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- W2092115220 abstract "Abstract Since the introduction of opioids as spinally active analgesics into the field of pain research and management, the spinal cord and the peripheral nervous system have been explored for numerous different physiological and pharmacological pain modulating systems. Thereby the use of cholinergic agonists and acetylcholinesterase-inhibitors was investigated with respect to their specific antinociceptive activity, any potential side effects and also with regard to any potential toxicity after their spinal administration. Besides analgesia, spinal cholinergic agonists will also result in motor weakness. Neostigmine, a clinically well-known acetylcholine (ACh)-esterase inhibitor, was found however to result in dose-dependent, potent analgesia after spinal and peripheral administration in preclinical and clinical trials. The clinical studies exploiting spinal or epidural administration of neostigmine revealed an analgesic effect for neostigmine 50–100 μg comparable to that of spinally applied morphine. Neostigmine lacks any neurotoxicity after intrathecal injection, although its spinal and epidural use might be limited by another side effect — the high incidence of nausea and vomiting. Based on the findings of a peripheral analgesic action of opioids, neostigmine's peripheral analgesic effects were also demonstrated in acute pain states. Here it is shown that postoperative analgesia can be accomplished by intra-articular neostigmine and by co-delivery of neostigmine with mepivacaine in axillary plexus blockade. However, further studies on the underlying mechanisms of peripheral antinociception are warranted before the routine clinical use of neostigmine as a peripheral acting analgesic can be recommended. In conclusion, due to its potential side effects, the use of the otherwise very effective spinal analgesic neostigmine will be limited to certain specific pain states or as a co-drug with other analgesics." @default.
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- W2092115220 date "1999-03-01" @default.
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- W2092115220 title "The novel analgesic neostigmine and the morning after: Nothing more than sedation, nausea and vomiting?" @default.
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- W2092115220 doi "https://doi.org/10.1016/s1366-0071(99)80034-5" @default.
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