Comparing the effect of pregabalin, gabapentin, and acetaminophen on post-dural puncture headache

Post-dural puncture headache [PDPH] is a common complication of lumbar puncture for any purpose. To avoid the need for invasive methods of treating PDPH such as blood patch, the search for novel pharmacological agents to manage PDPH continues. The aim of this study was to compare the effects of acetaminophen, gabapentin and pregabalin in controlling PDPH in patients who underwent surgery under spinal anesthesia. A total of 90 patients who underwent elective orthopedic surgery under spinal anesthesia and suffered from PDPH consequently were enrolled in this randomized trial. Patients were categorized randomly into three groups. Group A, B and C have received Acetaminophen, Gabapentin and Pregabalin [3 times a day for 3 days], respectively. The effect of medications on the severity of PDPH was evaluated and compared using visual analog scale [VAS]. The mean VAS score was significantly lower in pregabalin group compared with others 24, 48 and 72 h after the onset of headache [P = 0.001 for all of them] and lower in Gabapentin group compared with Acetaminophen group 24, 48 and 72 h after the onset of headache [P = 0.001 for all analyses]. No adverse outcome was reported in groups. Pregabalin and gabapentin are both useful and safe in management of PDPH, but pregabalin is more effective in this regard

effect of pre-operative administration of gabapentin on post-operative pain relief after herniorrhaphy

Gabapentin, an anticonvulsant, recently has been suggested as an effective post-operative "analgesic" agent. The objective of the present study was to examine the analgesic effectiveness and opioid-sparing effects associated with the use of a single dose of gabapentin as a prophylactic analgesic. In a randomized double-blinded clinical trial, 50 American Society of Anesthesiologists I and II patients with an age range of 40-60 years who were the candidate for inguinal herniorrhaphy under spinal anesthesia were randomly assigned to receive 400 mg gabapentin or placebo 2 h prior to surgery. Post-operatively, the pain was assessed on a visual analog scale [VAS] at 2, 4, 12 and 24 h at rest. Morphine 0.05 mg/kg intravenously was used to treat post-operative pain on patient's demand. Total morphine consumption in the first 24 h after surgery was also recorded. Patients in the gabapentin group had significantly lower VAS scores at the all-time intervals of study than those in the placebo group [P < 0.05]. The total morphine consumption in the first 24 h after surgery was also significantly lower in gabapentin group than in the placebo group [0.9 +/- 1.23 vs. 1.8 +/- 1.5; P = 0.003]. There was no significant difference between the first time of analgesic request among the two groups. In conclusion, prophylactic administration of gabapentin decreases pain scores and analgesic consumption in the first 24 h after repair of inguinal hernia.

effect of acupressure on nausea and vomiting after cesarean section under spinal anesthesia

Postoperative nausea and vomiting [PONV] is one of the most common postoperative complications. Aside from pharmacological interventions, other complementary healing modalities have been introduced to assist patients in decreasing PONV and improving postoperative outcomes. This study examined acupressure as a safe complement to the more traditional approach of using drugs to prevent and/or relieve nausea and vomiting in the Cesarean section [C/S] under spinal anesthesia. In a prospective randomized clinical trial, 152 patients who were candidate for elective C/S under spinal anesthesia were evaluated in two groups [acupressure vs control groups]. Subjects in the acupressure group received constant pressure by a specific wrist elastic band [without puncture of the skin] on the Nei-Guan acupuncture point, 30 min prior to spinal anesthesia. The incidence of PONV was assessed during the surgery, at recovery room and at 1[st], 2[nd] and 3[rd] two hours after the surgery. Significant differences in the incidence of the post-operative nausea and vomiting were found between the acupressure and control groups, with a reduction in the incidence rate of nausea from 35.5% to 13.2%. The amount of vomitus and the degree of discomfort were, respectively, less and lower in the study group. In view of the total absence of side-effects in acupressure, its application is worthy. Our study confirmed the effectiveness of acupressure in preventing post-operative nausea and vomiting, when applied 30 minutes prior to surgery

[Comparison of pulseoximetry oxygen saturation and arterial oxygen saturation in open heart intensive care unit]

Pulseoximetry is widely used in the critical care setting, currently used to guide therapeutic interventions. Few studies have evaluated the accuracy of SPO[2] [pulseoximetry oxygen saturation] in intensive care unit after cardiac surgery. Our objective was to compare pulseoximetry with arterial oxygen saturation [SaO[2]] during clinical routine in such patients, and to examine the effect of mild acidosis on this relationship. In an observational prospective study 80 patients were evaluated in intensive care unit after cardiac surgery. SPO[2] was recorded and compared with SaO[2] obtained by blood gas analysis. One or serial arterial blood gas analyses [ABGs] were performed via a radial artery line while a reliable pulseoximeter signal was present. One hundred thirty seven samples were collected and for each blood gas analyses, SaO[2] and SPO[2] we recorded. O[2] saturation as a marker of peripheral perfusion was measured by Pulseoximetry [SPO[2]]. The mean difference between arterial oxygen saturation and pulseoximetry oxygen saturation was 0.12% +/- 1.6%. A total of 137 paired readings demonstrated good correlation [r=0.754; P<0.0001] between changes in SPO[2] and those in SaO[2] in samples with normal hemoglobin. Also in forty seven samples with mild acidosis, paired readings demonstrated good correlation [r=0.799; P<0.0001] and the mean difference between SaO[2] and SPO[2] was 0.05% +/- 1.5%.Data showed that in patients with stable hemodynamic and good signal quality, changes in pulseoximetry oxygen saturation reliably predict equivalent changes in arterial oxygen saturation. Mild acidosis doesn't alter the relation between SPO[2] and SaO[2] to any clinically important extent. In conclusion, the pulse oximeter is useful to monitor oxygen saturation in patients with stable hemodynamic.

[ effects of tranexamic acid on postoperative bleeding in coronary artery bypass graft surgery]

Perioperative administration of tranexamic acid [TA], decreases bleeding and the need for transfusion after cardiac procedures. Hence, the results may vary in different clinical settings and the most appropriate timing to get the best results is unclear. The primary objectives of the present study were to determine the efficacy of TA in decreasing chest tube drainage, the need for perioperative allogeneic transfusions and the best timing for TA administration following primary, elective, coronary artery bypass grafting [CABG] in patients with a low baseline risk of postoperative bleeding. In this double-blind, prospective, placebo-controlled clinical trial in Seiedoshohada Hospital during 2011-2012, we evaluated 150 patients scheduled for elective, primary coronary revascularization. They were randomly divided into three groups. Group B received tranexamic 10 mg/kg prior to, Group A received tranexamic acid 10 mg/kg after cardiopulmonary bypass and group C received an equivalent volume of saline solution. Blood requirement and postoperative chest tube drainage were recorded. The placebo group [group C] had a greater postoperative blood loss 12 h after surgery [501 +/- 288 vs. 395 +/- 184 in group B and 353 +/- 181 mL in group A, P=0.004]. The placebo group also had greater postoperative total blood loss [800 +/- 347 vs. 614 +/- 276 in group B and 577 +/- 228 mL in group A, P=0.001]. There was a significant increase in allogeneic blood requirement in the placebo group [P=0.001]. For elective, first time coronary artery bypass surgery, a single dose of tranexamic acid before or after cardiopulmonary bypass is equally effective

Intraoperative minimal acute normovolemic hemodilution in patients undergoing coronary artery bypass surgery

Efficacy of minimal acute normovolemic hemodilution [ANH] in avoiding homologous blood transfusion during cardiovascular surgery remains controversial. Postoperative bleeding and transfusion remain a source of morbidity and cost after open heart operations. Our objective was to evaluate the impact of minimal ANH on blood transfusion requirements during open cardiovascular surgery using cardiopulmonary bypass [CPB]. This study was a randomized controlled trial. One hundred one patients scheduled for elective coronary artery bypass graft [CABG] under cardiopulmonary bypass in October 2007 through March 2008 in Imam Khomeini hospital were randomly assigned to a control group [standard care, no=47] or an ANH or study group [no=54]. We used minimal ANH [representing 10% of patients' blood volume]. Mean 490 +/- 50 ml of fresh autologous blood was removed after induction of anesthesia and reinfused at the end of CPB. The blood transfusion guidelines were uniformly applied to all patients. Significant decrease in the number of red blood cell units transfused per patient per group [1.39 +/- 1.0 and 2.551.9 +/- units; p>0.0001] in the ANH group versus the control group was observed. Conversely, chest tube output, postoperative hematocrits, and platelet count did not differ between two groups. Percentage of patients in whom allogeneic red blood cells were transfused was 44% in study group versus 76% in control group; [p<0.01]. No patient was transfused with platelet concentrates or fresh frozen plasma. Minimal ANH is safe and cost effective and its routine use in eligible patients is therefore justified. Intraoperative autologous blood donation in CABG surgery decreased perioperative allogeneic blood requirement. However, the removal and reinfusion of about one unit autologous blood had no effect on postoperative bleeding or platelet count

Use of ketamine in severe status asthmaticus in intensive care unit

Bronchial asthma represents an increased airways responsiveness to various stimulants, leading to reversible obstruction of expiratory flow and chronic inflammatory changes in airways wall. Ketamine has been demonstrated to lower airway resistance and to increase lung compliance in the asthmatic patients. In several studies and case reports it has been used successfully in the management of status asthmaticus, resistant to conventional therapy, but so far no clinical trial has been carried out to support this empirical use of ketamine. For this reason, we designed a prospective observational study. Eleven, 15-40 years old patients, with status asthmaticus whose respiratory failure did not respond to conventional therapy and mechanical ventilation [after 24h], were entered in this study [provided that there were not any contraindications to ketamine use]. These patients received ketamine at a loading dose of 1 mg/kg [IV], followed by a continuous infusion of 1 mg/kg/hr for 2h. Peak airway pressure, PaCO[2] and PaO[2] were measured prior to ketamine administration, 15min after administration and 2h after infusion of ketamine. Mean peak airway pressure and PaCO[2] significantly decreased 15min and 2h after administration and infusion of ketamine [p<0.005] and PaO[2] significantly increased in these time intervals [p<0.005]. Ketamine is a useful and safe drug in the intensive treatment of status asthmaticus. However, ketamine should only be used for asthmatics whose respiratory failure does not respond to standard therapy