Epidural Neostigmine for enhanced Analgesia

Abstract Background: The addition of medications for enhanced epidural analgesia is a well-known topic. Many medications have been studied including steroids, opioids, clonidine, precedex and others. UsingNeostigmine has been hypothesized to enhance the efficacy of analgesia without some of the side effects associated with opioid use and risks of Local anesthetic systemic toxicity (LAST) from large Local Anesthetic (LA) requirements. Neostigmine administration in conjunction with alternative medications in neuraxial anesthesia is associated with a reduced dosage of LA required during labor and postoperatively following cesarean section. Studies have shown how neuraxial administration of neostigmine significantly minimized local anesthetic usage without causing serious negative side effects. Methods: A detailed search strategy encompassed the databases CINAHL, Cochrane Library and PUBMED. Articles found to be eligible for review were found to fit within the constraints of the original PICO question. Population (P): Anesthesia Providers who participate in epidural management, Intervention (I): Educating about epidural Neostigmine analgesia, Comparison (C): Comparing epidural neostigmine knowledge before and after education, Outcome (O): Improve provider knowledge on methods to improve analgesia when additional local analgesia is contraindicated or opioid puritis is unwanted. These abstracts and titles were reviewed to include only randomized control trials. A total of seven articles were chosen and were deemed fitting within the PICO constraints. Results: Participants were asked the likelihood to use alternative therapies rather than local anesthetics and opioids to enhance epidural analgesia. Two participants (40%) said extremely likely. An additionaltwo participants (40%) said somewhat likely and one participant (20%) said neither likely nor unlikely. This showed that practitioners are willing to try alternative approaches to enhance epidural analgesia if patients will benefit. Additionally, participants were asked the likelihood that after watching the video on epidural neostigmine for enhanced analgesia, would the participant be willing to use neostigmine in their daily practice. Based upon the results, two participants would be extremely likely to use epidural neostigmine. This result shows that the YouTube presentation provided a positive educational experience which may influence practitioners to consider epidural neostigmine in their pharmacological arsenal