Prasad Gab, A (2010) Evaluation of the Preemptive Analgesic efficacy of Oral Gabapentin for Postoperative Epidural Analgesia requirement in patients undergoing Elective Orthopaedic Lower Limb Surgeries. Masters thesis, Stanley Medical College, Chennai.
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Abstract
INTRODUCTION: Emotion, perception and past experience all affect an individual’s response to noxious stimuli. Patient’s attitudes and concerns about postoperative pain need to be addressed preoperatively. Early interventions influence long-term outcomes. Because of the multiplicity of mechanisms involved in post operative pain, a multimodal analgesia regimen, with a combination of opioid and non-opioid analgesic drugs is often used to enhance analgesic efficacy and reduce opioid requirements and side effects. Preemptive analgesia was assumed to reduce risk of developing persistent postoperative pain. Peripheral tissue injury provokes peripheral sensitization and central sensitization. These changes contribute to the post injury pain hypersensitivity state which manifests as an increase in the responsiveness to noxious stimuli and a decrease in the pain threshold, both at the site of injury and in the surrounding uninjured tissue. The preemptive treatment could be directed at the periphery, at inputs along sensory axons and at central neurons. Different treatment regimen could be used at different levels of sensory inputs. Gabapentin, a structural analogue of gamma-amino butyric acid, has been used as an anticonvulsant and antinociceptive drug but its mode of action is not well understood4. In addition it has been effective in neuropathic pain, diabetic neuropathy, post herpetic neuralgia and reflex sympathetic dystrophy. Pretreatment with gabapentin can block the development of hyperalgesia. Studies have demonstrated that mechanical hyperalgesia surrounding the wound in post operative patients and experimentally, heat-induced secondary hyperalgesia share a common mechanism and the central neuronal sensitization contributes to postoperative pain. Gabapentin has a selective effect on the nociceptive process involving central sensitization. In our institution we chose to study the efficacy of oral Gabapentin administered preoperatively on the postoperative pain relief and it’s influence on the postoperative Epidural analgesic requirement in patients undergoing elective lower limb orthopaedic procedures undercombinedspinalepidural anaesthesia. AIMS AND OBJECTIVES: 1. To evaluate the preemptive analgesic efficacy of gabapentin given orally for postoperative epidural analgesia requirement in patients undergoing elective orthopaedic lower limb surgeries. 2. To evaluate the hemodynamic response of oral gabapentin. 3. To evaluate the side effect profile of oral gabapentin. MATERIALS AND METHODS: The study population consisted of 40 ASA I & II patients in the age group of 18 years to 65 years admitted to undergo elective Orthopaedic lower limb surgeries at Govt. Stanley Hospital, Chennai during the period of January 2009 to June 2009. After getting approval by the institutional ethics committee and after obtaining written informed consent from each patient the study was conducted. Inclusion Criteria: 1. Age group 18-65 yrs, 2. ASA I &ASA II, 3. Elective lower limb orthopaedic surgeries, 4. Duration of surgery between 2:00 to 2:30 hours. Exclusion Criteria: 1. Emergency surgery, 2. Pre existing neurologic disorders, 3. Liver & Renal disorders, 4. Psychiatric illness, 5. Local infection at lumbar area, 6. Coagulation defects & patients on anticoagulation. STATISTICS AND ANALYSIS: Forty patients posted for orthopaedic lower limb surgeries of ASA I & II were taken up for the study. They were allocated randomly in a double - blind fashion into two groups in equal number of 20 each. Group P (placebo) received a tablet of alike looking placebo (Vitamin C), Group G (Gabapentin) received 300mg tablet of gabapentin 90 minutes prior to anaesthesia. A standard anaesthetic technique was followed in all patients. The patients were assessed by an observer in the postoperative period who was blinded for the group assignment. Data was expressed as mean + standard deviation (SD). Qualitative data were compared with chisquare test. Quantitative variables were compared with the student 't' test. the level of statistical significance was set at * P <0.05 and ** P < 0.01. SUMMARY: This double blind study was designed to evaluate the preemptive analgesic efficacy of gabapentin given 90 minutes prior to elective lower limb orthopaedic procedures under combined spinal epidural anaesthesia Forty ASA I & II patients undergoing elective orthopaedic lower limb surgical procedure under epidural anaesthesia were randomly allocated in a double blinded fashion of one of the two groups. Group P received a similar looking placebo .Pain was assessed using a verbal rating scale (VRS). The number of supplementary analgesic doses required for 24 hours were noted for the two groups. Pain score were significantly less in group G at 2, 4, 8, 12, 24 hours (P < 0.05) than in group P, after surgery. Overall pain score over 24 hour period also revealed better pain relief in group G (P<0.05) as compared to Group P. The postoperative analgesic consumption was also significantly less in Group G (4.25 doses for 24 hours) than in Group P (6.35 doses for 24 hours). The incidence of hypotension did not differ significantly between the two groups & with no reported case of any bradycardia in both the groups. The study demonstrates that oral gabapentin given 90 minutes before surgery would improve analgesic quality and reduce postoperative analgesic consumption without any hemodynamic instability. There was no headache or dizziness in any of the patients who received oral gabapentin which shows the pre emptive analgesic efficacy is with out any major side effects. CONCLUSION: 1. Single dose oral administration of gabapentin as pre emptive analgesic effectively reduces the post operative epidural analgesia requirements in patients undergoing elective orthopaedic lower limb surgeries. 2. Oral gabapentin has no effect on the hemodynamics of the Patient. 3. No side effects were noted with a single dose of oral gabapentin.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Preemptive Analgesic efficacy ; Oral Gabapentin ; Postoperative Epidural Analgesia ; patients ; undergoing Elective Orthopaedic Lower Limb Surgeries. |
| Subjects: | MEDICAL > Anaesthesiology |
| Depositing User: | Subramani R |
| Date Deposited: | 22 Apr 2018 16:12 |
| Last Modified: | 28 Apr 2018 16:09 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/7250 |
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