EFFECT OF EPIDURAL NEOSTIGMINE WITH BUPIVACAINE ON HEMODYNAMIC AND STRESS RESPONSE IN TOTAL ABDOMINAL HYSTERECTOMY

Dr. Sahin Sultana Chowdhury*, Dr. Debabrata Banik, Dr. Mohammad Abdul Hannan, Dr. Md Abdus Salam, Dr. Rahnuma Tasnim and Dr. Abul Ishrat

ABSTRACT

Background: Regional anesthesia techniques are not only performed for adequate anesthesia in the lower abdominal surgical procedures. They have also other advantages including excellent postoperative pain control, reduced side effects, decreased blood loss, and shortened stay in the postanesthesia care unit (PACU). Epidural administration of neostigmine has been suggested to reduce the stress response on major total abdominal hysterectomy. Epidural neostigmine used as an adjunct to epidural anesthesia. The purpose of this study was to determine whether a combination of low-dose neostigmine reduce the stress responses in patients undergoing total abdominal hysterectomy. Objective: To evaluate the effect of epidural neostigmine with bupivacaine on haemodynamics and stress response for total abdominal hysterectomy. Method: It was a prospective randomized study conducted in the dept. of Anasthesiology, BSMMU. A total 70 patients aged 40- 55 years, posted for total abdominal hysterectomy procedures was included in the study. Assessment of physical status of the patients was tested by American Society of Anaesthesiology (ASA) (Physical status ASA I, ASA II, ASA III and ASA IV). The intervertebral space at L3-4 was identify. The epidural neostigmine dose was 2 g/kg body weight, delivered via the epidural catheter with 0.5 % bupivacaine as a local anesthetic. Assessment of the stress response was done by monitoring and recording of haemodynamic variables,blood sugar level and cortisol level peri-operatively. Procedure details was recorded on specifically designed proforma. Result: All the demographic and haemodynamic variables of both groups were almost alike between two groups. Regarding the hemodynamic variables like heart rate and mean arterial blood pressure, preoperatively there was no significant difference between this two groups of people (p>0.05). In the periopeartive period the heart rate and mean arterial pressure were more stable in Group B study population. Preoperatively in the cortisol level and the blood sugar level there were no significant differences between two groups of population. In intraoperative period the cortisol level and the capillary blood sugar level was significantly low in group B study population. Conclusion: Use of epidural neostigmine with bupivacaine significantly reduce the stress response in total abdominal hysterectomy operation.

Keywords: Bupivacaine, haemodynamics, epidural anaesthesia, analgesia.