Postoperative analgesic effect of adding neostigmine to levobupivacaine in ultrasound-guided spermatic cord block for testicular sperm extraction surgery.

Background and aims: Providing postoperative pain management in patients who underwent scrotal surgeries is achieved using several methods, one of which is the ultrasound-guided spermatic cord block (US-SCB). To enhance anesthesia quality and extend analgesia postoperatively, several agents have been added in conjunction with local agents. This study targeted assessing the results of combining neostigmine with levobupivacaine in US-SCB for providing perioperative analgesia in patients undergoing testicular sperm extraction (TESE) surgery.

Material and methods: This double-blind, randomized controlled study was performed for 112 subjects undergoing TESE operation using general anesthesia. They were randomly and equally divided into two groups. All participants received bilateral US-SCB after induction of general anesthesia by 19 mL of levobupivacaine 0.5% combined with 1 mL of neostigmine 500 μg in (group N) or 1 mL of normal saline in (group C). The first analgesic dose request time and the amount of analgesic consumed in the first 24 h were the main points of comparison in both groups.

Results: The mean postoperative analgesia duration was noticeably increased in the N group compared to the C group, with a value of 480 ± 41.34 min versus 404 ± 34.14 min, independently (P < 0.001). Moreover, the total amount of postoperative analgesic consumption was remarkably decreased in group N when compared to group C without statistically remarkable divergence concerning complications between both groups.

Conclusion: Adding neostigmine to a local anesthetic solution in US-SCB proved to detain the first analgesic request postoperatively with reduced perioperative analgesia consumption, without significant side effects.