efficacy of gabapentin in patients with central post-stroke pain

Thalamic pain syndrome, a type of central post-stroke pain [CPSP], may develops after a hemorrhagic or ischemic stroke and results in impairment of the thalamus. There is limited experience about gabapentin in treatment of central pains like CPSP. In a prospective observational study, the intensity of pain was recorded using the Numeric Rating Scale [NRS] at the entrance to the study. Patients eligible for treating with gabapentin, received gabapentin 300 mg twice-daily. The pain intensity was measured at entrance to the study and after one month using NRS. Decrease of 3 points from the initial NRS considered being clinically significant. From a total of 180 primarily screened patients, 84 [44 men and 40 women] were recruited. There was a significant difference between pre-treatment and post-treatment NRS [5.9 +/- 2.51 vs. 4.7 +/- 3.01; 95% CI: 0.442-1.962, p = 0.002]. Fisher›s exact test showed no statistically significant effect of clinical and demographic characteristics of patients on their therapeutic response to gabapentin. Given the safety, efficacy, well tolerability and lack of interaction with other drugs we suggest gabapentin to be more considered as a first line therapy or as add-on therapy for reducing the pain severity in patients with thalamic syndrome

Comparative study of intravenous paracetamol and fentanyl for pain management in ICU

Pain in ICU patients should be managed effectively and safely. Fentanyl and Paracetamol are used frequently in ICU. However experience using IV Paracetamol in the setting of critically ill patients is limited. We evaluated the analgesic effect and adverse reactions of intravenous Paracetamol compared to Fentanyl in ICU patients with mild to moderate pain. Forty patients in a general ICU were randomized into two groups of IV Paracetamol and IV Fentanyl in a single blinded fashion. Pain was assessed by Visual Analogue Scale [VAS] before drug administration and six hourly for 48 h of 1 g IV Paracetamol every 6 h for 48 h in the first group and 25 [micro]g Fentanyl intravenously every three hours for 48 h in the second group. Patients were monitored for significant adverse reactions particularly of CNS and hepatic nature. Results showed the age, sex and pain score before analgesia was matched in both groups. Pain scores were similar in both groups at 24 h 2.60 [+/- 1.2] and 2.40 [+/- 1.5] and at 48 h 2.25 [+/- 0.96] and 2.05 [+/- 1.1] in Paracetamol and Fentanyl groups respectively. Clinical and laboratory adverse reactions were also similar in both groups. The analgesic properties of Paracetamol and Fentanyl were similar in this study. We did not observe any significant adverse effects in the two groups. Clinical and laboratory findings including liver functions remained without any statistically significant difference in two groups. This study demonstrates intravenous Paracetamol may be as safe and effective as Fentanyl in ICU patients with mild to moderate pain

Sonographic optic nerve sheath diameter as a screening tool for detection of elevated intracranial pressure

Timely diagnosis and treatment of post-traumatic elevated intracranial pressure [EICP] could be reduced morbidity and mortality, and improved patients' outcome. This study is trying to evaluate the diagnostic accuracy of sonographic optic nerve sheath diameter [ONSD] in detection of EICP. Sonographic ONSD of patients with head trauma or cerebrovascular accident suspicious for EICP were evaluated by a trained chief resident of emergency medicine, who was blind to the clinical and brain computed tomography scan [BCT] find-ings of patients. Immediately after ultrasonography, BCT was performed and reported by an expert radiologist without awareness from other results of the patients. Finally, ultrasonographic and BCT findings regarding EICP were compared. To evaluate the ability of sonographic ONSD in predicting the BCT findings and obtain best cut-off level, receiver operating characteristic [ROC] curve were used. Sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV], positive likelihood ratio [PLR], and negative likelihood ratio [NLR] of so-nographic ONSD in determining of EICP was calculated. P < 0.05 was considered as statistically significant. There were 222 patients [65.3% male], with mean age of 42.2 +/- 19.5 years [range: 16-90 years]. BCT showed signs of EICP, in 28 cases [12.6%]. The means of the ONSD in the patients with EICP and normal ICP were 5.5 +/- 0.56 and 3.93 +/- 0.53 mm, respectively [P<0.0001]. ROC curve demonstrated that the best cut off was 4.85 mm. Sensitivity, specificity, PPV, NPV, PLR, and NLR of ONSD for prediction of EICP were 96.4%, 95.3%, 72.2%, 98.9%, 20.6, and 0.04, respectively. Sonographic diameter of optic nerve sheath could be considered as an available, accurate, and noninvasive screening tool in determining the elevated intracranial pressure in cases with head trauma or cerebrovascular accident

[Comparison of intraoperative hemodynamic parameters and post operative analgesia of gabapentin and tizanidine in patients with tibial fractures]

Preoperative consumption of some drugs can control intra operative and post operative pain. Gabapentin and Tizanidine analgesic effects have been studied but a comparison between analgesic effects of these two drugs has not been studied before. We studied 60 patients with tibial fractures between 15 to 80 years. They were divided into two groups: 30 patients were given 300 mg Gabapentin orally 1 hour before operation [Group G], and 30 patients were given 8 mg Tizanidine by oral route 1 hour before operation [Group T]. Pain was assessed 1 hour before until 12 hours post operation using Visual Analogue Scale [VAS]. All patients had general anesthesia. Vital signs and fentanyl consumption during Surgery, the first time morphine was needed and the total dose of Morphine after operation were assessed. Systolic, diastolic blood pressure and heart rates during operation between two groups were not statistically significant. intra operative fentanyl dose in group G was significantly less than group T[P = 0.001]. The first time morphine was needed in group G was significantly longer than group T [P = 0.001] and total dose of Morphine Consumption during 12 hours after operation in group G was significantly less than group t [P = 0.003]. VAS was only different between two groups 12[th] hours. After operation. Preoperative oral consumption of Gabapentin compared to Tizanidine might facilitate better analgesia and more opioid saving during and after operation