الفهرس يوجد فقط 14 صفحة متاحة للعرض العام
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المستخلص
Post operative pain is one of the most common postoperative complications which may affect the overall outcome, as it may cause delayed recovery from surgery, delayed resumption of normal pulmonary function, restriction of mobility (with increasing risk of thromboembolic cmplications) and increased catecholamine response with increased cardiac work load. Also poorly relieved pain has a negative psychological effect causing sleepleness and depression (Oglivy and Smith, 1994).
Epidural analgesia has been commonly used for postoperative pain relief. The epidural administration of various anaesthetic drugs gained increasing popularity following the discovery of opioid receptors in the spinal cord capable of producing potent analgesia (James, 2000).Its potential advantages include; improved pulmonary functions, cardiac protection as a result of sympathetic blockade, partial blockade of hormonal and metabolic components of stress response and excellent analgesia.
Epidural bupivacaine has been widely used but many side effects have been reported such as motor weakness, urinary retention, cardiovascular and central nervous system toxicity.
Efforts to improve postoperative pain relief have concentrated on pain preventive regimens directed at decreasing noxious input and sensitization in pain pathways.There have been also multiple comparisons of neuraxial blockade to general anaesthesia, and a recent meta-analysis of these comparisons shows a significant reduction in mortality and morbidity with regional techniques (Rodgers et al., 2000).
The cholinergic system is thought to modulate pain perception and transmission by a spinal mechanism, and intrathecal administration of cholinesterase inhibitors provides antinociception by increasing in acetylecholine in the cerebrospinal fluid (Bouaziz et al., 1995).Intrathecal neostigmine produces a dose-independent analgesia without respiratory depression or hypotension and potentiates common spinal analgesics, such as local anesthetics and opiates (Chung et al., 1998) .
Studies indicate that spinal cholinergic receptor stimulation produces analgesia in humans as well as animals, most probably by an interaction with muscarinic receptors (Kirdemir et al., 2000).Unfortunately, after intrathecal injection, severe gastrointestinal side effects (nausea and vomiting, diarrhea) occur and thus limit its routine clinical use. In contrast, epidural injection does not appear to be associated with these side effects. It has been reported that epidural neostigmine produces postoperative analgesia lasting for several hours, as well as a significant opioid-sparing effect (Lauretti et al., 1999).