Lumbar spinal anaesthesia, Hyperbaric bupivacaine, Neostigmine, Fentanyl, Lower limb and abdominal surgery


Objective: Many adjuvants are used during lumbar spinal anaesthesia for lower limb and abdominal surgeries in day-to-day anaesthesia practice. The objectives of the study are to evaluate the time to onset of sensory and motor block, analgesic effect, and side effects of Neostigmine and Fentanyl as an adjuvant to hyperbaric Bupivacaine in spinal anaesthesia.

Methods: 80 patients aged 18 to 60 y of either sex, American Society of Anaesthesiologist (ASA) Physical Status I and II, undergoing elective lower limb and abdominal surgeries under lumbar spinal anaesthesia, were randomly divided into two groups-Group N and Group F, with 40 patients each. Group N received 50 µg Neostigmine and Group F received 30 µg Fentanyl with 03 ml of 0.5% hyperbaric Bupivacaine intrathecally. Intraoperative vitals, onset of sensory and motor block, time to first rescue analgesia, and side effects were recorded.

Results: There was no significant difference in the time to the onset of sensory block, peak sensory block (T6) and motor block in both groups (p-value>0.05). However, the two-segment block regression was slower, and the time to rescue analgesia was delayed in Group N than in Group F (p-value<0.0001). Except for nausea and vomiting, other side effects like hypotension, bradycardia, etc., were not significant and managed successfully.

Conclusion: Both Neostigmine and Fentanyl are safe and effective adjuvant to hyperbaric Bupivacaine in spinal anaesthesia for post-operative analgesic effect. However, due to the higher incidence of nausea and vomiting, the use of Neostigmine as an adjuvant is limited.


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Mehta N, Aasima tu Nisa Qazi S. Adjuvant drugs to local anesthetics. topics in local anesthetics. IntechOpen; 2020. doi: 10.5772/intechopen.91980

Hurley RW, Elkassabany NM, Wu CL. Acute post-operative pain. In: Gropper MA, Cohen NH, Eriksson LI, Fleisher LA, Leslie K, Wiener Kronish JP, editors. Miller’s anaesthesia. 9th ed. Amsterdam: Elsevier; 2020. p. 2614-38.

Taylor P. Anticholinesterase agents. In: Brunton LL, Chabner BA, Knollmann BC, editors. Goodman and Gilman’s the pharmacological basis of therapeutics. 12th ed. New York: McGraw-Hill; 2011. p. 239-54.

Lauretti GR, Lima IC. The effects of intrathecal neostigmine on somatic and visceral pain: improvement by association with a peripheral anticholinergic. Anesth Analg. 1996 Mar;82(3):617-20. doi: 10.1097/00000539-199603000-00033, PMID 8623971.

Lauretti GR, Mattos AL, Reis MP, Prado WA. Intrathecal neostigmine for post-operative analgesia after orthopedic surgery. J Clin Anesth. 1997;9(6):473-7. ISSN 0952-8180. doi: 10.1016/S0952-8180(97)00103-7, PMID 9278834.

Pandey V, Mohindra BK, Sodhi GS. Comparative evaluation of different doses of intrathecal neostigmine as an adjuvant to bupivacaine for postoperative analgesia. Anesth Essays Res. 2016 Sep-Dec;10(3):538-45. doi: 10.4103/0259-1162.180779, PMID 27746548, PMCID PMC5062199.

Ruparel DH, Dhumane P, Rathi A. Comparison of two different doses of intrathecal neostigmine as an adjuvant to bupivacaine for post-operative analgesia. Indian J Clin Anaesth. 2020;7(4):652-6. doi: 10.18231/j.ijca.2020.117.

Brull R, Macfarlane AJ, Chan VW. Spinal, epidural and caudal anesthesia. In: Gropper MA, Cohen NH, Eriksson LI, Fleisher LA, Leslie K, Wiener Kronish JP, editors. Miller’s anaesthesia. 9th ed. Amsterdam: Elsevier; 2020. p. 1413-49.

Bogra J, Arora N, Srivastava P. Synergistic effect of intrathecal fentanyl and bupivacaine in spinal anesthesia for cesarean section. BMC Anesthesiol. 2005 May 17;5(1):5. doi: 10.1186/1471-2253-5-5, PMID 15904498, PMCID PMC1159169.

Shakya ML, Yadav AS, Dwivedi S. Comparative evaluation of intrathecal neostigmine with intrathecal fentanyl for post-operative pain relief. Int J Sci Stud. 2016;4(5):168-71.

Bhaskar HU, Kankanala S, Reddy GN. A comparative study of intrathecal neostigmine and dexmedetomidine as adjuvant to bupivacaine spinal analgesia in sub umbilical regional surgeries acad. Anesthesiol Int. 2019;4(1):53-56. doi: 10.21276/aan.2019.4.1.12.

Palmer CM, Cork RC, Hays R, Van Maren G, Alves D. The dose-response relation of intrathecal fentanyl for labor analgesia. Anesthesiology. 1998;88(2):355-61. doi: 10.1097/00000542-199802000-00014, PMID 9477056.

Hamber EA, Viscomi CM. Intrathecal lipophilic opioids as adjuncts to surgical spinal anesthesia. Reg Anesth Pain Med. 1999 May-Jun;24(3):255-63. doi: 10.1016/s1098-7339(99)90139-6, PMID 10338179.

Seewal R, Shende D, Kashyap L, Mohan V. Effect of addition of various doses of fentanyl intrathecally to 0.5% hyperbaric bupivacaine on perioperative analgesia and subarachnoid-block characteristics in lower abdominal surgery: a dose-response study. Reg Anesth Pain Med. 2007 Jan-Feb;32(1):20-6. doi: 10.1016/j.rapm.2006.09.007, PMID 17196488.

Yoganarasimha N, Raghavendra TR, Radha MK. A clinical study of perioperative effectiveness of adjuvant neostigmine with intrathecal bupivacaine for lower abdominal surgeries. J Dent Med Sci. 2012 Nov-Dec;2(3):35-9.

Dalvi NP, Patil N. Comparison of effect of intrathecal fentanyl-bupivacaine and tramadol-bupivacaine combination on postoperative analgesia in lower abdominal surgeries. Journal of Research & Innovation in Anesthesia. 2016;1(2):35-40. doi: 10.5005/jp-journals-10049-0010.

Nahakpam S, Dhanachandra L, Devi NJ, Wahab Z, Samjetsabam L, Kumaragurubaran TR. A comparative study on three different doses of fentanyl with bupivacaine in spinal anaesthesia in caesarean section. J Evid Based Med Healthc. 2020;7(7):327-32. doi: 10.18410/jebmh/2020/70.

Hocking G, Wildsmith JA. Intrathecal drug spread. Br J Anaesth. 2004 Oct;93(4):568-78. doi: 10.1093/bja/aeh204, PMID 15220175.

Kumari Vasantha NS, Madhusudhana R. Intrathecal bupivacaine with neostigmine and bupivacaine with normal saline for post-operative analgesia: a cost-effective additive. Anesth Essays Res. 2018 Apr-Jun;12(2):328-32. doi: 10.4103/aer.AER_184_17, PMID 29962592, PMCID PMC6020563.

Moges K, Tarekegn F, Girma B. Postoperative analgesic effect of intrathecal neostgmine added to bupivacaine for adult patients undergoing lower limb orthopedic surgery. Pharm Pharmacol Int J. 2018;6(1):36-40. doi: 10.15406/ppij.2018.06.00152.

Lauretti GR, Hood DD, Eisenach JC, Pfeifer BL. A multi-center study of intrathecal neostigmine for analgesia following vaginal hysterectomy. Anesthesiology. 1998;89(4):913-8. doi: 10.1097/00000542-199810000-00016, PMID 9778009.

Farzi F, Mirmansouri A, Naderi Nabi B, Atrkar Roushan Z, Ghazanfar Tehran S, Nematollahi Sani M. Comparing the effect of adding fentanyl, sufentanil, and placebo with intrathecal bupivacaine on duration of analgesia and complications of spinal anesthesia in patients undergoing cesarean section. Anesth Pain Med. 2017 Aug 27;7(5):e12738. doi: 10.5812/aapm.12738, PMID 29696107, PMCID PMC5903220.

Cousins MJ, Mather LE. Intrathecal and epidural administration of opioids. Anesthesiology. 1984;61(3):276-310. doi: 10.1097/00000542-198409000-00008, PMID 6206753.

Liu SS, McDonald SB. Current issues in spinal anesthesia. Anesthesiology. 2001;94(5):888-906. doi: 10.1097/00000542-200105000-00030, PMID 11388543.

Onk D, Akarsu Ayazoglu T, Kuyrukluyıldız U, Aksüt M, Bedir Z, Küpeli I. Effects of fentanyl and morphine on shivering during spinal anesthesia in patients undergoing endovenous ablation of varicose veins. Med Sci Monit. 2016 Feb 12;22:469-73. doi: 10.12659/msm.897256, PMID 26871238, PMCID PMC4755667.

Klamt JG, Slullitel A, Garcia IV, Prado WA. Post-operative analgesic effect of intrathecal neostigmine and its influence on spinal anaesthesia. Anaesthesia. 1997 Jun;52(6):547-51. doi: 10.1111/j.1365-2222.1997.115-az0111.x, PMID 9203881.



How to Cite

BORAH, M., M. PATIR, and E. ANTONY. “COMPARISON BETWEEN INTRATHECAL NEOSTIGMINE AND FENTANYL AS ADJUVANT TO HYPERBARIC BUPIVACAINE IN SPINAL ANAESTHESIA FOR POST-OPERATIVE PAIN RELIEF”. International Journal of Current Pharmaceutical Research, vol. 16, no. 3, May 2024, pp. 12-17, doi:10.22159/ijcpr.2024v16i3.4071.



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