Addition of neostigmine to local anesthetic solution may reduce perioperative analgesia consumption, finds Study

Multiple techniques are used to manage postoperative pain in patients who have undergone scrotal surgeries, with one such approach being the ultrasound-guided spermatic cord block (US-SCB). In order to improve the quality of anesthesia and prolong postoperative pain relief, various agents have been combined with local agents. Recent study aimed to assess the effects of combining neostigmine with levobupivacaine in ultrasound-guided spermatic cord block (US-SCB) for providing perioperative analgesia in patients undergoing testicular sperm extraction (TESE) surgery. The double-blind, randomized controlled trial involved 112 subjects who were divided into two groups. One group received neostigmine and levobupivacaine in the US-SCB, while the other group received levobupivacaine alone. The primary outcomes measured were the duration of postoperative analgesia and the amount of analgesic consumed in the first 24 hours. The results showed that the group receiving the neostigmine and levobupivacaine combination had a significantly increased mean postoperative analgesia duration and reduced total analgesic consumption compared to the group receiving levobupivacaine alone. Additionally, the study found no significant differences in complications between the two groups.

Study Conclusion and Background Information

The study concluded that adding neostigmine to the local anesthetic solution in US-SCB delayed the first analgesic request postoperatively and reduced perioperative analgesia consumption without significant side effects. The study also discussed the background and aims, providing details about the TESE procedure and the various anesthesia options available, including local, spinal, and general anesthesia. The authors noted that while general anesthesia can control patient anxiety, it does not eliminate postoperative pain sensation, which can be managed with oral analgesics, parenteral opioids, and neuraxial or regional analgesia techniques. The paper discussed the benefits and limitations of using the spermatic cord block, as well as the importance of adding adjuvants to prolong the block's postoperative duration and reduce the local anesthetic dose.

Study Methodology and Comparison with Previous Research

The paper also provided a detailed description of the study methodology, including the inclusion and exclusion criteria, randomization process, and anesthesia and surgical procedures. The findings of the study were compared with previous research on the use of neostigmine as an adjuvant to local agents in other regional anesthesia techniques, noting both supportive and conflicting evidence. The study acknowledged some limitations, including the small sample size and the need for further research to test different doses of the agents and assess the sensorial blocked area. Overall, the study suggests that adding neostigmine to a local anesthetic solution in spermatic cord block can be a promising choice to prolong the time for the first analgesic requirement postoperatively and reduce perioperative analgesia consumption without significant side effects.

Key Points

- The study aimed to evaluate the effects of combining neostigmine with levobupivacaine in ultrasound-guided spermatic cord block (US-SCB) for perioperative analgesia in patients undergoing testicular sperm extraction (TESE) surgery.

- A double-blind, randomized controlled trial involving 112 subjects showed that the group receiving neostigmine and levobupivacaine in the US-SCB had significantly increased mean postoperative analgesia duration and reduced total analgesic consumption compared to the group receiving levobupivacaine alone.

- The study concluded that adding neostigmine to the local anesthetic solution in US-SCB delayed the first analgesic request postoperatively and reduced perioperative analgesia consumption without significant side effects.

- Background information about the TESE procedure and anesthesia options, including local, spinal, and general anesthesia, was provided. The study discussed the benefits and limitations of using the spermatic cord block and highlighted the importance of adding adjuvants to prolong the block's postoperative duration and reduce the local anesthetic dose.

- The paper detailed the study methodology, including inclusion and exclusion criteria, randomization process, anesthesia, and surgical procedures. The findings were compared with previous research on the use of neostigmine as an adjuvant to local agents in other regional anesthesia techniques.

- The study suggests that adding neostigmine to a local anesthetic solution in spermatic cord block can be a promising choice to prolong the time for the first analgesic requirement postoperatively and reduce perioperative analgesia consumption without significant side effects, though acknowledging the need for further research to test different doses of the agents and assess the sensorial blocked area.

Reference –

Wahdan AS, Moussa AA, Farag MA, Alayyaf HA, Mohamed MM. Postoperative analgesic effect of adding neostigmine to levobupivacaine in ultrasound‑guided spermatic cord block for testicular sperm extraction surgery. J Anaesthesiol Clin Pharmacol 2024 . DOI 10.4103/joacp.joacp_14_24.