Neostigmine intrathecal and transdermal nitroglycerine augment intrathecal bupivacaine-fentanyl postoperative analgesia following lower limb surgery

ABSTRACT

Sixty patients were scheduled for lower limb operations. Their age ranged from 24 to 49 years [mean 41.7 +/- 6.4]. Patients were divided into four groups each group included 15 patients. All patients were given intrathecal bupivacaine - fentanyl, plus group [I] was given [non transdermal nitroglycerine patch] as placebo, group [II] transdermal nitroglycerine patch 5mg /24 hours, group [III] intrathecal neostigmine 10 ug and [non transdermal nitroglycerine patch] as placebo and group [IV] transdermal nitroglycerine patch 5mg /24 hours plus intrathecal neostigmine 10 ug. All groups were assessed for intraoperative and a period of postoperative 24 hours for vital parameters, postoperative analgesia and duration of effective analgesia as time from intrathecal drug administration to the patients first requested for analgesic medication, adverse side effects and total dose to control pain in 24 hours postoperative. Results of this study revealed multiple drug combination may be useful in extending postoperative analgesia of spinal bupivacaine - fentanyl associated with transdermal nitroglycerine patch and neostigmine intrathecal .Suggesting that transdermal nitroglycerine patch and neostigmine may enhance each other's antinociceptive effects at the dose studied