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

comparison of 0.1% ropivacaine and 0.1% bupivacaine with patient-controlled epidural analgesia for labor: a double blind study

Objective: Ropivacaine has been claimed to be superior for epidural labor analgesia, with less motor blockade and toxicity as compared to bupivacaine, and it has largely replaced the later drug for this purpose. The objective of this study was to compare and evaluate the analgesic efficacy of ropivacaine 0.1% and bupivacaine 0.1% with 2 microg/ml fentanyl for painless labor using patient-controlled epidural analgesia [PCEA]

Methodology: This prospective, randomized and double blind study was undertaken in a tertiary care hospital. Fifty parturients of ASA grade I and II, were randomly allocated into two groups of 25 each, to receive either 10 ml of 0.1% bupivacaine or 0.1% ropivacaine with fentanyl 2microg/ml in Group B and Group R respectively as initial bolus dose. Same dose regimen was used as continuous background infusion and PCEA boluses of 10 ml according to the group allocation. Onset and quality of analgesia, motor weakness, total drug consumption, and fetomaternal outcome in both groups were compared

Results: Effective labor analgesia [VAS < 30] with onset time of 9.42 +/- 1.16 and 9.14 +/- 1.46 min in Group B and Group R respectively were comparable in both the groups [p > 0.05]. All the patients were pain free within 15 min after initiation of epidural analgesia. Sensory and motor block characteristics in both the groups were comparable. No patient had motor blockade till two hours after initiation of epidural analgesia. Motor block increased as the duration of labor increased. Overall, drug consumption was 85.04 +/- 21.02 ml in Group R and 81.56 +/- 22.81 ml in Group B with fentanyl during labor [p->0.05]. There were no significant changes in hemodynamic parameters, duration of labor or maternal satisfaction. No adverse effects related to neonatal or maternal outcomes were noted in both groups

Conclusion: We conclude that 0.1% ropivacaine or 0.1% bupivacaine with fentanyl 2 microg/ml using PCEA were equally effective for labor analgesia. There were no statistically significant differences in the quantity of drug used, motor weakness, labor duration, or fetomaternal outcome

Management of high spinal injury: an anaesthetic riddle

Cord injured patients pose unique difficulties, autonomic dysreflexia merits special concern. A sixty six years old female patient with a history of compressive myelopathy at the level of T1-T2 was placed for anterolateral decompression under general anaesthesia. During intraoperative period the patient developed several episodes of bradycardia and hypertension. Towards the end of surgery she developed hypothermia and hypotension needing the support of vasopressors. On the 3rd postoperative day she developed left sided collapse of the lung, which responded to chest physiotherapy and mucolytics. This case report demonstrates several issues confronting the anaesthetist while dealing with patients of high spinal cord lesion. An adequate knowledge and quick anticipation of complications can however avert a major disaster