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Revista Mexicana de Coloproctología Enfermedades del Ano, Recto y Colon

2004, Number 3

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Rev Mex Coloproctol 2004; 10 (3)

Neuraxial Administration of Neostigmine as Analgesic in Hemorrhoidectomy Clinical Testing

Cordoví AL, Pérez RM, Vallongo MMB, Gutiérrez RAR, Llanes DG, Aguillar MFJ

Language: Spanish
References: 33
Page: 9-20
PDF size: 124.77 Kb.


ABSTRACT

Pain after haemorrhoidectomy is a problem without definitive solution. Researches support the neuroaxial administration of neostigmine for analgesia. Postoperative nauseas and vomiting (PONV) have limited their wide application. Neuroaxial neostigmine has not been evaluated in haemorrhoidectomized patients neither their peridural use has been contrasted vs. the Intrathecal one. Purposes: To evaluate: analgesia, consumption of dipyrone, behavior of PONV and satisfaction. Method: 120 patients ASA I-II scheduled for haemorrhoidectomy. All of them received spinal anesthesia with a hyperbaric technique in sit-down position. Randomly 4 groups of 30 each. Group C (control), Group IT-NEO, 25 µg of intrathecal neostigmine , Group EPI-NEO 1, 50 µg of epidural neostigmine, Group EPI-NEO 2, 150 µg of epidural neostigmine. Variables of answer: Pain and PONV according to similar visual scale (VAS) 1, 4, 8, 12, 20 and 24 hours later. Dipyrone and metoclopramide consumption, satisfaction and occurrence of other side effects. Statistic: Kruskal-Wallis and Chi2. P ‹ 0.05 was considered significants. Results: VAS values for pain was significantly smaller for the groups IT-NEO and EPI-NEO 2 (p ‹ 0.05) in the first one and fourth hours and IT-NEO at 24. VAS values for PONV was significantly higher for the IT-NEO and EPI-NEO 2 (p ‹ 0.05). For both, the analgesic drug consumption were significantly smaller and those of metoclopramide were higher (p ‹ 0.05). Conclusions: Epidural neostigmine 2.2 µg/kg reduced VAS values for pain but PONV had a significant incidence There was bigger satisfaction with this alternative but without significant values.


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