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The analgesic effectiveness of epidural neostigmine in early postoperative period in lower extremity surgery
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134. Prophylactic ondansentron reduces the side effects of morphine following the epidural use for postoperative pain control Kolotoura A, Provataki G, Vassilas N, Emexidis Th.Koudouna E, Gialitaki E, Anastassiou E. okiskira @yahoo.com Anaesthesia Department and Pain Clinic, G.Gennimatas General Hospital Elefsina “Thriassio’’, Chiou 30 Glyfada 16561 Athens, Greece Epidural analgesia, the administration of local anaesthetics and/or opioids in the epidural space has been used extensively by anaesthesiologists to control pain associated with surgical procedures since the late 70’s.The adverse effects of the opioids could be a problem, the most common of which is PONV and pruritus. This study aims to investigate if the administration of ondansetron prevents these side effects. After the institutional and ethics committee’s approval, 90 patients, aged 56-70, ASA I-II, that were undergoing total knee arthoplasty combined with spinal-epidural anaesthesia, were enrolled in this randomized double-blinded placebo controlled study. Patients were given standardized spinal anaesthesia. When the motor block was restored, all patients received 4 ml ropivacaine2% plus 2mg of morphine in a total volume of 6ml. After that, a pump of constant flow 2ml/h was connected with the epidural catheter, which was giving 5,4mg/h ropivacaine and 0.2mg/h morphine. Patients in group I, before the administration of the solution, were receiving 4mg ondansentron iv, while group II patients were receiving placebo. Patients were observed for PONV and pruritus the first 24 hrs. A statistic analysis was performed.
Group I Group II
PONV
Pruritus
9 (20%) 17 (37%)
10 (22%) 19 (42%)
The 2 groups had statistically significant difference regarding the side effects of the opioids p⬍0.001. The administration of ondansentron (4 mg) is effective for the prevention of the opioid side effects caused by its use epidural.
•
Postoperative Pain Management
35
183. The analgesic effectiveness of epidural neostigmine in early postoperative period in lower extremity surgery Taspınar V, Pala Y, Diker S, Ozdogan L, Akcay M, Dikmen B, Gogus N [email protected] Ankara Numune Training and Research Hospital Anesthesiology and Reanimation Departments, Ankara Numune Hastanesi, Anesteziyoloji ve Reanimasyon Klinigi, Talapasa Bulvari Sihhiye, Ankara, Turkey Background and goal of study: Epidural injection of neostigmine produces analgesia in patients with acute postoperative and chronic pain(1,2). In 1997, Khurukowski et al investigated the analgesic effect of intrathecal(IT) neostigmine and found that significant reduction of morphine consumption occured after 10 hour(hr) from IT injection of neostigmine. However, the analgesic effect of epidural neostigmine in early postoperative period could not have been tested in lower extremity surgery yet. The purpose of our study was to investigate the analgesic effect of epidural neostigmine in early postoperative period. Material-Method: After ethical committee approval and informed consent, 45 patients scheduled for lower extremity surgery were included. Spinal anesthesia was performed with %2 lidocaine 1.2mg/kg using combined spinal epidural technique. 10 minutes after intrathecal injection, study solutions distiled 10 mL were administred by epidurally way. Group SP: %09 NaCl, Group N4: Neostigmine 4mcg/kg, Group N8: Neostigmine 8mcg/kg . A PCA device including fentanyl 4 mcg/mL solution was connected to the epidural catheter at the operation ended. It was set as basal infusion rate 2.5 mL/ hr, bolus dose 5 mL, lockout time15 min, no loading and 4hr limit. Postoperative analgesia was evaluated with first demand bolus time(FDT), VAS scores and fentanyl consumption(FC) at postoperative 1., 2., 4., 6., 12. and 24. hrs. Variance analyze, Tukey B, Bonferroni and, Chi-Square tests were used for statistical analysis. Results: Demographical data, ASA scores, duration of operation and spinal block properties were similar in all groups. No significant difference was observed in FDT between groups. For the first 6 hrs there weren’t differences in FC among the groups. In the GrN8, FC at the 12th and 24th hours values significantly lower than GrSP, while there were no differences between N8 with N4, N4 with SP groups (12th hr: SP⫽261.75, N4⫽240.94, N8⫽209.74mcg p⬍0.05; 24th hr: SP⫽470.20, N4⫽453.13, N8⫽386.42mcg p⬍0.01). The number of the bolus delivered and demand were significantly lower in the GrN8 compared with the SP and N4(Delivered: SP⫽11.80, N4⫽10.93, N8⫽7.53 p⬍0.01, Demand: SP⫽14.20, N4⫽12.06, N8⫽8.73 p⬍0.05). Conclusion: We conclude that epidural neostigmine can provide effective analgesia together with fentanyl administration by PCEA as from 12th hour postoperatively and also its effect is dose dependent and enhanced during the postoperative period.
References: 1-Krukowski J.A: Anesth Analg 1997; 84:1269-75 2-Lauretti G.R: Anesthesiology 1999; 90(6):1534-8
134. Prophylactic ondansentron reduces the side effects of morphine following the epidural use for postoperative pain control Kolotoura A, Provataki G, Vassilas N, Emexidis Th.Koudouna E, Gialitaki E, Anastassiou E. okiskira @yahoo.com Anaesthesia Department and Pain Clinic, G.Gennimatas General Hospital Elefsina “Thriassio’’, Chiou 30 Glyfada 16561 Athens, Greece Epidural analgesia, the administration of local anaesthetics and/or opioids in the epidural space has been used extensively by anaesthesiologists to control pain associated with surgical procedures since the late 70’s.The adverse effects of the opioids could be a problem, the most common of which is PONV and pruritus. This study aims to investigate if the administration of ondansetron prevents these side effects. After the institutional and ethics committee’s approval, 90 patients, aged 56-70, ASA I-II, that were undergoing total knee arthoplasty combined with spinal-epidural anaesthesia, were enrolled in this randomized double-blinded placebo controlled study. Patients were given standardized spinal anaesthesia. When the motor block was restored, all patients received 4 ml ropivacaine2% plus 2mg of morphine in a total volume of 6ml. After that, a pump of constant flow 2ml/h was connected with the epidural catheter, which was giving 5,4mg/h ropivacaine and 0.2mg/h morphine. Patients in group I, before the administration of the solution, were receiving 4mg ondansentron iv, while group II patients were receiving placebo. Patients were observed for PONV and pruritus the first 24 hrs. A statistic analysis was performed.
Group I Group II
PONV
Pruritus
9 (20%) 17 (37%)
10 (22%) 19 (42%)
The 2 groups had statistically significant difference regarding the side effects of the opioids p⬍0.001. The administration of ondansentron (4 mg) is effective for the prevention of the opioid side effects caused by its use epidural.
•
Postoperative Pain Management
35
183. The analgesic effectiveness of epidural neostigmine in early postoperative period in lower extremity surgery Taspınar V, Pala Y, Diker S, Ozdogan L, Akcay M, Dikmen B, Gogus N [email protected] Ankara Numune Training and Research Hospital Anesthesiology and Reanimation Departments, Ankara Numune Hastanesi, Anesteziyoloji ve Reanimasyon Klinigi, Talapasa Bulvari Sihhiye, Ankara, Turkey Background and goal of study: Epidural injection of neostigmine produces analgesia in patients with acute postoperative and chronic pain(1,2). In 1997, Khurukowski et al investigated the analgesic effect of intrathecal(IT) neostigmine and found that significant reduction of morphine consumption occured after 10 hour(hr) from IT injection of neostigmine. However, the analgesic effect of epidural neostigmine in early postoperative period could not have been tested in lower extremity surgery yet. The purpose of our study was to investigate the analgesic effect of epidural neostigmine in early postoperative period. Material-Method: After ethical committee approval and informed consent, 45 patients scheduled for lower extremity surgery were included. Spinal anesthesia was performed with %2 lidocaine 1.2mg/kg using combined spinal epidural technique. 10 minutes after intrathecal injection, study solutions distiled 10 mL were administred by epidurally way. Group SP: %09 NaCl, Group N4: Neostigmine 4mcg/kg, Group N8: Neostigmine 8mcg/kg . A PCA device including fentanyl 4 mcg/mL solution was connected to the epidural catheter at the operation ended. It was set as basal infusion rate 2.5 mL/ hr, bolus dose 5 mL, lockout time15 min, no loading and 4hr limit. Postoperative analgesia was evaluated with first demand bolus time(FDT), VAS scores and fentanyl consumption(FC) at postoperative 1., 2., 4., 6., 12. and 24. hrs. Variance analyze, Tukey B, Bonferroni and, Chi-Square tests were used for statistical analysis. Results: Demographical data, ASA scores, duration of operation and spinal block properties were similar in all groups. No significant difference was observed in FDT between groups. For the first 6 hrs there weren’t differences in FC among the groups. In the GrN8, FC at the 12th and 24th hours values significantly lower than GrSP, while there were no differences between N8 with N4, N4 with SP groups (12th hr: SP⫽261.75, N4⫽240.94, N8⫽209.74mcg p⬍0.05; 24th hr: SP⫽470.20, N4⫽453.13, N8⫽386.42mcg p⬍0.01). The number of the bolus delivered and demand were significantly lower in the GrN8 compared with the SP and N4(Delivered: SP⫽11.80, N4⫽10.93, N8⫽7.53 p⬍0.01, Demand: SP⫽14.20, N4⫽12.06, N8⫽8.73 p⬍0.05). Conclusion: We conclude that epidural neostigmine can provide effective analgesia together with fentanyl administration by PCEA as from 12th hour postoperatively and also its effect is dose dependent and enhanced during the postoperative period.
References: 1-Krukowski J.A: Anesth Analg 1997; 84:1269-75 2-Lauretti G.R: Anesthesiology 1999; 90(6):1534-8