• Eiji Masaki, Hirokazu Saito, Kazuhiro Shoji, and Masato Matsushima.
• Department of Anesthesiology and Division of Clinical Research and Development, Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-ku Tokyo 105-8461, Japan. ejmasaki@jikei.ac.jp
• J Clin Anesth. 2004 Nov 1;16(7):488-92.

Study ObjectivesTo examine whether epidural administration of neostigmine reduces the stress and inflammatory responses thereby improving postoperative pain status.DesignRandomized, double-blinded clinical study.SettingOperating rooms and wards of a university hospital.Patients40 ASA physical status I patients undergoing lower open abdominal surgery for benign gynecological disease.InterventionsPatients were randomly divided into four groups to receive different doses of epidural neostigmine (0, 0.05, 0.1, or 0.15 mg) with mepivacaine (100 mg) before general anesthesia induction.MeasurementsThe plasma levels of cortisol and interleukin-6 (IL-6) were determined perioperatively. The patients' pain rating was assessed by visual analog scale (VAS) in the postoperative period.Main ResultsEpidural neostigmine at all doses significantly reduced the plasma levels of cortisol in the early surgical period; however, IL-6 levels were not affected by the neostigmine. The VAS scores were significantly decreased at 2 hours after the end of surgery by all doses of epidural neostigmine used in this study.ConclusionsThe preincisional epidural neostigmine transiently suppresses the stress responses during surgery and improves postoperative analgesia in patients undergoing lower open abdominal surgery.

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