Comparing the Effect of Adding Ketamine and Neostigmine to 0.25 %-Bupivacaine for Epidural Analgesia in Patients Candidate for Elective Surgery of Femur Fracture

Pain is a complex medical problem that its postoperative inadequate control can produce adverse effects on patients’ physiological, metabolic and mental states. Adding new supplements can lead to an increased duration of analgesia. Therefore, this study aimed to compare the addition of neostigmine and ketamine to 0.25% -bupivacaine for epidural analgesia in increasing duration of postoperative analgesia. In this double blind clinical trial, 90 patients aged over 50 years, candidate for elective hip surgery with ASA class I, II, were randomly divided to three groups: Neostigmine, Ketamine and control groups. All patients received 2cc/segment of 0.25%-bupivacaine for epidural anesthesia. Furthermore, 60 micrograms of neostigmine were added in first group and 40 mg of ketamine in the second group. Level of postoperative pain was based on VAS and duration of analgesia and amount of analgesic was compared between the three groups. The mean of pain score at 6 and 12 hours after surgery was significantly lower in the ketamine group than the other groups. Moreover, in neostigmine group, it was less than that of placebo group (P≤0.01). The mean of duration of postoperative analgesia in the Ketamine group was significantly higher than those of other groups and in neostigmine group it was more than placebo(P≤0.01). The mean dose of analgesic (Pethidine) was the least in the Ketamine group (P≤0.001). The study findings revealed that utilizing Neostigmine and Ketamine with 0.25%-bupivacaine for epidural anesthesia increased the duration of analgesia for postoperative and reduced analgesic consumption that was reported to be more effective with Ketamine than Neostigmine.