Intrathecal or epidural neostigmine has a postoperative analgesic effect. In this study we evaluated the effects of epidural neostigmine on postoperative analgesia and stress responses after gastrectomy.

Eighty, ASA physical status 1 or 2, patients scheduled for gastrectomy were randomly assigned to one (n = 20) of four groups. Patients received 5 ml of 0.25% bupivacaine with either saline (N0 group), neostigmine 5microgram/kg (N5 group), neostigmine 10µg/kg (N10 group), neostigmine 15µg/kg (N15 group) epidurally 30 minutes before operation. All patients received identical general anesthesia. Patient-controlled epidural analgesia (PCEA) was provided by bupivacaine (0.05%) and fentanyl (4 µg/ml) for postoperative analgesia.

The N10 and N15 groups showed reduced 24-h PCEA consumptions compared with the N0 and N5 groups (P < 0.05). No differences in visual analog pain scores at rest or during movement were observed between the groups. The concentrations of plasma cortisol, epinephrine, norepinephrine and glucose did not differ among the four groups, and their incidences of postoperative adverse effects were similar.

Epidural neostigmine 10 and 15µg/kg in bupivacaine produced a postoperative analgesic effect, but did not suppress stress responses after gastrectomy