Evaluation of analgesic efficacy of pregabalin for postoperative pain relief after laparoscopic cholecystectomy: a double blind study

Objective: Postoperative pain after laparoscopic cholecystectomy [LC] is the prevailing complaint and the primary reason for delayed discharge. Several studies have demonstrated the role of pregabalin in the postoperative pain management. However, there are limited studies, which evaluated the role of preoperative pregabalin in attenuating postoperative pain after LC. So, the present study was designed to evaluate the effect of a single oral dose of pregabalin to reduce postoperative pain and analgesic consumption after LC

Methodology: The design of study was prospective, randomized and double blind in a tertiary-care hospital. Sixty consenting patients were randomly allocated into two group of thirty each to receive either a matching alprazolam 0.5 mg [placebo] or pregabalin 150 mg, orally 2 hours before surgery in a double-blind manner. The parameters assessed were; postoperative pain by VAS score, total analgesic consumption, hemodynamic parameters, sedation level, nausea and vomiting and dizziness at 0, 2, 4, 6, 12, 18, and 24 hours. Overall patient satisfaction with pain management was also assessed as a secondary outcome

Results: Postoperative VAS scores for pain were reduced in pregabalin group; at 0, 2, 4 hours [p < 001] and 6, 12, 18 and 24 hours [p < 0.05]. Analgesic consumption was also reduced in the study group [68.83 +/- 37.36 vs. 175.87 +/- 35.31, p < 0.001]. The frequency of nausea and vomiting [p < 0.05 - < 0.001] was reduced in pregabalin group compared with placebo. The preoperative anxiety; postoperative hemodynamic parameters, and sedation scores were comparable in both of the groups. The patients in pregabalin group were more satisfied with overall pain management

Conclusion: The results of our study show that a single dose of pregabalin 150 mg can effectively attenuate postoperative pain and reduce tramadol requirement as well as nausea and vomiting, without any untoward side-effects, and with higher satisfaction level of the patients

Bupivacaine induced aseptic meningitis following subarachnoid block

All anesthesiologists performing subarachnoid block should be familiar with the possible sources of contamination during the procedure and means to prevent them. Despite following stringent practices of asepsis by the anesthesia care givers there can still be a rare possibility of iatrogenic meningitis due to the spinal anesthesia. We report a rare case of aseptic meningitis succeeding subarachnoid block in our institute, probably by hyperbaric bupivacaine, injected in the subarachnoid space and its subsequent management

Paroxysmal autonomic instability with dystonia (PAID) syndrome following cardiac arrest

Paroxysmal autonomic instability with dystonia (PAID) appears to be a unique syndrome following brain injury. It can echo many life-threatening conditions, making its early recognition and management a challenge for intensivists. A delay in early recognition and subsequent management may result in increased morbidity, which is preventable in affected patients. Herein, we report the case of a patient who was diagnosed with PAID syndrome following prolonged cardiac arrest, and discuss the pathophysiology, clinical presentation and management of this rare and under-recognised clinical entity.

Recent advances in pre-eclampsia management: an anesthesiologist's perspective

Pre-eclampsia is an important cause of mortality and morbidity in parturients with varied presentations and controversial pathophysiology. The central pathology is a profound vasoconstriction in the vasculature leading to volume contraction and placental hypoperfusion. The management mainly involves a multi-disciplinary approach with the anesthesiologist playing a significant role for a positive outcome. Anesthesia for such parturients remains a challenge and starts with provision of labor analgesia which should be offered to all preeclamptic parturients. The neuraxial techniques of analgesia are most favourable for adequate pain relief and if contraindicated, intravenous PCA technique with the use of opioids should be used. Recent studies show favourable maternal and fetal outcomes with the use of patient controlled epidural analgesia technique with the combination of lower concentrations of local anesthetics with opioids. Regional anesthesia should be preferred in these parturients for cesarean section if not contraindicated. If general anesthesia is indicated, the techniques should be modified to prevent any stress response. A careful and prompt use of oxytocics should be done in all cases as the incidence of postpartum hemorrhage is high in these parturients

Two point fixation of endotracheal tube in submentotracheal intubation during craniomaxillofacial surgeries-our experience!

Airway management in the craniomaxillofacial trauma surgery may require some modifications of the standard intubation techniques. Nasotracheal intubation is often not an option in panfacial and midfacial injuries due to the probable presence of fractures of base of the skull and associated risk of brain trauma and iatrogenic meningitis. Submental endotracheal intubation may serve as an effective and safe alternative route in these conditions. In standard technique of submentotracheal intubation, the tube is fixed extraorally at the submental incision site with sutures to prevent displacement of the tube during the surgical intervention. But still it leaves a possibility of accidental extubation during the conversion of orotracheal to submental route and vice versa. To counteract this problem we in our institution, fix the tube at two points, one at molar teeth in intraoral region and second at skin surface externally near submental incision site ensuring a secured airway. This procedure has eliminated accidental displacement or extubation in our cases