comparison of post-operative analgesic and hemodynamic effects of extradural neostigmine plus fentanyl with fentanyl alone in patients of hysterectomy

ABSTRACT

To study the comparative analgesic and haemodynamic effects of fentanyl with a combination of neostigmine plus fentanyl administered epidurally for post-operative pain in patients undergoing hysterectomy. This is an interventional, randomized, controlled study leading to therapeutic trial of a combination of drugs. The study was conducted at High Dependency Unit [HDU], Nishtar Hospital Multan, Pakistan. The study was completed in six months period from June to December 2004. One hundred female patients belonging to age range 40 60 years, of ASA 1 and 2, undergoing elective abdominal hysterectomy, were included in this study. They were randomly divided into two groups by the consultant anaesthetist. Patients having any clinical or biochemical evidence of any systemic diseases were excluded from the study. The procedure was explained to the patients and informed consent was obtained. All the patients were examined an evening before the operation. A lumber epidural catheter was passed before induction of general anesthesia. From immediate postoperative period till 20 hours, patients were given fentanyl alone in group A and fentanyl plus neostigmine in group B by epidural infusion. While assessing the intensity of pain relief in both the groups, the effects on hemodynamics were also recorded. Significant reduction in the intensity of pain was noted in the neostigmine plus fentanyl group. Moreover lower values of mean arterial pressure were recorded in this group, while significantly slower heart rates were found in the 4 th to 7 th hours of postoperative period. Epidurally administered neostigmine along with fentanyl gives better pain [qualitative] relief than fentanyl alone. Lower values of mean arterial pressure and slower heart rates at 4,5,6 and 7 hrs of infusion were seen