| Estudio del efecto de la gabapentina oral que se usa como analgesia preventiva para atenuar el dolor post-operatorio en pacientes sometidos a cirugía abdominal con anestesia general |
Study of the effect of oral gabapentin used as preemptive analgesia to attenuate post-operative pain in patients undergoing abdominal surgery under general anesthesia
Harshel G Parikh, Sananta Kumar Dash, Chitra B Upasani
Department of Anesthesia & Critical Care, Grant Medical College & Sir J.J. Group of Hospitals, Mumbai-08, India
Saudi J of Anaesthesia 2010:4;137-141. doi:10.4103/1658-354X.71409
Aims: To study the effect of oral gabapentin used as preemptive analgesia to attenuate post operative pain in patients undergoing abdominal surgery under general anesthesia. Materials and Methods: In a randomized double blind study, 60 patients were divided into two groups. Group A received 600mg gabapentin and group B oral received placebo 1 h prior to surgery. Anesthesia was induced with Propofol 2 mg/kg and Vecuronium 0.1mg/kg and maintained with 60% N 2 O in O 2 and Vecuronium 0.02 mg/kg. All cases were given Fentanyl 2μg/kg as pre-medication and a repeat dose 1μg/kg at the end of the first hour. Assessment of post-operative pain was made with the visual analog score (VAS) at extubation (0 h), 2, 4, 6, 12, and 24 h post-operatively. Post-operative analgesia was provided with intravenous Tramadol. The first dose was given in the Post Anesthesia Care Unit as 2mg/kg, and repeated at 8 and 16 h. Rescue analgesia was given with Diclofenac 1.5mg/kg, slow intravenous. The number of doses of rescue analgesia in both the groups was noted. Results: The VAS scores at 0, 2, 4, 6, 12, and 24 h were 1.9 vs. 2.4 (P=0.002), 2.3 vs. 3.0 (P=0.000), 3.2 vs. 3.7 (P=0.006), 2.9 vs. 4.4 (P=0.000), 3.6 vs. 4.6 (P=0.000), and 3.7 vs.4.6 (P=0.000), respectively. Numbers of patients requiring rescue analgesia with Diclofenac were 3 vs. 14 (P=0.004). Conclusion: A single oral dose of gabapentin given pre-operatively enhanced the analgesic effect of Tramadol as it also reduced the requirement of rescue analgesia with Diclofenac.
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| Evaluación del factor quirúrgico en el control del dolor postoperatorio |
Evaluation of the surgical factor in postoperative pain control
Mohamed E Shams, Hosam M Atef
Department of Surgery, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
Department of Anesthesia, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
Saudi J of Anaesthesia 2010:4:127-130. doi:10.4103/1658-354X.71134
Background: Postoperative pain control has been studied extensively, including many perioperative pain control procedures. Unfortunately, the impact of the surgical technique was not objectively studied. Aim: The aim of this study is to evaluate if the type of surgical dissection needed for extensive abdominal wall dissection actually has an effect in the reduction of postoperative pain or not. Materials and Methods: Forty adult patients, 19 males and 21 females, were randomly divided into two groups with each group containing 20 patients having different varieties of anterior abdominal wall ventral hernia. Patients in group I had their hernias and abdominal wall flaps dissected by only sharp dissection using scalpel. Patients in group II had their hernias and abdominal wall flaps dissected using mainly blunt dissection assisted by sharp dissection where blunt dissection could not do the job. All the patients had general anesthesia. No preemptive analgesia was used. Nalbufen was used as the only postoperative pain killer and the total amount used of it was treated as the indicator for the intensity of postoperative pain. Results: The results of the present study showed that the total amount of Nalbufen used for the control of postoperative pain is significantly less in group I throughout the postoperative follow-up period. Conclusion: This study concludes that use of sharp dissection in cases of extensive abdominal wall dissection is statistically better than other methods of dissection in terms of postoperative pain control.
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| Revisión cualitativa sistemática sobre dextrometorfan perioperatorio en dolor postoperatorio |
A qualitative systematic review of peri-operative dextromethorphan in post-operative pain
T. H. Duedahl, J. Rømsing, S. Møiniche, J. B. Dahl
Acta Anaesthesiol Scand 2006; 50: 1-13
Abstract
Background: The N-methyl-D-aspartate (NMDA) receptor antagonist, dextromethorphan (DM), has received interest as an adjunctive agent in post-operative pain management. Clinical trials have been contradictory. This systematic review aims to evaluate the available literature examining the analgesic efficacy of DM in post-operative patients. Methods: Twenty-eight randomized, double-blind, clinical studies, with 40 comparisons, including a variety of dosing regimens comparing DM treatment with placebo, were included. Meta-analysis was intended but deemed to be inappropriate because of the substantial difference in methodology and reporting between trials. The outcome measures (pain scores at rest, time to first analgesic request and supplemental analgesic consumption) were evaluated qualitatively by significant difference (P < 0.05) as reported in the original investigations. Results: DM did not reduce the post-operative pain score with a clinically significant magnitude. The time to first analgesic request was significantly prolonged in most comparisons with DM. Significant decreases in supplemental opioid consumption were observed in the majority of parenteral DM studies and in about one-half of the oral studies. The decreases were of questionable clinical importance in most comparisons, although a relationship between a decrease in opioid consumption and opioid-related side-effects was established in some studies. Conclusion: Based on the studies available, DM has the potential to be a safe adjunctive agent to opioid analgesia in post-operative pain management, but the consistency of the potential opioid-sparing and pain-reducing effect must be questioned. Consequently, it is not possible to recommend dose regimens or routine clinical use of DM in post-operative pain. The route of administration may be important for the beneficial effect.
Keywords:dextromethorphan; N-methyl-D-aspartate (NMDA) receptor antagonists;post-operative pain;systematic review.
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