Cesarean birth is a common surgical procedure. After cesarean birth, postsurgical pain may delay recovery, interfere with maternal-newborn bonding, and reduce the breastfeeding if not adequately controlled. Postpartum analgesia has become a common concern. Many adjuvant drugs used for peripheral nerve blocks as( N-methyl-d-aspartate (NMDA) receptor antagonists , Magnesium , Ephedrine , Dexamesathone , Fentanyl , Midazolam and Neostigmine) The potential of neostigmine as an adjuvant in peripheral nerve block is through its action to increase acetylcholine at muscarinic junctions of peripheral nerves. 500 mcg neostigmine was used as adjuvant to local anesthetic in an axillary brachial plexus block leads to decreased pain and less use of analgesics in the first 24 hours postoperatively with no incidence of adverse effects.
This prospective double-blinded randomized controlled study will be done on parturients that are scheduled for elective cesarean delivery under spinal anesthesia to assess the efficacy of neostigmine as an adjuvant to isobaric bupivacaine inTranversus abdominis plane (TAPB) for postoperative analgesia in cesarean section under spinal anesthesia.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
DOUBLE
Enrollment
58
20 mL bupivacaine 0.25% plus 1 mL Neostigmine (500 mcg)
20 mL bupivacaine 0.25% plus 1 mL normal saline 0.9%
Mansoura University-Emergency hospital-ICU
El Mansoura, Mansoura, Egypt
The time of the first postoperative analgesic requirement
during the first 24 postoperative hours
Time frame: during the first 24 postoperative hours
Total amount of the postoperative analgesic drugs (ketolac, paracetamol and fentanyl) consumed in the
mg
Time frame: during the first 24 postoperative hours
The visual analog scale (VAS) scores during rest
11-point VAS (where 0 for no pain and 10 for the worst possible pain) at 0, 2, 4,6,12 and 24 hours postoperatively
Time frame: during the first 24 postoperative hours
The visual analog scale (VAS) scores during movement
11-point VAS (where 0 for no pain and 10 for the worst possible pain) at 0, 2, 4,6,12 and 24 hours postoperatively
Time frame: during the first 24 postoperative hours
Mean arterial blood pressure (MBP)
mmHg
Time frame: basal (preoperative), intraoperative each 10 minutes and postoperatively every hour during first 6 hours
heart rate (HR)
beat per minute
Time frame: basal (preoperative), intraoperative each 10 minutes and postoperatively every hour during first 6 hours
Patient satisfaction about the quality of postoperative analgesia
poor = 1, fair = 2, good = 3, excellent = 4
Time frame: during the first 24 postoperative hours
The side effects (nausea, vomiting, abdominal colic and lower limb weakness)
incidence
Time frame: during the first 24 postoperative hours
the time from intrathecal injection till regression of spinal anesthesia to L2 dermatome
Time frame: during the first 24 postoperative hours
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