JOURNAL HOME CME HOME THIS MONTH PAST ISSUES ETOC COLLECTIONS AUTHORS REVIEWERS EDITORIAL BOARD FEEDBACK RSS HELP
		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (5) Citing Articles via Google Scholar Google Scholar Articles by Chia, Y.-Y. Articles by Wang, Y.-M. Search for Related Content PubMed PubMed Citation Articles by Chia, Y.-Y. Articles by Wang, Y.-M.

---

PAIN MEDICINE

The Efficacy of Thoracic Epidural Neostigmine Infusion After Thoracotomy

Yuan-Yi Chia, MD^*, Ting-Hang Chang, MD^*, Kang Liu, MD^*, Huang-Chou Chang, MD, Nai-Hua Ko, RN^*, and Ying-Ming Wang, MD^*

Departments of *Anesthesiology and Chest Surgery, Kaohsiung Veterans General Hospital and School of Medicine, National Yang-Ming University, Taiwan; Institution of Health Care Management, National Sun Yat-Sen University, Kaohsiung, Taiwan

Address correspondence and reprint requests to Ying-Ming Wang, MD, Department of Anesthesiology, Kaohsiung Veterans General Hospital, 386 Ta-Chung First Road, Kaohsiung 813, Taiwan. Address e-mail to ymwang{at}isca.vghks.gov.tw.

Few anesthesia studies have explored perioperative continuous epidural infusion of neostigmine. We examined such a regimen in thoracotomy patients. Ninety patients were randomized to one of three groups in this double-blind trial. Before anesthesia induction, an epidural catheter was inserted in all patients at T5-8 levels under local anesthesia. Pre-neo patients received bolus 500-µg epidural neostigmine before anesthesia induction followed by infusion of 125 µg/h until the end of surgery. Post-neo patients received epidural saline during the same time periods plus bolus 500-µg epidural neostigmine at end of surgery. Patients in the control group received saline placebo during all three periods. Patients in the neostigmine groups postoperatively received patient-controlled epidural analgesia with morphine 0.02 mg/mL, bupivacaine 0.08 mg/mL, and neostigmine 7 µg/mL. Control patient-controlled epidural analgesia excluded neostigmine. Data were recorded for 6 postoperative days. Daily patient-controlled epidural analgesia consumption (mL) for Pre-neo patients was significantly less than that of post-neo and control group patients for postoperative days 1–6 (at least 10% and 16% less, respectively; P < 0.05). There was a modest decrease in pain intensity on postoperative days 3–6 for pre-neo patients versus other groups (P < 0.05). These results suggest that continuous thoracic epidural neostigmine started before anesthesia provided preemptive, preventive analgesia and an analgesic-sparing effect that improved postoperative analgesia for these patients without increasing the incidence of adverse effects.

This article has been cited by other articles:

				E. Caliskan, A. Turkoz, M. Sener, N. Bozdogan, O. Gulcan, and R. Turkoz A Prospective Randomized Double-Blind Study to Determine the Effect of Thoracic Epidural Neostigmine on Postoperative Ileus After Abdominal Aortic Surgery Anesth. Analg., March 1, 2008; 106(3): 959 - 964. [Abstract] [Full Text] [PDF]

				A. Gottschalk, M. Freitag, E. Steinacker, S. Kreissl, C. Rempf, H.-J. Staude, T. Strate, and T. Standl Pre-incisional epidural ropivacaine, sufentanil, clonidine, and (S)+-ketamine does not provide pre-emptive analgesia in patients undergoing major pancreatic surgery Br. J. Anaesth., January 1, 2008; 100(1): 36 - 41. [Abstract] [Full Text] [PDF]

				P. F. White, H. Kehlet, J. M. Neal, T. Schricker, D. B. Carr, F. Carli, and the Fast-Track Surgery Study Group The Role of the Anesthesiologist in Fast-Track Surgery: From Multimodal Analgesia to Perioperative Medical Care Anesth. Analg., June 1, 2007; 104(6): 1380 - 1396. [Abstract] [Full Text] [PDF]

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999