RESUMO
To determine the effect of pre-emptive epidurally administered 4 or 8 mcg/kg neostigmine on analgesia, mean arterial pressure, heart rate and side effects in intra and postoperative period. Randomized, double blinded, controlled clinical trial. Ankara Numune Training and Research Hospital, Turkey, from January to December 2008. Forty-five patients scheduled for lower extremity surgery were included in the study following the approval of the ethics committee and the patients. The study group was split into three groups and received combined spinalepidural anaesthesia. Diluting with 10 ml normal saline, group N4 and group N8 were delivered 4 mcg/kg and 8 mcg/kg epidural neostigmine, respectively, whereas group SF received 10 ml epidural saline. Lidocaine [2%] at 1.2 mg/kg dose was preferred for spinal anaesthesia. Analgesic efficacy, time to first analgesic requirement, Visual Analog Scale, Fentanyl consumption in the postoperative patient-controlled epidural analgesia, and delivered/required number of boluses, were evaluated. Haemodynamic data and side effects were noted. Statistically, analgesic consumptions at 12 and 24 hours in the N8 group was lower than those in the SF group, the number of delivered boluses was lower in the N8 group compared with the SF and N4 groups, number of required boluses was lower in the N8 group than in the SF group. In terms of haemodynamics and side effects, no difference was found between the groups regarding the entire intraoperative and postoperative parameters. Epidural Neostigmine administration at 8 mcg/kg was found to be a viable additional agent against analgesia, with the postoperative period depending on the dosage
RESUMO
To determine the characteristic profiles of 2 hypobaric spinal anesthetic solutions for selective spinal anesthesia in inguinal herniorrhaphy. The study took place in the general surgery room of Anesthesia Department, Ankara Numune Research and Training Hospital between May and July 2005 as a prospective, randomized and double-blind trial. Sixty-one ASA I-III patients scheduled for inguinal herniorrhaphy were randomly divided into 2 groups. Group R received combined spinal epidural anesthesia with ropivacaine 7.5 mg and group B received bupivacaine 5 mg; in both groups 25 micro g of fentanyl was added. Solutions were diluted with 1.5 ml of sterile water. A Portex 18/27 or 16/27 needle was inserted at L1-2 or L2-3 with patients sitting upright; surgery began after the sensory block reached the T6 dermatome. Sensory and motor block characteristics, hemodynamic data, side effects, recovery time, the timing of the onset of pain, and the walkout were assessed. Motor block duration was shorter in Group R [56.1 +/- 36.1 minutes versus 72.5 +/- 23.3 minutes] [p=0.013]. Complete motor block duration was shorter in Group R. There was no difference between the 2 groups. Intra-group analysis showed that hemodynamic values after anesthesia induction were lower than initial values. Ropivacaine plus fentanyl provided similar sensory anesthesia, but with a shorter duration of motor block than bupivacaine plus fentanyl when used for selective spinal anesthesia in herniorrhaphy surgery. Furthermore, we suggest that hemodynamic should be carefully monitored during surgery