అనస్థీషియా & క్లినికల్ రీసెర్చ్
అందరికి ప్రవేశం

నైరూప్య

Comparison of Effectiveness of Intrathecal Magnesium Sulphate 100 mg Plus Inj. Bupivacaine Heavy 0.5% 15 mg Versus Intrathecal Neostigmine 75 Microgram Plus Inj. Bupivacaine Heavy 0.5% 15 mg in Unilateral Inguinal Hernia

Dhvanika Y Upadhyay*, Vandana Trivedi

Background: Spinal anesthesia type of neuraxial regional anesthesia is widely used for inguinal hernia repair surgeries. Need of study raised due to evolution of non-opioid adjuvants to avoid risks of intrathecal opioids. Our aims were to study change in hemodynamic parameters intra and postoperatively, block characteristics, duration of analgesia and adverse effects intraoperatively and postoperatively.

Objectives: A type of prospective, double blinded randomized controlled trial study carried out at Tertiary Care Hospital, during 2018-2019 with 70 adult male patients in the age group of 18-65 years having unilateral inguinal hernia after taking Institutional Ethical Committee clearance (registration number: ECR/6/INST/GUJ/2013) and written informed consent were taken in their own language according to institutional protocols and explaining the cause, pathology and consequences of the disease process.

Methods: In this study, 70 patients, after matched inclusion criteria, posted for unilateral inguinal hernia were assessed. They were divided into two, Group M and Group N, 35 each who received Magnesium sulphate (100 mg) and Neostigmine methyl sulphate (75 mcg) respectively; along with 0.5% Bupivacaine (15 mg). Primary outcome was to study hemodynamic stability and secondary outcome was to study blockage characteristics and adverse effects. Statistical analysis done by using the SPSS Statistical Software version 24.0. Mean and Standard deviation were calculated for analysis. Unpaired 'T' test were applied between Group M and Group N.

Results: Significantly delayed onset of sensory block with neostigmine (2.19 ± 0.40 min, p<0.05), significantly delayed onset (2.85 ± 1.29 min, p<0.05) and longer duration in motor block (188.82 ± 14.5 min, p<0.05) observed with neostigmine. Significant bradycardia and hypotension with neostigmine and maximum at 1 min (P<0.01).There was significant hypotension with neostigmine at 10 min and 15 min (P<0.05). Duration of analgesia was longer with neostigmine as compared to magnesium Sulphate (Group M=98.4 ± 30.86 min, Group N=215.45 ± 17.4 min). Adverse effects were more with neostigmine.

Conclusion: Longer duration of blockage and analgesia seen by Neostigmine methylsulphate with significant hypotension, bradycardia and vomiting.