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There is a significant increase in postoperative analgesia when neostigmine is added tointrathecal bupivacaine in patients undergoing total abdominal hysterectomy. Acombination of 5 mg/day transdermal nitroglycerine patch and intrathecal low doseneostigmine (5 mcg) resulted in an average of 10 hours of postoperative analgesia after totalabdominal hysterectomy during bupivacaine spinal block, compared to 3.5 hours in thecontrol group. Also the use of intrathecal neostigmine and transdermal nitroglycerine delaysthe first requirement of rescue analgesia by 6.5 hours. Transdermal nitroglycerine has beenshown to increase the postoperative analgesia of intrathecal opioids44.
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