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 Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (5) Citing Articles via Google Scholar Google Scholar Articles by Caliskan, E. Articles by Turkoz, R. Search for Related Content PubMed PubMed Citation Articles by Caliskan, E. Articles by Turkoz, R. Related Collections Anesthetic Techniques Complications Pain Medicine Regional Anesthesia Pain

---

PAIN MEDICINE

A Prospective Randomized Double-Blind Study to Determine the Effect of Thoracic Epidural Neostigmine on Postoperative Ileus After Abdominal Aortic Surgery

Esra Caliskan, MD^*, Ayda Turkoz, MD^*, Mesut Sener, MD^*, Nesrin Bozdogan, MD^*, Oner Gulcan, MD, and Riza Turkoz, MD

From the Departments of *Anesthesiology and Reanimation, and Cardiovascular Surgery, Baskent University Faculty of Medicine, Ankara, Turkey.

Address correspondence and reprint requests to Esra Caliskan, MD, Baskent University, Faculty of Medicine, Adana Teaching and Medical Research Center, Anesthesiology Department, Dadaloglu Mahallesi, 39.sokak, No: 36, Yüregir 01250 Adana, Turkey. Address e-mail to esra_ertr{at}yahoo.com.

BACKGROUND: Postoperative ileus is a major gastrointestinal complication of abdominal aortic surgery leading to increased rates of morbidity and mortality, longer lengths of hospital stay, and higher costs. In this study, we evaluated the effect of epidurally administered neostigmine on postoperative ileus after abdominal aortic surgery.

METHODS: We enrolled 45 patients who were scheduled for elective abdominal aortic surgery at our institution. All patients received identical general and epidural anesthesia. Before the induction of general anesthesia, an epidural catheter was placed at the T₇–T₈ intervertebral space, and 20 mL bupivacaine (0.5%) was injected over 15 min. Patients were randomized into two groups. Patients received a 5 mL bolus of neostigmine (1 µg/kg) diluted with normal saline (Group 1) or a 5 mL bolus of normal saline (Group 2) via an epidural catheter at the end of surgery and 8 h postoperatively. Times of bowel sounds were recorded postoperatively in the intensive care unit. Times of daily passage of flatus and defecation also were recorded.

RESULTS: Times to the first bowel sounds and the first flatus were significantly shorter in Group 1 than they were in Group 2 (11.6 ± 11.2 h vs 22.6 ± 12.8 h and 21.8 ± 15.6 h vs 36.6 ± 19.1 h, respectively, P < 0.05). The times to first defecation were similar in both groups (P > 0.05). Nausea was more frequent in patients in Group 2 than in Group 1 (P < 0.05). The incidence of postoperative complications was similar between the groups (P > 0.05).

CONCLUSIONS: Thoracic epidural neostigmine enables faster restoration of bowel sounds and shortens duration of postoperative ileus after abdominal aortic surgery.

This article has been cited by other articles:

				M. G. MYTHEN Postoperative gastrointestinal tract dysfunction: An overview of causes and management strategies Cleveland Clinic Journal of Medicine, November 1, 2009; 76(Suppl_4): S66 - S71. [Abstract] [Full Text] [PDF]

				J. C. Eisenach Epidural Neostigmine: Will It Replace Lipid Soluble Opioids for Postoperative and Labor Analgesia? Anesth. Analg., August 1, 2009; 109(2): 293 - 295. [Full Text] [PDF]