Devendra Gupta

Evaluation of a single preoperative dose of pregabalin for attenuation of postoperative pain after laparoscopic cholecystectomy.

BACKGROUND Postoperative pain is the dominating complaint and the primary reason for prolonged convalescence after laparoscopic cholecystectomy. We have evaluated the efficacy of a single preoperative dose of pregabalin for attenuating postoperative pain and fentanyl consumption after laparoscopic cholecystectomy. METHODS Sixty adults (16-60 yr), ASA physical status I and II, of either sex undergoing elective laparoscopic cholecystectomy were included in this prospective, randomized placebo controlled, double-blind study. Subjects were divided into two groups of 30 each to receive either a matching placebo or pregabalin 150 mg, administered orally 1 h before surgery. Postoperative pain (static and dynamic) was assessed by a 100 mm visual analogue scale, where 0, no pain; 100, worst imaginable pain. Subjects received patient-controlled i.v. fentanyl analgesia during the postoperative period. Results were analysed by Students t-test, chi(2) test, Mann-Whitney U-test, and Fishers exact test. RESULTS Postoperative pain (static and dynamic) and postoperative patient-controlled fentanyl consumption were reduced in the pregabalin group compared with the placebo group (P<0.05). Side-effects were similar in both groups. CONCLUSIONS A single preoperative oral dose of pregabalin 150 mg is an effective method for reducing postoperative pain and fentanyl consumption in patients undergoing laparoscopic cholecystectomy.

Preemptive gabapentin decreases postoperative pain after lumbar discoidectomy

PurposeWe investigated whether the preemptive use of gabapentin, a structural analogue of gamma amino butyric acid could reduce postoperative pain and fentanyl consumption in patients after single-level lumbar discoidectomy.MethodsFifty-six ASA I and II patients were randomly allocated into two equal groups to receive either gabapentin 300 mg or placebo two hours before surgery. After surgery, the pain was assessed on a visual analogue scale (VAS) at intervals of 0–6, 6–12, 12–18, and 18–24 hr at rest. Total fentanyl consumption in the first 24 hr after surgery was also recorded. Fentanyl 2 μg·kg−1 intravenously was used to treat postoperative pain on patients’ demand.ResultsPatients in the gabapentin group had significantly lower VAS scores at all time intervals of 0–6, 6–12, 12–18,and 18–24 hr than those in the placebo group (3.5 ± 2.3, 3.2 ± 2.1, 1.8 ± 1.7, 1.2 ± 1.3 vs 6.1 ± 1.7, 4.4 ± 1.2, 3.3 ± 1.1, 2.1 ± 1.2; P < 0.05). The total fentanyl consumed after surgery in the first 24 hr in the gabapentin group (233.5 ± 141.9, mean + SD) was significantly less than in the placebo group (359.6 ± 104.1 ; P < 0.05).ConclusionPreemptive gabapentin 300 mg po significantly decreases the severity of pain postoperatively in patients who undergo single-level lumbar discoidectomy.RésuméObjectifVérifier si l’usage préventif de gabapentine, analogue structurel de l’acide gamma amino-butyrique, pouvait réduire la douleur postopératoire et la consommation de fentanyl dans les cas de discectomie lombaire à un seul niveau.MéthodeCinquante-six patients d’état physique ASA I et II, répartis au hasard en deux groupes égaux, ont reçu soit 300 mg de gabapentine, soit un placebo, deux heures avant l’opération. Après l’opération, la douleur a été évaluée selon une échelle visuelle analogique (EVA) de 0–6, 6–12, 12–18 et 18–24 h au repos. La consommation totale de fentanyl pendant les 24 premières heures postopératoires a aussi été notée. Une dose iv de 2 μg·kg−1 de fentanyl a été utilisée pour traiter la douleur postopératoire sur demande.RésultatsLes patients sous gabapentine ont eu des scores significativement plus bas à l’EVA, pour toutes les mesures aux intervalles de 0–6, 6–12, 12–18 et 18–24 h, que ceux du groupe placebo (3,5 ± 2,3 ; 3,2 ±2,1 ; 1,8 ± 1,7 ; 1,2 ± 1,3 vs 6,1 ± 1,7 ; 4,4 ± 1,2 ; 3,3 ± 1,1 ; 2,1 ± 1,2 ; P < 0,05). La consommation postopératoire totale de fentanyl pendant les 24 premières heures a été significativement plus faible avec la gabapentine (233,5 ± 141,9, moyenne + écart type) qu’avec le placebo (359,6 ± 104,1 ; P < 0,05).ConclusionL’administration préventive de 300 mg po de gabapentine diminue significativement la sévérité de la douleur postopératoire chez les patients qui subissent une discectomie lombaire à un seul niveau.

Pretreatment with thiopental for prevention of pain associated with propofol injection.

Propofol causes pain on IV injection in 28%–90% of patients. A number of techniques have been tried to minimize propofol-induced pain, with variable results. We compared the efficacy of pretreatment with thiopental 0.25 mg/kg and 0.5 mg/kg and lidocaine 40 mg after venous occlusion for prevention of propofol-induced pain. One-hundred-twenty-four adult patients, ASA physical status I–II, undergoing elective surgery were randomly assigned into 4 groups of 31 each. Group I received normal saline, group II received lidocaine 2% (40 mg), and groups III and IV received thiopental 0.25 mg/kg and 0.5 mg/kg, respectively. All pretreatment drugs were made in 2 mL and were accompanied by manual venous occlusion for 1 min. Propofol was administered after release of venous occlusion. Pain was assessed with a four-point scale: 0 = no pain, 1 = mild pain, 2 = moderate pain, and 3 = severe pain at the time of propofol injection. Twenty-four patients (77%) complained of pain in the group pretreated with normal saline as compared with 12 (39%), 10 (32%), and 1 (3%) in the groups pretreated with lidocaine 40 mg, thiopental 0.25 mg/kg, and thiopental 0.5 mg/kg, respectively (P < 0.05). Thiopental 0.5 mg/kg was the most effective treatment. We therefore suggest routine pretreatment with thiopental 0.5 mg/kg along with venous occlusion for 1 min for prevention of pain associated with propofol injection.

The efficacy of tolterodine for prevention of catheter-related bladder discomfort: a prospective, randomized, placebo-controlled, double-blind study.

Bladder discomfort secondary to an indwelling urinary catheter is distressing, particularly for patients awakening from anesthesia. We sought to discover the incidence and severity of bladder discomfort in patients who were catheterized intraoperatively and to evaluate the efficacy of tolterodine, a pure muscarinic receptor antagonist, in preventing this. Two-hundred-fifteen consecutive adult patients, ASA physical status I and II, either sex, undergoing urologic surgery requiring bladder catheterization were enrolled. Group C (control, n = 165) received placebo and group T (tolterodine, n = 50) received tolterodine 2 mg. Drugs were administered orally 1 h before surgery. After induction of anesthesia, patients were catheterized with a 16F Foley catheter and the balloon was inflated with 10 mL of normal saline. In the postanesthesia care unit, bladder discomfort was assessed on arrival (0), 1, 2 and 6 h. Severity of bladder discomfort was graded as mild, moderate, and severe. Bladder discomfort observed in group C was 55% (91 of 165). Tolterodine reduced both the incidence 36% (18 of 50) and severity of bladder discomfort (P < 0.05).

An evaluation of the efficacy of aspirin and benzydamine hydrochloride gargle for attenuating postoperative sore throat: a prospective, randomized, single-blind study.

Postoperative sore throat (POST), although a minor complication, remains a source of postoperative morbidity. We compared the efficacy of dispersible aspirin gargle to benzydamine hydrochloride (a topical nonsteroidal anti inflammatory drug) gargles for prevention of POST. We enrolled 60 consecutive female patients, 16–60 yr of age, ASA physical status I or II, undergoing elective modified radical mastectomy under general anesthesia in this prospective, randomized, placebo-controlled, single-blind study. Patients were randomly divided into 3 groups of 20 subjects each: Group 1 (C) mineral water; Group 2 (AS) tab aspirin 350 mg; and Group 3 (BH) 15 mL of benzydamine hydrochloride (0.15%). All the medications were made into 30 mL of solution. Patients were asked to gargle this mixture for 30 s, 5 min before induction of anesthesia. Grading of POST was done at 0, 2, 4, and 24 h postoperatively on a 4-point scale (0–3). Aspirin gargles reduced the incidence of POST for 4 h whereas benzydamine hydrochloride gargles reduced POST for 24 h. POST was more severe in the control group at 0 and 2 h (P < 0.05). Aspirin and benzydamine hydrochloride gargles significantly reduced the incidence and severity of POST (P < 0.05).

An evaluation of the efficacy of gabapentin for prevention of catheter-related bladder discomfort: a prospective, randomized, placebo-controlled, double-blind study.

BACKGROUND:Catheter-related bladder discomfort (CRBD) secondary to catheterization of urinary bladder is distressing. In the present study, we evaluated gabapentin for preventing CRBD. METHODS:One-hundred and eight consecutive adult patients, ASA physical status I and II, of either sex, undergoing elective percutaneous nephrolithotomy were randomized into two groups of 54 each. Group control: placebo and group G gabapentin: gabapentin 600 mg. Drugs were administered orally 1 h before surgery. After induction of anesthesia, patients were catheterized with a 16F Foley catheter and the balloon was inflated with 10 mL normal saline. In the postanesthesia care unit, the incidence and severity (mild, moderate, and severe) of CRBD were assessed on arrival (0) and at 1, 2, and 6 h. RESULTS:Gabapentin reduced the incidence of CRBD to 50% (27 of 54) compared with 80% (43 of 54) observed in the control group (P < 0.05). Gabapentin also reduced the severity of CRBD and postoperative pain as observed by a reduction in the number of patients requiring any fentanyl and the total fentanyl consumption postoperatively (P < 0.05). CONCLUSION:Gabapentin (600 mg) administered orally 1 h before surgery reduced the incidence and severity of CRBD, postoperative pain, number of patients requiring fentanyl and postoperative total fentanyl requirement.

Evaluation of intra-operative tramadol for prevention of catheter-related bladder discomfort: a prospective, randomized, double-blind study

BACKGROUND Catheter-related bladder discomfort (CRBD) is defined as an urge to void or discomfort in the supra-pubic region; reported postoperatively in patients who have had urinary catheterization intra-operatively. We have evaluated tramadol, a centrally acting opioid analgesic with muscarinic receptor antagonist properties for prevention of CRBD. METHODS Fifty-four adults (18-60 yr), ASA physical status I and II of either sex, undergoing elective percutaneous nephro-lithomy were randomly divided into two groups of 27 each. Control (C) group received normal saline (NS; 2 ml), whereas Tramadol (T) group received tramadol 1.5 mg kg(-1). All medications were diluted in 2 ml NS and administered 30 min before extubation. Intra-operatively, urinary catherization was performed with a 16 Fr Foleys catheter, and the balloon was inflated with 10 ml distilled water. The CRBD was assessed at 0, 1, 2, and 6 h after patients arrival in the post-anaesthesia care unit along with total postoperative fentanyl requirement. Severity of CRBD was graded as none, mild, moderate and severe. Data were analysed by one-way ANOVA, Z-test, and Fishers exact test. P<0.05 was considered significant. RESULTS Incidence and severity of CRBD was reduced in T group compared with C group at all time points (P<0.05). Postoperative pain as assessed by visual analogue scale and total postoperative fentanyl requirement (microg kg(-1)) was also reduced in the T group [176 (SD 26.5)] compared with C group [210 (34.6)] (P<0.05). CONCLUSIONS Tramadol 1.5 mg kg(-1) administered i.v. 30 min before extubation decreases the incidence and severity of CRBD and postoperative fentanyl requirement.

An evaluation of the efficacy of licorice gargle for attenuating postoperative sore throat: a prospective, randomized, single-blind study.

BACKGROUND: Postoperative sore throat (POST) contributes to postoperative morbidity. Licorice has been used as an expectorant in cough and cold preparations. In this study, we evaluated the efficacy of licorice gargle for attenuating POST. METHODS: Forty adults (18-60 yr), ASA physical status I and II of either sex, undergoing elective lumber laminectomy were randomized into two groups of 20 each. Group C: received water; Group L: received 0.5 g licorice in water. Both groups received a 30 mL mixture for 30 s, 5 min before anesthesia which was standardized. The incidence and severity of POST at rest and on swallowing and side effects were assessed at 0, 2, 4, and 24 h, postoperatively. Severity of POST was assessed by visual analog scale (between 0 and 100 mm; where 0 means no sore throat and 100 means worst imaginable sore throat). Postextubation cough was assessed immediately after tracheal extubation. Data were analyzed by Z test and Fisher’s exact test. P < 0.05 was considered as significant. RESULTS: POST (incidence and severity) was reduced in the Group L compared with Group C at rest and on swallowing for all time points (P < 0.05), except that the severity of POST at rest, at 24 h, was similar in both groups (P > 0.05). Postextubation cough was reduced in Group L compared with Group C (P < 0.05). There was no difference in side effects between groups (P > 0.05). CONCLUSION: Licorice gargle performed 5 min before anesthesia is effective in attenuating the incidence and severity of POST.

An evaluation of efficacy of balloon inflation on venous cannulation pain in children: a prospective, randomized, controlled study.

Venipuncture is the most common painful event for a hospitalized child. We evaluated the efficacy of balloon inflation for attenuating venipuncture pain in children. Seventy-five pediatric patients aged 6–12 yr, ASA physical status I–II, of either sex, undergoing elective surgery were included in this prospective and randomized study. Patients were randomly divided into 3 equal groups of 25 each; Group I (control), Group II (distraction) pressed a rubber ball, and Group III (balloon) inflated a balloon. A manual venous occlusion was applied on the forearm and venipuncture was performed with a 22-gauge venous cannula. Pain was self-reported by a pain face scale with a 10-cm visual analog scale (VAS) placed at its back, where 0 = “no pain” and 10 = “worst imaginable pain.” VAS scores of 1-3 were rated as mild, 4–6 as moderate, and >6 as severe. Median (interquartile range) VAS score in the balloon group was 1 (3), which was reduced as compared with 2 (2) and 4 (2) observed in the distraction and control groups, respectively (P < 0.000). Significant reduction in the incidence and severity of venipuncture pain was also observed in the balloon group compared with the other 2 groups (P < 0.05).

Vein pretreatment with magnesium sulfate to prevent pain on injection of propofol is not justified

PurposePropofol produces anesthesia with rapid recovery. However, it causes pain or discomfort on injection. A number of techniques have been tried for minimizing propofol-induced pain with variable results. We have compared the efficacy of magnesium and lidocaine for the prevention of propofol induced pain.MethodsThree hundred ASA I and II adults undergoing elective surgery were randomly assigned into three groups of 100 each. Group I received magnesium sulfate 1 g, Group II received lidocaine 2% (40 mg) and Group III received normal saline, all in a volume of 2 mL and accompanied by venous occlusion for one minute. Induction with propofol 2.5 mg·kg−1 was accomplished following the release of venous occlusion. Pain was assessed on a four-point scale: 0 = no pain, 1 = mild pain, 2 = moderate pain, and 3 = severe pain at the time of pretreatment and propofol injection. Results were analyzed by ‘Z’ test. A P value of < 0.05 was considered as significant.ResultsPain during iv pretreatment with magnesium was 31 % as compared to 2% for both the lidocaine and control groups (P < 0.05). Seventy-six percent of patients in the control group had pain during iv propofol as compared to 32% and 42% in the magnesium and the lidocaine groups respectively (P < 0.05). Lidocaine and magnesium pretreatment were equally effective in attenuating pain during the propofol injection (P > 0.05).ConclusionsIntravenous magnesium and lidocaine pretreatment are equally effective in attenuating propofol-induced pain. However, magnesium pretreatment itself causes pain. Therefore, there is no justification in the use of magnesium pretreatment for attenuating pain associated with iv propofol.RésuméObjectifLe propofol produit une anesthésie dont la récupération est rapide. Son injection cause toutefois de la douleur ou de l’inconfort. On a tenté de réduire cette douleur au moyen de quelques techniques aux résultats variables. Nous avons comparé l’efficacité du magnésium et de la lidocaïne pour prévenir la douleur induite par le propofol.MéthodeTrois cents adultes d’état physique ASA I et II devant subir une intervention chirurgicale réglée ont été aléatoirement répartis en trois groupes égaux. Ceux du groupe I ont reçu 1 g de sulfate de magnésium, ceux du groupe II, 40 mg de lidocaïne à 2 % et ceux du groupe III, une solution saline, tous dans un volume de 2 mL et accompagnés d’une occlusion veineuse d’une minute. L’induction avec 2,5 mg·kg−1 de propofol a été réalisée après la levée de l’occlusion veineuse. La douleur a été évaluée selon une échelle en quatre points : 0 = aucune douleur, 1 = douleur légère, 2 = douleur modérée et 3 = douleur sévère, au moment du prétraitement et de l’injection de propofol. Les résultats ont été analysés par le test «Z». Une valeur de P < 0,05 était considérée significative.RésultatsLa douleur du prétraitement iv au magnésium a été de 31 %, et de 2 % pour la lidocaïne et la solution salée (P < 0,05). On a noté que 76 % des témoins, mais 32 % et 42 % des patients des groupes magnésium ou lidocaïne, respectivement (P < 0,05) ont eu des douleurs à l’injection iv de propofol. La lidocaïne et le magnésium ont une action similaire comme prétraitement de la douleur causée par le propofol (P > 0,05).ConclusionsLes prétraitements intraveineux au magnésium et à la lidocaïne réduisent de façon similaire la douleur induite par le propofol. Mais le prétraitement au magnésium peut lui-même être douloureux. Rien ne justifie donc son usage pour atténuer la douleur associée à l’injection iv de propofol.