The effect of addition of neostigmine to epidural levobupivacaine/fentanyl mixture on return of intestinal motility in postoperative ICU

Background Postoperative ileus is a major cause of morbidity and mortality. It has a direct correlation with pain and the use of narcotic analgesics. Neostigmine is an anticholine esterase. It acts as an adjuvant analgesic in the epidural space. This study aimed to demonstrate the effect of epidural neostigmine addition to levobupivacaine/fentanyl mixture on postoperative analgesia following abdominal hysterectomy. Materials and methods A total of 40 patients were divided into group N (the neostigmine group) and group C (the control group). In group N, neostigmine 1 μg/kg was added to the epidural infusion of levobupivacaine and fentanyl. Results Both groups were comparable in demographic data, surgical time, and hemodynamic data. Group N had significantly lower visual analogue scale (P 0.05). In addition, time to first analgesic request was significantly longer in group N (9.5+ or −1.3 vs. 8.1+ or −0.9 in group C). The number of patients requiring analgesia in group N was two (10%), whereas in group C the number was nine (45%), which was statistically significant. Total narcotic consumption was significantly less in group N (104 ± 21.6 vs. 218 ± 35.2 mg in group C) and return of intestinal sounds was significantly faster in group N (8.1 ± 0.7 vs. 10.5 ± 1.8 h in group C). Group N had less nausea and vomiting. However, the difference was nonsignifi cant. Conclusion Neostigmine addition to levobupivacaine and fentanyl in lumbar epidural analgesia reduces pain scores and helps early return of intestinal motility during the postoperative period following abdominal hysterectomy.