Comparative study between (Dexamethasone – levobupivacaine) versus (Neostigmine - levobupivacaine) for postoperative analgesia in Patient Undergoing Perianal Surgeries

Document Type : Original Article


1 Department of anesthesia and ICU, Sohag University, sohag, Egypt.

2 Department , of Surgery Faculty of , Medicine University of ,Sohag


Aim: This work aims to compare the postoperative analgesic effects and side effects of Dexamethasone orNeostigmine that added to levobupivacaine. Patient and Methods: Eighty patients aged between 20–80 years with ASA I– II who were scheduled for perianal surgeries under spinal anesthesia were enrolled in our study after written informed consent and approval of ethical committee; This Study was conducted in Sohag University Hospitals from August 2016 to March 2017. Patients Were divided into 2 equal groups:- (Group A) 40 patients received 100μg Neostigmine in 0.5 ml normal saline added to2.5ml volume of levobupivacaine.- (Group B) 40 patients received 4mg dexamethasone added to 2.5ml volume of levobupivacaine. Under complete aseptic conditions, spinal anesthesia was carried out in the sitting position, at level (L3-4 or L4-5). After a free flow of cerebrospinal fluid was confirmed, each patient received one of the coded spinal solutions (GA or GB). After administration; the patients stilled in sitting potion for 10 minutes then patients were turned into the supine position. Patients were monitored for: Heart rate; NIBP and Oxygen Saturation. Patients were observed for onset, duration of sensory block and motor block; In the post-anesthesia care unit (PACU), the patients were asked to assess their level of pain based on a visual analog scale (VAS). Complications also were observed .
                     Results: Dexamethasone had a faster Onset of sensory block onset than Neostigmine; Dexamethasone had a longer duration of regard Duration of motor block than Neostigmine; Neostigmine group had a longer analgesic effect stayed longer than Dexamethasone group .No Significant difference Between Two groups in rate of Complications ; Hypotension and Bradycardia were the most frequent complications in the two groups .Conclusion: the addition of  Dexamethasone 4mg Neostigmine 100μg to intrathecally injected Levobupivacaine improved the effect of Levobupivacaine and the postoperative analgesic effect and duration

1-Bani-Hashem N, Hassan-Nasab B, Pour EA, Maleh PA, Nabavi A, Jabbari A. Addition of intrathecal dexamethasone to bupivacaine for spinal anesthesia in orthopedic surgery. Saudi J Anaesth 2011; 5:382-386. 
2- BROMAGE P.R.: An evaluation of bupivacaine in epidural analgesia for obstetrics. Can. Anesth. Soc. J., 16: 46-56, 1969. Coated from Jaiswal P., Ranjan N., Tewari N., Agrawal R., Mathur S.K.: Comparative study of epidural midazolam and butorphanol as adjuvant with bupivacaine for labor analgesia: A double blind study. The Intenret Journal of Anesthesiology, Vol 14 Number 1, 2007.
3- BUVANENDRAN A., MCCARTHY R.J., KROIN J.S., LEONG W., PERRY P. and TUMAN K.J.: Intrathecal magnesium prolongs fentanyl analgesia: A prospective, randomized, controlled trial. Anesth. Analg., 95: 661-6, 2002.
4-Gupta R, Bogra J, Verma R, Kohli M, Kushwaha JK, Kumar S. Dexmedetomidine as an intrathecal adjuvant for postoperative analgesia. Indian J Anaesth 2011; 55:347-351.  
5-Hisham Ahmed Fouad, Amal Mohammed Sabry Ahmed, Yasser Mohammed Mohammed Osman and Gamal Mohammed Taha Abouelmagd, Efficacy of primitive Dexamethasone added to Bupivacaine in ultrasound guided transverses abdominis plain block for POSTOPERATIVE analgesia after inguinal herniorrraphy. American Journal of Research Communication 2016
6-Movafegh A, Razazian M, Hajimaohamadi F, Meysamie A. Dexamethasone added to lidocaine prolongs axillary brachial plexus blockade. Anesth Analg 2006; 102:263-267.  
7- Sapna Shashni, Abhijit S. Nair, T V S Gopal. Clinical effects of intrathecal midazolam versus intrathecal magnesium sulfate as adjuncts to hyperbaric bupivacaine: A comparative study. Indian journal of pain .Jan 2014.
8- -Lauretti GR , Azevedo VMS . Intravenous ketamine or fentanyl prologs  postoperative analgesia after intrathecal neostigmine . Anesth Analg 1996 ; 83 :766 - 770.