Anesthesia & Analgesia, Vol 82, 1182-1187, Copyright © 1996 by International Anesthesia Research Society

GENERAL ARTICLES

Dose-response study of intrathecal morphine versus intrathecal neostigmine, their combination, or placebo for postoperative analgesia in patients undergoing anterior and posterior vaginoplasty

GR Lauretti, MP Reis, WA Prado and JG Klamt
Department of Surgery, Hospital das Clnicas-Faculdade de Medicina de Ribeirao Preto-USP, Sao Paulo, Brazil.

This study was designed to examine postoperative analgesia with intrathecal neostigmine in a randomized, blinded trial with morphine as the active control in patients undergoing anterior and posterior vaginoplasty. A secondary aim was to provide preliminary data on the interaction between these two drugs. The incidence of adverse effects was also assessed. Forty-eight patients were divided into eight groups (50 micrograms, 100 micrograms, and 200 micrograms morphine [M]; saline; 50 micrograms, 100 micrograms, and 200 micrograms neostigmine [N]; and 50 micrograms morphine + 50 micrograms neostigmine). Anesthesia was provided with a balanced technique. All patients stayed 24 h in the recovery room where adequacy of postoperative analgesia and side effects were assessed. Increasing doses of intrathecal morphine (50 micrograms, 100 micrograms, and 200 micrograms) and intrathecal neostigmine (50 micrograms, 100 micrograms, and 200 micrograms) showed a dose-dependent pattern of analgesia (P < 0.001). The M50 + N50 combination resulted in a better analgesic effect with fewer side effects than M50, N50, and control groups. These preliminary data suggest that spinal neostigmine produces analgesia for vaginoplasty surgery similar in duration to spinal morphine and that the combination of morphine and neostigmine may allow a reduction in the dose of each component for postoperative analgesia.

This article has been cited by other articles:

				S. L. Shafer Anesthesia & Analgesia's Policy on Off-Label Drug Administration in Clinical Trials Anesth. Analg., July 1, 2007; 105(1): 13 - 15. [Full Text] [PDF]

				Y.-Y. Chia, T.-H. Chang, K. Liu, H.-C. Chang, N.-H. Ko, and Y.-M. Wang The Efficacy of Thoracic Epidural Neostigmine Infusion After Thoracotomy Anesth. Analg., January 1, 2006; 102(1): 201 - 208. [Abstract] [Full Text] [PDF]

				M. Omais, G. R. Lauretti, and C. A.J. Paccola Epidural Morphine and Neostigmine for Postoperative Analgesia After Orthopedic Surgery Anesth. Analg., December 1, 2002; 95(6): 1698 - 1701. [Abstract] [Full Text] [PDF]

				M. Abdulatif and M. El-Sanabary Caudal Neostigmine, Bupivacaine, and Their Combination for Postoperative Pain Management After Hypospadias Surgery in Children Anesth. Analg., November 1, 2002; 95(5): 1215 - 1218. [Abstract] [Full Text] [PDF]

				A. Turan, B. Karamanlyoglu, D. Memis, G. Kaya, and Z. Pamukcu Intravenous Regional Anesthesia Using Prilocaine and Neostigmine Anesth. Analg., November 1, 2002; 95(5): 1419 - 1422. [Abstract] [Full Text] [PDF]

				S. M. Walker, L. C. Goudas, M. J. Cousins, and D. B. Carr Combination Spinal Analgesic Chemotherapy: A Systematic Review Anesth. Analg., September 1, 2002; 95(3): 674 - 715. [Full Text] [PDF]

				R. Poyhia, M. Xu, V. K. Kontinen, S. Paananen, and E. Kalso Systemic Physostigmine Shows Antiallodynic Effects in Neuropathic Rats Anesth. Analg., August 1, 1999; 89(2): 428 - 428. [Abstract] [Full Text] [PDF]

				A. U. Höglund and H. A. Baghdoyan M2, M3 and M4, but not M1, Muscarinic Receptor Subtypes are Present in Rat Spinal Cord J. Pharmacol. Exp. Ther., April 1, 1997; 281(1): 470 - 477. [Abstract] [Full Text]

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