A Comparative Study of Analgesic Effect of Intrathecal Neostigmine, Fentanyl and Combination of both as an Adjuvant to Intrathecal Bupivacaine and Bupivacaine Alone for Abdominal Hystrectomy

Relief of pain during surgery is the main aim of anesthesia. Any expertise acquired in this field should be extended into post operative period. Many options are available for the treatment of post-operative pain, including systemic analgesics (i.e., opioid and non opioid); and regional techniques. In this study opioid analgesic fentanyl and neostigmine which were injected in intrathecal space along with local anaesthetic agent hyperbaric bupivacaine 0.5% for operative and post operative pain relief in patients undergoing abdominal hysterectomy. The primary goal of this study was to determine whether the combination of fentanyl and neostigmine with intrathecal bupivacaine has better analgesic duration than fentanyl and neostgmine alone with intrathecal bupivacaine. Method: One hundred and sixty four patients of ASA physical status grade I and II, scheduled for elective Total Abdominal Hysterectomy under subarachnoid block were randomly allocated to four groups (n=41): Group A received 15mg bupivacaine intrathecally.Group B received 15mg bupivacaine plus 25 micrograms of fentanyl intrathecally.Group C received 15mg bupivacaine plus 25 micrograms neostigmine intrathecally. Group D received 15mg bupivacaine plus 25 micrograms neostigmine and 25 micrograms fentanyl intrathecally with total volume made upto 4.0ml with NS in each group. Result: Duration of analgesia in post operative period was group A (126.05±19.33 minutes), group B (208.2±15.74 minutes), group C (194.37±15.54 minutes), group D (290.8±20.24 minutes. Statistically significant difference in duration of post operative analgesia was found when group A was compared with other 3 groups. Duration of 2 segment regression was group A (79±11.64 minutes), group B (125±19.57 minutes), group C(125±7.85 minutes), group D(135±8.24 minutes).Statistically significant difference in duration of 2 segment regression was seen when group A was compared with rest of groups. Onset of motor block was also found to be similar in all the 4 groups. Onset of motor block was also found to be similar in all the 4 groups.Conclusion: The combination of intrathecal neostigmine and fentanyl with bupivacaine significantly prolonged post operative analgesia as compare to other three study groups.