Comparison of side effect Profile of Epidural Neostigmine with or without Low dose Morphine

Bhusal S*, Acharya SP**, Gurung R**, Marhatta MN***,


INTRODUCTION:Epidural analgesia has been claimed to attain superior postoperative analgesia. Many agents can be given through the epidural route to provide analgesia. Among them is a
cholinesterase inhibitor Neostigmine. But it was found to be associated with increased incidence of nausea and vomiting. Addition of epidural morphine in low dose seem to reduce the incidence of nausea and vomiting in some of the past studies. So we conducted a study to compare the side effects profile of epidural Neostigmine with or without low dose morphine.
METHOD: A prospective, randomized, double- blind study was conducted including sixty ASA physical status I & II female patients undergoing lower abdominal surgery between the age of 15 to 65 years. Patients were randomized into two groups. Group N received epidural Neostigmine 50 mcg diluted in normal saline (NS) to total of 6 ml. Group NM received epidural mixture of
Neostigmine 50 mcg and Morphine 0.6 mg diluted in NS to total of 6 ml. Immediately after epidural injection, spinal anesthesia was given with 4 ml of 0.5% Bupivacaine. Any incidence of
nausea and or vomiting was recorded intraoperatively and in the postoperative room for 24 hours.
RESULT: There was no significant difference in the incidence of intra operative nausea, vomiting and hypotension between the two groups. While there was increased incidence of post operative nausea and vomiting in Group N compared to Group NM (52.28% v/s 19.98) which was statistically significant (p=0.007). There was no significant difference in incidence of postoperative hypotension between the two groups.
CONCLUSION: This study has demonstrated that epidural 50 mcg Neostigmine with 0.6 mg Morphine lowers incidence of nausea and vomiting in the post operative period compared to epidural Neostigmine alone.

Full Text: