مقایسه اثر افزودن نئوستیگمن و کتامین به بوپیواکائین 25% جهت بی دردی ‏اپیدورال در بیماران کاندید عمل جراحی غیر اورژانس شکستگی فمور

Background:Pain is a complex medical problem that its inadequate control of postoperative has adverse effects onpatients physiological , metabolic and mentalstatus. Adding new supplements will lead to an increased duration of analgesia . The purpose of this study was to compare the addition of neostigmine and ketamine to bupivacaine 0.25% for epidural analgesiainincreasing duration ofpostoperative analgesia. Materials and Methods:In this double blind clinical trial, 90 patients over 50 years candidate for elective hip surgerywith ASA class I, II randomly divided to three groups: neostigmine , ketamine and control groups. All patients received epidural with bupivacaine 0.25% by 2cc/segment .Furthermore 60 micrograms neostigmineadded in first group and 40 mg ketamine ingroup II . Level of postoperative pain based on VAS and duration of analgesia and amount of analgesic determined and compared between the three groups . Results:The mean of  pain score at 6 and 12 hours after surgery was significantly lower in the ketamine group than the other groups and in neostigmine group was less than placebo( P ≤ 0.01). The mean of duration of postoperative analgesia in the ketamine group was significantly higher than the other groups and in neostigmine group was more than placebo(P ≤ 0.01). The mean dose of analgesic (pethedin)  wasthe least in the ketamine group (P ≤ 0.001). Conclusion:Neostigmine and ketamine with bupivacaine 0.25% for epidural anesthesia increased the duration of analgesia for postoperative and reduced analgesicconsumption that  about ketaminewas more than neostigmine .