RESUMO
BACKGROUND: Intrathecal neostigmine and magnesium sulfate (MgSO4) produce substantial antinociception, potentiate analgesia of bupivacaine without neurotoxicity. AIMS: The aim was to investigate the effect of neostigmine and MgSO4 on characteristics of spinal anesthesia (SA), hemodynamic stability and postoperative analgesia when added to 0.5% hyperbaric bupivacaine for SA. SUBJECTS AND METHODS: In this prospective, randomized, double-blind study 75 American Society of Anesthesiologist status I and II adult females posted for major gynecological surgery were assigned to one of the three groups (n = 25). Group N received Neostigmine 25 µg, Group M received MgSO4 50 mg, Group C received 0.5 ml saline as an adjuvant to 17.5 mg hyperbaric bupivacaine. Onset, duration of block, heart rate, mean arterial pressure, postoperative analgesia, analgesic requirement, and adverse effects were recorded. Data expressed as mean (standard deviation) or number (%). P <0.05 were statistically significant. RESULTS: The three groups were comparable in characteristics of SA. The mean duration of analgesia was significantly longer in Group N (5.1 h) followed by Group M (4.2 h) and Group C (3.8 h) (P = 0.0134). Analgesic requirement was significantly less in Group N followed by Group M and Group C (P = 0.00232). The pain score was significantly less in Group M (P < 0.05). The incidence of hypotension and vasopressor requirement was lowest (48%) in Group N than in Group M (64%) and Group C 84% (P = 0.0276). The incidence of bradycardia and atropine requirement was the lowest in Group M (P = 0.0354). Sedation was observed in 56% patients in Group M compared to 20% in Group N and 8% in Group C (P = 0.0004). CONCLUSION: Intrathecal Neostigmine and MgSo4 does not affect characteristics of SA. Postoperative analgesia of neostigmine was better than MgSO4. Neostigmine provides some protection against hypotension of SA whereas MgSO4 protects against bradycardia.
RESUMO
The aim of present study is to report our experience concerning the effectiveness, quality of analgesia, ease of performance, complications and safety of spinal anaesthesia in children undergoing infra-umbilical surgery. An open, non-comparative study was performed on 40 children aged 5-15 years undergoing elective infra-umbilical surgery. After parents' written consent and premedication, spinal anaesthesia was induced with hyperbaric bupivacaine (5mg/ml), 0.4mg/kg for children up to 15 kg body weight and 0.3mg/kg for >15 kg via L3-L4 or L4-L5 interspace in lateral decubitus position. A 26-gauge disposable hypodermic needle with attached syringe and drug appearing at the tip of needle was used for lumbar puncture. The success rate, spread and duration of analgesia, degree-of motor block, additional anaesthetic, haemodynamic parameters and adverse effects were recorded. The descriptive results were presented as mean (SD) or number (%). Value of p<0.05 was considered significant. The success rate of the procedure was 92.5%. The mean onset of analgesia was 4.2(1.8) minutes. The highest sensory level (T8) was achieved within 6.2(3.1) minutes. The duration of block was 69.8(15) minutes. The dose of intrathecal bupivacaine used was 4-9 mg. No evidence of cardiovascular instability, postdural puncture headache, transient neurological symptoms, urinary complication was observed. Spinal anaesthesia with hyperbaric bupivacaine using 26-gauge hypodermic needle provides safe and effective analgesia for paediatric infra-umbilical surgery with high success rate.
