Neostigmine versus Fentanyl administration with Ropivacaine by patient-controlled epidural analgesia for the management of labor pain

Aim The aim of this study was to evaluate the use of epidural Neostigmine (4 mcg/ml) in patientcontrolled epidural anesthesia ( PCEA) in the management of labor pain. Patients and methods This randomized double-blind controlled prospective study was designed to compare PCEA Ropivacaine 0.15%+Fentanyl 2 mcg/ml (F group) with PCEA Ropivacaine 0.15%+Neostigmine 4 mcg/ml (N group). The study included 60 ASA I–II laboring mothers. Pain, sedation, nausea, maternal vital signs, motor power, and fetal heart rate were evaluated every 5 min after epidural bolus for the first 30 min, and then every 2 h until delivery. The incidence of shivering was documented. Apgar scores at 1 and 5 min were documented. Results There were no differences in maternal and labor characteristics between groups. Progress of labor and modes of delivery were the same (P = 0.47). Pain scores were significantly reduced 20 min after initiation of analgesia compared with baseline in both groups (P 0.001) and did not differ between groups at any time during the study (P = 0.21–0.43). Addition of Neostigmine reduced the mean hourly epidural dose of Ropivacaine by 11% compared with the Fentanyl group (P = 0.003). There were no differences in maternal vital signs between groups. The sedation score increased compared with baseline through the first 20 min after initiation of analgesia in both groups (Fentanyl P = 0.043 – Neostigmine P = 0.04). There was no significant difference in sedation scores between groups at any time or compared with baseline (P = 0.23–0.46). The incidence of nausea, shivering, pruritus, and motor block was similar in both groups. Conclusion Neostigmine 4 mcg/ml can be used as a safe adjuvant with Ropivacaine 0.15% by PCEA for the management of labor pain. Its analgesic properties are comparable to that of epidural Fentanyl. It causes temporary sedation within the first 20 min. This sedation is comparable to that of Fentanyl. Epidural low-dose Neostigmine infusion did not increase the risk for nausea during labor.