Postoperative Analgesic Effect Of Intrathecal Neostgmine Added To Bupivacaine In Comparison With Bupivacaine Alone For Adult Patients Undergoing Lower Limb Orthopaedic Surgery At Tikur Anbessa Specialized Hospital Addis Ababa

Background: Several additives have been suggested to enhance analgesic effect of localrnanesthetic agents to decrease the adverse effects and increase the degree of satisfaction.rnObjective: - To assess postoperative analgesic effect of intrathecal neostigmine added tornbupivacaine in comparison with bupivacaine alone for adult patients undergoing Lower limbrnOrthopedic Surgery at Tikur Anbessa specialized Hospital, Addis Ababa, Ethiopia, from Januaryrn1 to February 30, 2017 G.C.rnMethods: -This institutional based prospective observational cohort study was conducted amongrn60 adult patients scheduled for elective lower limb orthopedic surgery under spinal anesthesiarnand grouped in to bupivacaine group based on independent decision of responsible anesthetist.rnPatient‟s vital signs were taken intraoperativley. Postoperatively duration & consumption ofrnanalgesia, first analgesia request as well as severity of pain using 100mm visual analogue scalernscore were assessed over 24hrs. Normality of the data was checked using Shapiro-Wilk test andrnanalyzed using student t test for normal distributed data and chi-square test for categorical data.rnNon- parametric data was analyzed using Mann –Whitney U test with 95% CI and p- value lessrnthan 0.05 is considered as statistically significant.rnResults: - Bupivacaine neostigmine group (BN, n=30) compared with bupivacaine only grouprn(BS, n=30) which was presented by mean ±standard deviation, time of the first analgesic requestrnin neostigmine and bupivacaine group was (377.60 ± 9.14) and (230.07 ± 17.11) in minuternrespectively, p < 0.001.Morever total amount of tramadol consumption was also significantlyrndifferent between the two groups that was presented by median (inter quartile range),which wasrn50(50) mg in neostigmine group vs. 100 (50) mg in bupivacaine group. The visual analoguernscale score also reduced at1hr, 2hrs, 3hrs, 4hrs, 5hrs and 6hrs in neostigmine group.rnConclusion and recommendation: -Addition of 25mcg intrathecal neostigmine as an adjuvantrnto 15 mg bupivacaine for elective lower limb orthopedic surgery increased first analgesia requestrntime, reduced postoperative analgesia consumption and with minimal hemodynamic changes andrnside effects. We recommend that the use of intrathecal neostigmine combined with bupivacainernfor lower limb surgery in our setup.rnKey words: - Spinal Anesthesia, lower limb orthopedic surgery, intrathecal neostigmine, postoprnanalgesia.

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