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A systematic review of the effects of adding neostigmine to local anesthetics for neuraxial administration in obstetric anesthesia and analgesia.
Int J Obstet Anesth. 2015 Aug; 24(3):237-46.IJ

Abstract

BACKGROUND

Drugs used in obstetric patients must accomplish two goals: efficacy and safety for both mother and fetus. Neostigmine has been co-administered epidurally and intrathecally with local anesthetics and other adjuncts in the obstetric setting. The aim of this meta-analysis was to assess the efficacy and incidence of adverse events related to the use of neostigmine in obstetric anesthesia.

METHODS

A meta-analysis of randomized-controlled human trials was conducted using the data sources Google Scholar and PubMed (updated 1 November 2014). Inclusion criteria were: random allocation to treatment; comparison of neostigmine or neostigmine with local anesthetics and/or other adjuvants versus placebo or placebo with local anesthetics and/or other adjuvants; and approval by an ethics committee.

RESULTS

The use of neostigmine as an adjuvant in neuraxial anesthesia is associated with a reduction in the dose of local anesthetic during labor analgesia and postoperative analgesia following cesarean section: mean reduction of local anesthetic (ropivacaine or bupivacaine) vs. control -4.08 (95% CI -6.7 to -1.5) mg/h (P=0.002). The risk of nausea was increased vs. control with intrathecal neostigmine (OR 8.99 [95% CI 4.74 to 17.05], P <0.001) but not with epidural neostigmine (OR 0.97 [95% CI 0.46 to 2.05], P=0.94). Use of neuraxial neostigmine was associated with a decrease in the risk of pruritus but there was no increase in the incidence of hypotension, dizziness or sedation and no effect on the incidence of abnormal fetal heart rate patterns or Apgar scores.

CONCLUSIONS

Neuraxial administration of neostigmine significantly reduces local anesthetic consumption without serious adverse side effects to the mother or fetus. However, neostigmine is only recommended for epidural administration as intrathecal use significantly increases the incidence of maternal nausea and vomiting.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

UOC Anesthesia and Intensive Care, AOU Sassari, Department of Surgical and Medical Sciences, University of Sassari, Italy. Electronic address: andreapcossu@yahoo.it.

UOC Anesthesia and Intensive Care and, Pain Therapy Service, AOU Cagliari, Department of Medical Sciences "M. Aresu", University of Cagliari, Italy.

UOC Anesthesia and Intensive Care and, Pain Therapy Service, AOU Cagliari, Department of Medical Sciences "M. Aresu", University of Cagliari, Italy.

UOC Anesthesia and Intensive Care and, Pain Therapy Service, AOU Cagliari, Department of Medical Sciences "M. Aresu", University of Cagliari, Italy.

University of Sassari, Italy.

University of Sassari, Italy.

UOC Anesthesia and Intensive Care and, Pain Therapy Service, AOU Cagliari, Department of Medical Sciences "M. Aresu", University of Cagliari, Italy.

UOC Anesthesia and Intensive Care and, Pain Therapy Service, AOU Cagliari, Department of Medical Sciences "M. Aresu", University of Cagliari, Italy.

UOC Anesthesia and Intensive Care, AOU Sassari, Department of Surgical and Medical Sciences, University of Sassari, Italy.

MeSH

Analgesia, ObstetricalAnesthesia, ObstetricalAnesthetics, LocalFemaleHumansInjections, SpinalNeostigminePregnancy

Pub Type(s)

Journal Article

Meta-Analysis

Review

Systematic Review

Language

eng

PubMed ID

26119258

Clinical Trial Links

Intrathecal Neostigmine for Prevention of PDPH

Citation

Cossu, A P., et al. "A Systematic Review of the Effects of Adding Neostigmine to Local Anesthetics for Neuraxial Administration in Obstetric Anesthesia and Analgesia." International Journal of Obstetric Anesthesia, vol. 24, no. 3, 2015, pp. 237-46.

Cossu AP, De Giudici LM, Piras D, et al. A systematic review of the effects of adding neostigmine to local anesthetics for neuraxial administration in obstetric anesthesia and analgesia. Int J Obstet Anesth. 2015;24(3):237-46.

Cossu, A. P., De Giudici, L. M., Piras, D., Mura, P., Scanu, M., Cossu, M., Saba, M., Finco, G., & Brazzi, L. (2015). A systematic review of the effects of adding neostigmine to local anesthetics for neuraxial administration in obstetric anesthesia and analgesia. International Journal of Obstetric Anesthesia, 24(3), 237-46. https://doi.org/10.1016/j.ijoa.2015.05.002

Cossu AP, et al. A Systematic Review of the Effects of Adding Neostigmine to Local Anesthetics for Neuraxial Administration in Obstetric Anesthesia and Analgesia. Int J Obstet Anesth. 2015;24(3):237-46. PubMed PMID: 26119258.

* Article titles in AMA citation format should be in sentence-case

TY - JOUR T1 - A systematic review of the effects of adding neostigmine to local anesthetics for neuraxial administration in obstetric anesthesia and analgesia. AU - Cossu,A P, AU - De Giudici,L M, AU - Piras,D, AU - Mura,P, AU - Scanu,M, AU - Cossu,M, AU - Saba,M, AU - Finco,G, AU - Brazzi,L, Y1 - 2015/05/19/ PY - 2014/09/01/received PY - 2015/04/22/revised PY - 2015/05/12/accepted PY - 2015/6/30/entrez PY - 2015/6/30/pubmed PY - 2016/6/1/medline KW - Cesarean section KW - Labor analgesia KW - Neostigmine KW - Neuraxial anesthesia SP - 237 EP - 46 JF - International journal of obstetric anesthesia JO - Int J Obstet Anesth VL - 24 IS - 3 N2 - BACKGROUND: Drugs used in obstetric patients must accomplish two goals: efficacy and safety for both mother and fetus. Neostigmine has been co-administered epidurally and intrathecally with local anesthetics and other adjuncts in the obstetric setting. The aim of this meta-analysis was to assess the efficacy and incidence of adverse events related to the use of neostigmine in obstetric anesthesia. METHODS: A meta-analysis of randomized-controlled human trials was conducted using the data sources Google Scholar and PubMed (updated 1 November 2014). Inclusion criteria were: random allocation to treatment; comparison of neostigmine or neostigmine with local anesthetics and/or other adjuvants versus placebo or placebo with local anesthetics and/or other adjuvants; and approval by an ethics committee. RESULTS: The use of neostigmine as an adjuvant in neuraxial anesthesia is associated with a reduction in the dose of local anesthetic during labor analgesia and postoperative analgesia following cesarean section: mean reduction of local anesthetic (ropivacaine or bupivacaine) vs. control -4.08 (95% CI -6.7 to -1.5) mg/h (P=0.002). The risk of nausea was increased vs. control with intrathecal neostigmine (OR 8.99 [95% CI 4.74 to 17.05], P <0.001) but not with epidural neostigmine (OR 0.97 [95% CI 0.46 to 2.05], P=0.94). Use of neuraxial neostigmine was associated with a decrease in the risk of pruritus but there was no increase in the incidence of hypotension, dizziness or sedation and no effect on the incidence of abnormal fetal heart rate patterns or Apgar scores. CONCLUSIONS: Neuraxial administration of neostigmine significantly reduces local anesthetic consumption without serious adverse side effects to the mother or fetus. However, neostigmine is only recommended for epidural administration as intrathecal use significantly increases the incidence of maternal nausea and vomiting. SN - 1532-3374 UR - https://www.unboundmedicine.com/medline/citation/26119258/A_systematic_review_of_the_effects_of_adding_neostigmine_to_local_anesthetics_for_neuraxial_administration_in_obstetric_anesthesia_and_analgesia_ DB - PRIME DP - Unbound Medicine ER -