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Enhancement of Axillary Brachial Plexus Block Anesthesia by Coadministration of Neostigmine
  1. Hans Georg Bone, M.D.,
  2. Hugo Van Aken, M.D., Ph.D.,
  3. Michael Booke, M.D. and
  4. Hartmut Bürkle, M.D.
  1. From the Department of Anesthesiology and Operative Intensive Care Medicine, Westfälische Wilhelms-Universität Münster, Münster, Germany.
  1. Reprint requests: Hans Georg Bone, M.D., Department of Anesthesia and Intensive Care Medicine, Westfälische Wilhelms-Universität Münster, Münster, Germany, Albert-Schweitzerstr. 33, 48129 Münster, Germany.


Background and Objectives The acetylcholinesterase inhibitor neostigmine has shown peripherally mediated analgesic action in recent preclinical and clinical studies. The present study investigates the effectiveness of adding neostigmine to a local anesthetic, mepivacaine, in patients receiving axillary brachial plexus block for upper extremity surgery.

Methods In a double-blind, randomized study 34 patients were assigned to the treatment group: Neostigmine (NM) (500 μg) + mepivacaine (M) (500 mg) (NM, n = 17) as drugs for the plexus block, or to control group: mepivacaine (500 mg) + saline (0.9%, 1 mL) (M, n = 17).

Results The onset and duration of sensory and motor block was similar in both groups. Patients receiving NM had significantly lower pain ratings [visual analogue scores (VAS): 14.7 ± 9.9 vs 32.4 ± 23.5; P < .05] 24 hours after surgery, and a lower number of patients in the NM group needed supplemental analgesics during the first 24 hours postoperatively. No adverse events were recorded for either group.

Conclusions Peripherally administered neostigmine improves postoperative analgesia in axillary brachial plexus block.

  • peripheral pain
  • antinociception
  • neostigmine
  • axillary plexus block.

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  • This study was performed at the University of Münster, Germany. This study was funded by a grant from the Department of Anesthesiology and Intensive Care Medicine, Chair H. Van Aken, M.D., Ph.D. The results of the study were presented in part at the 72nd Clinical and Scientific Congress of the International Anesthesia Research Society, Orlando, Florida, March 7-11, 1998.