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