.2% + neostigmine 4 ug/kg in total volume 30 ml . Intraoperative monitoring for ECG, heart rate,mean arterial blood pressure, arterial oxygen saturation and capnography was recorded every 15 minutes till the end of the study period. Postoperative pain was assessed immediately after surgery and at 2, 4, 8, 12 hour postoperatively by the visual analogue scale [VAS], where 0 =no pain, 5= medium degree of pain and 10 =severe pain. The time at which first analgesic medications [mepredine, 25mg dosage] required by the patient in the postoperative period was recorded .Duration of postoperative analgesia [duration from the end of surgery to the first pain sensation] was recorded. Postoperative complications [nausea, vomiting, and any other complications] were recorded. There were no statistically significant differences between the three groups as regard hemodynamics, nausea and vomiting while urine retention was more observed in all patients received ropivacaine [R and RN groups]. As regard postoperative analgesia, group RN [received ropivacaine+ neostigmine] had the best pain score and longer duration of postoperative analgesia as compared with the other groups. Addition of neostigmine 4 micro g/kg to caudal ropivacaine 0.2% improves the quality of postoperative analgesia and prolongs its duration compared with caudal ropivacaine or neostigmine alone without increasing incidence of side effects in patients subjected for lumbar disc surgery

Effect of local and systemic fentanyl on ropivacaine-induced supraclavicular block of brachial plexus

This prospective, randomized double blind study was designed to evaluate different effects of the addition of fentanyl to ropivacaine, on the analgesic profile after supraclavicular block of brachial plexus and to assess the hemodynamic effect and complications of this mixture in cases scheduled for elective upper limb orthopedic surgery at Mansoura University Hospitals. Forty five adult patients, ASA I-II, subjected for elective upper limb orthopedic surgery at Mansoura University Hospital were enrolled in this study. The patients were randomly assigned, using sealed envelope method, into 3 groups, each one consisted of 15 patients according to the mixture of anesthetic solution: ropivacaine group[R]: received 30 ml 0.75% local ropivacaine + 2ml saline i.m, local fentanyl group [FL]:received 30 ml 0.75% local ropivacaine mixed with 1 micro g / kg fentanyl + 2 ml saline i.m and systemic fentanyl group [FS]: received 30 ml 0.75% local ropivacaine and i.m 1 micro g/kg fentanyl. The previously mentioned injectates were prepared in similar syringes by an Anesthetist other than the anesthesia provider. Parameters of brachial plexus blockade were recorded and included: Onset of sensory block, Onset of motor block, Postoperative analgesia duration and duration of anesthesia. Haemodynamic variables [heart rate and arterial blood pressure] and oxygen saturation were recorded. Intraoperative and postoperative complications as cardiovascular, respiratory or neurological disturbance were also recorded. Data were obtained and analyzed using statistica program. In this study, we recorded no effect on the duration of anesthesia or the duration of postoperative analgesia after addition of perineural fentanyl. But, we recorded a delay in the onset of anesthesia which occurred only with perineural fentanyl. We did not record any cardiovascular, respiratory or neurological complications. As regards our conclusions concerning effect of adding1 micro g /kg fentanyl to ropivacaine in supraclavicular brachial plexus blockade, we assumed that addition of perineural fentanyl was of no benefit as regards the duration, quality of anesthesia and postoperative analgesia