Aim of the study: To evaluate and compare the efficacy, safety and adverse effects of combining intrathecal neostigmine with transdermal nitroglycerine patch for pain relief in patients undergoing hysterectomies under bupivacaine spinal anaesthesia.

Materials and Methods: The study was conducted on 78 patients aged 30 to 60years of ASA grade I and II, planned for hysterectomies. Patients were allocated into 3 groups, each group containing 26 patients.
Group C: Patients received 15mg [3ml] of intrathecal bupivacaine.
Group N: Patients received 15mg [3ml] of intrathecal Bupivacaine and 25µg [1ml] of neostigmine.
Group P: Patients in addition to 15 mg [3ml] of intrathecal Bupivacaine and 25µg [1ml] of neostigmine, received transdermal NTG patch [5mg / 24hours] at chest wall in non- anaesthetized area 15 minutes after intrathecal administration of drug solution. Sensory level during anaesthesia, Postop VAS score and incidence of side effects were noted in all patients.

Observation and Results: Duration of analgesia was longest in Group P (316.3 minutes) compared to other two groups. (Group N 211.3 minutes and Group C 150.4 minutes) which was statistically significant. Incidence of nausea and vomiting were higher in Group N and P compared to Group C.

Conclusion: Addition of transdermal nitroglycerine patch [5mg/24hrs] and intrathecal 25µg neostigmine to 3ml of 0.5% bupivacaine spinal anaesthesia provided prolonged uration of analgesia but with increased incidence of nausea and vomiting.