Compare the effect of adding ketamine and Neostigmine to bupivacaine ‎‎0.25 % for epidural analgesiain patients candidate for elective surgery‎

Pain is a complex medical problem that its inadequate control of postoperative has adverse effects onpatients physiological , metabolic and mentalstatus. Adding new supplements will lead to an increased duration of analgesia . The purpose of this study was to compare the addition of neostigmine and ketamine to bupivacaine 0.25% for epidural analgesiainincreasing duration ofpostoperative analgesia.
In this double blind clinical trial, 90 patients over 50 years candidate for elective hip surgerywith ASA class I, II randomly divided to three groups: neostigmine , ketamine and control groups. All patients received epidural with bupivacaine 0.25% by 2cc/segment .Furthermore 60 micrograms neostigmineadded in first group and 40 mg ketamine ingroup II . Level of postoperative pain based on VAS and duration of analgesia and amount of analgesic determined and 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 and in neostigmine group was less than placebo( P ≤ 0.01). The mean of duration of postoperative analgesia in the ketamine group was significantly higher than the other groups and in neostigmine group was more than placebo(P ≤ 0.01). The mean dose of analgesic (pethedin) wasthe least in the ketamine group (P ≤ 0.001).
Neostigmine and ketamine with bupivacaine 0.25% for epidural anesthesia increased the duration of analgesia for postoperative and reduced analgesicconsumption that about ketaminewas more than neostigmine .