Prophylactic use of gabapentin to reduce postoperative nausea and vomiting in patients undergoing diagnostic gynecological laparoscopy

Introduction: Postoperative nausea and vomiting [PONV] occurs in patients during the first 24 hours of the surgery. Many drugs have been used for the prevention and treatment of PONV. In this trial, we used gabapentin to evaluate its prophylactic effect in reducing the severity and incidence of PONV in patients undergoing diagnostic laparoscopic gynecological surgery

Methodology: This, double blind randomized controlled trial, was done in operation theatre complex over a period of six months. 140 patients undergoing diagnostic gynecological laparoscopic surgery were selected. Two groups were formed and 70 patients were recruited in each group using lottery method as method of randomization. Group C [control group] was given placebo medication orally two hours before surgery and group G [gabapentin group] received 600 mg of gabapentin orally two hours before the procedure. Standard general anesthesia technique was used in all patients and incidence and severity of postoperative nausea and vomiting [PONV] was recorded in these patients till 24 hours of laparoscopy

Results: Severity of PONV was graded from mild to severe. There was no PONV in 25 patients [35.7%] in group C and 47 patients [67.1%] in group G. It was mild in severity in 8 patients [11.4%] in group C and 5 patients [7.1%] in group G, moderate in 31 patients [44.3%] in group C and 15 patients[21.4%] in group G and severe PONV was seen in 6 patients [8.6%] in group C and 3 patients [4.3%] in group G [P=0.003]. Postoperative nausea and vomiting within 24 hours after procedure was present in 45 patients [64.3%] in group C and 23 patients [32.9%] in group G. Results were significant between two groups after statistical analysis with p value of 0.001

Conclusion: Administration of 600 mg of gabapentin two hours before diagnostic gynecological laparoscopy decreases the frequency and severity of PONV

Gabapentin Differentially Modulate c-Fos Expression in Hypothalamus and Spinal Trigeminal Nucleus in Surgical Molar Extraction

Abstract The study on the efficacy of oral analgesics reported that no single class of drug is effective in post-surgical dental pain. Pain following removal of third molar is most commonly used and widely accepted acute pain model for assessing the analgesic effect of drugs in humans. Reports demonstrated that analgesic efficacy in the human dental model is highly predictive. The high incidence of false-negative findings in analgesic investigations hinders the process of molecular discovery. Molecular mechanism of post-surgical pain is not known. More importantly, the animal model for postoperative dental pain is not well established. In an attempt to discover an effective post-surgical dental pain blocker with acceptable side effects, it is essential to elucidate the molecular mechanism of post-operative dental pain. The present study investigated mandibular molars extraction in rat as an animal model for the post-operative dental pain in central nervous system. Using c-Fos immunohistochemistry, we demonstrated that pre administration of GBP (150 mg/kg. i.p) significantly (p< 0.01) neutralized the surgical molar extraction induced c-Fos expression bilaterally in rat hypothalamus. Present results indicate that pain after surgical molar extraction might follow novel neural pathways therefore difficult to treat with existing anti-nociceptive drugs.

Resumo O estudo da eficácia relativa dos analgésicos orais relatou que nenhuma classe única de fármaco é eficaz na dor pós-cirúrgica dental. A dor após a remoção do terceiro molar é o modelo de dor aguda mais comumente usado e amplamente aceito para avaliar o efeito analgésico de drogas em seres humanos. Os relatos demonstraram que a eficácia analgésica no modelo dental humano é altamente preditiva. A alta incidência de achados falso-negativos em investigações analgésicas dificulta o processo de descoberta molecular. O mecanismo molecular da dor pós-cirúrgica não é conhecido. Mais importante ainda, o modelo animal para a dor pós-operatória não está bem estabelecido. Numa tentativa de descobrir um bloqueador de dor dental pós-cirúrgico eficaz com efeitos secundários aceitáveis, é essencial elucidar o mecanismo molecular da dor pós-operatória dental. Neste estudo investigamos a extração de molares inferiores de ratos como modelo animal para a dor pós-operatória no sistema nervoso central. Utilizando análise imunohistoquímica de c-Fos, demonstrou-se que a administração prévia de GBP (150 mg/kg i.p) significativamente (p<0,01) neutralizou a expressão c-Fos induzida por extração molar cirúrgica bilateralmente no hipotálamo de rato. Os resultados indicam que a dor após a extração molar cirúrgica pode seguir novas vias neurais, portanto, difícil tratar com as drogas anti-nociceptivas existentes.

Psychotropics in different causes of itch: systematic review with controlled studies

Abstract Among the wide range of symptoms neglected or resistant to conventional treatments in clinical practice, itch is emerging gradually as a theme to be studied. Itch complaints and the negative effects in the quality of life are observed in several medical fields. Although the partially obscure pathophysiology, some researchers decided to check and test the use of psychotropic drugs in resistant itch to conventional topical treatments and antihistamines. The objective of this study was to evaluate scientific evidence in psychotropic use in the treatment of itch of various causes. This is a systematic review of scientific literature. The following databases were used: PubMed, Web of Science, Scopus and Scielo. Randomized controlled trials that should focus on treatment with psychotropic drugs of pruritus of various causes were the inclusion criteria. All articles were analyzed by the authors, and the consensus was reached in cases of disagreement. Fifteen articles were included after analysis and selection in databases, with the majority of clinical trials focusing on psychopharmacological treatment of itch on account of chronic kidney disease. Clinical trials with psychotropic drugs mostly indicated significant improvement in the itching. In most trials of chronic kidney disease as basal disease for itch, greater effectiveness was observed with the use of psychotropic drugs compared with placebo or other antipruritic. However, the small amount of controlled trials conducted precludes the generalization that psychiatric drugs are effective for itch of various causes.

Treatment of patients with painful blind eye using stellate ganglion block / Tratamento de pacientes portadores de olho cego doloroso por meio de bloqueio de gânglio estrelado

BACKGROUND AND OBJECTIVES: management of pain in painful blind eyes is still a challenge. Corticosteroids and hypotensive agents, as well as evisceration and enucleation, are some of the strategies employed so far that are not always effective and, depending on the strategy, cause a deep emotional shock to the patient. Given these issues, the aim of this case report is to demonstrate a new and viable option for the management of such pain by treating the painful blind eye with the stellate ganglion block technique, a procedure that has never been described in the literature for this purpose. CASE REPORT: six patients with painful blind eye, all caused by glaucoma, were treated; in these patients, VAS (visual analogue scale for pain assessment, in which 0 is the absence of pain and 10 is the worst pain ever experienced) ranged from 7 to 10. We opted for weekly sessions of stellate ganglion block with 4 mL of bupivacaine (0.5%) without vasoconstrictor and clonidine 1 mcg/kg. Four patients had excellent results at VAS, ranging between 0 and 3, and two remained asymptomatic (VAS = 0), without the need for additional medication. The other two used gabapentin 300 mg every 12 h. CONCLUSION: currently, there are several therapeutic options for the treatment of painful blind eye, among which stand out the retrobulbar blocks with chlorpromazine, alcohol and phenol. However, an effective strategy with low rate of serious complications, which is non-mutilating and improves the quality of life of the patient, is essential. Then, stellate ganglion block arises as a demonstrably viable and promising option to meet this demand.

JUSTIFICATIVA E OBJETIVOS: o manejo da dor em olhos cegos dolorosos ainda é um desafio. Corticosteroides e hipotensores, bem como evisceração e enucleação, são algumas das estratégias até então empregadas, nem sempre eficazes e que, a depender da estratégia, causam um profundo abalo emocional no paciente. Dadas essas questões, o objetivo deste relato de caso é demonstrar uma nova e viável opção para o manejo desse tipo de dor por meio do tratamento do olho cego doloroso com bloqueios de gânglio cervicotorácico, técnica nunca descrita na literatura para esse fim. RELATO DE CASO: foram tratados seis pacientes portadores de olho cego doloroso, todos por glaucoma, nos quais a EVA (escala visual analógica para avaliação da dor em que 0 é ausência de dor e 10 é a maior dor já experimentada) variava de 7 a 10. Optou-se por sessões semanais de bloqueio de gânglio cervicotorácico com 4 mL de bupivacaína (0,5%) sem vasoconstritor e clonidina 1 mcg/Kg. Quatro pacientes apresentaram excelente resultado EVA, com variação entre 0 e 3, e dois permaneceram assintomáticos (EVA = 0), sem necessidade de medicação suplementar. Os outros dois usaram gabapentina 300 mg de 12 em 12 horas. CONCLUSÃO: atualmente, várias são as opções terapêuticas para o tratamento do olho cego doloroso, entre as quais se destacam os bloqueios retrobulbares com clorpromazina, álcool e fenol. No entanto, uma estratégia eficaz, com pequeno índice de complicações graves, não mutilante e que melhore a qualidade de vida do paciente é imprescindível. O bloqueio do gânglio cervicotorácico surge, pois, como uma opção comprovadamente viável e promissora para atender a essa demanda.

The Effectiveness of Oral Corticosteroids for Management of Lumbar Radiating Pain: Randomized, Controlled Trial Study

BACKGROUND: Although both pregabalin and gabapentin are known to be useful for treating lumbar radiating pain and reducing the incidence of surgery, the oral corticosteroids sometimes offer a dramatic effect on severe radiating pain despite the lack of scientific evidence. METHODS: A total of 54 patients were enrolled among 703 patients who complained of lumbar radiating pain. Twenty patients who received an oral corticosteroid was classified as group A and 20 patients who received the control drugs (pregabalin or gabapentin) as group B. Oswestry Disability Index (ODI), Revised Roland Morris disability questionnaire (RMDQ), Short Form 36 (SF-36) questionnaire, lumbar radiating pain, objective patient satisfaction, and objective improvement of patients or physicians were assessed at 2, 6, and 12 weeks after medication. RESULTS: No difference in the sex ratio and age was observed between the groups (p = 0.70 and p = 0.13, respectively). Group A showed greater improvement in radiating pain after 2, 6, and 12 weeks than group B (p < 0.001, p = 0.001, and p < 0.001, respectively). No differences were observed between the groups in satisfaction at the beginning and 12 weeks after taking the medication (p = 0.062 and p = 0.061, respectively) and in objective improvement of patients and physicians (p = 0.657 and p = 0.748, respectively). Group A was less disabled and had greater physical health scores than group B (p = 0.014 and p = 0.017, respectively). CONCLUSIONS: Oral corticosteroids for the treatment of lumbar radiating pain can be more effective in pain relief than gabapentin or pregabalin. The satisfaction of patients and physicians with the drug and objective improvement status were not inferior to that with gabapentin or pregabalin.

[Evaluation of the therapeutic effect of oral gabapentin on the severity of acute low back pain]

Acute low back pain is one of the most common complaints of the patients seeking medical advice. Nowadays various drugs are recommended for the treatment of this problem. Selection of appropriate medications with high efficacy and minimal side effects has always been a challenging issue in medical treatments. The present study was conducted to investigate the effect of oral gabapantin on pain intensity in patients with acute low back pain. This double-blind clinical trial study included 100 patients with acute low back pain who had referred to the treatment centers affiliated with Shahrekord University of Medical Sciences in 2011-2012.Using convenient sampling method the patients were randomly assigned to intervention [n50] and control [n=50] groups. Intervention group received two 500 mg naproxen tablets and two 100 mg gabapantin tablets/ day and control group, received two 500 mg naproxen tablets and two placebo tablets/ day. The patients were examined for pain intensity based on visual analogue scale and the rate of complications on the days of 0, 8, 15, and 30.Using SPSS software, data analysis was performed by descriptive and inferential statistics. In this study, mean pain score was significantly lower in the intervention group compared to the control group [p<0.05]. Also, the women in the intervention group had a lower mean pain score on all 3 examinations-compared to the women in the control group. But no statistically significant difference was observed in pain intensity between the men in the intervention and control groups. In this study, pain significantly relieved in the patients in the intervention group compared to those in the control group. It seems that use of gabapantin in addition to nonsteroidal anti-inflammatory drugs [NSAIDs] is more effective than NSAIDs alone in reducing the pain intensity

Efficacy of gabapentin in the improvement of pruritus and quality of life of patients with notalgia paresthetica

BACKGROUND: notalgia paresthetica is a subdiagnosed sensory neuropathy presenting as a condition of intense itching and hyperchromic macule on the back that interferes with daily habits. OBJECTIVES: To determine the efficacy of treatment of notalgia paresthetica using oral gabapentin, assessing the degree of improvement in itching and influence on quality of life. Moreover, to evaluate the signs and symptoms associated with notalgia paresthetica. METHODS: We conducted an experimental, non-randomized, parallel, non-blinded study including 20 patients with clinical and histopathological diagnosis of notalgia paresthetica. After application of the visual analogue scale of pain adapted for pruritus and of the questionnaire of dermatology life quality index (DLQI), ten patients with visual analogue scale > 5 were given treatment with gabapentin at the dose of 300 mg/day for four weeks. The other ten were treated with topical capsaicin 0.025% daily for four weeks. After the treatment period, patients answered again the scale of itching. RESULTS: The use of gabapentin was responsible for a significant improvement in pruritus (p=0.0020). Besides itching and hyperchromic stain on the back, patients reported paresthesia and back pain. It was observed that the main factor in the worsening of the rash is heat. CONCLUSION: Gabapentin is a good option for the treatment of severe itching caused by nostalgia paresthetica. .

Manejo dos sintomas climatéricos em pacientes com câncer de mama / Management of menopausal symptoms in patients with breast cancer

O câncer de mama é a neoplasia maligna mais frequente nas mulheres, inclusive na pós-menopausa. O tratamento hormonal e quimioterápico dessa doença pode induzir o aparecimento de sintomas vasomotores, atrofia urogenital, alteração da função sexual e instalação da menopausa precocemente, os quais merecem avaliação e controle. O tratamento dos sintomas climatéricos em pacientes sobreviventes do câncer de mama tem grande relevância clínica, pois, em razão do aumento da incidência e dos avanços na abordagem terapêutica, o número de mulheres que sobrevivem ao câncer de mama e experimentam sintomas climatéricos tem aumentado. Objetivou-se identificar na literatura evidências recentes acerca das opções terapêuticas na redução dos sintomas climatéricos. Dessa forma, foi realizada uma revisão na literatura por meio de consulta nas principais bases de dados, priorizando artigos mais recentes e com maior nível de evidência. Os estudos randomizados controlados sobre o uso de fitoterápicos, acupuntura e ioga no tratamento de fogachos em pacientes com câncer de mama são limitados, tanto nas opções de tratamento e tempo de seguimento quanto na comprovação científica de sua eficácia. Abordando os tratamentos farmacológicos, vários inibidores da recaptação de serotonina (paroxetina, fluoxetina e citalopram) e inibidores da recaptação de serotonina e adrenalina (venlafaxina e desvenlafaxina) têm sido mais eficazes que o placebo na redução dos sintomas vasomotores em estudos a curto prazo em mulheres com câncer de mama. A avaliação dos sintomas e seu impacto na qualidade de vida, além do desejo da paciente, são determinantes na escolha do tratamento. Independentemente do tipo de tratamento indicado, as modificações de estilo de vida devem ser recomendadas.(AU)

Breast cancer is the most commonly diagnosed malignancy in women, including after menopause. The hormonal and chemotherapeutic treatment of this disease can induce the appearance of vasomotor symptoms, urogenital atrophy, abnormal sexual function and installation of early menopause that require evaluation and control. The treatment of climacteric symptoms in breast cancer survivors is of great clinical relevance, once the number of women experiencing menopausal symptoms has increased because of the high incidence of breast cancer and advances in therapeutic approach. The purpose is to identify recent evidence in the literature on the therapeutic options in reducing these menopausal symptoms. Thus, a literature review through consultation was held in the main databases, prioritizing newer and higher level of evidence items. Randomized controlled trials on the use of herbals, acupuncture and yoga in the treatment of hot flashes in patients with breast cancer are limited, such as treatment options, follow-up time and the scientific evidence of its effectiveness. Addressing the pharmacological treatments, several serotonin reuptake inhibitors (paroxetine, fluoxetine and citalopram) and reuptake inhibitors of serotonin and adrenaline (venlafaxine and desvenlafaxine) have been more effective than placebo in reducing vasomotor symptoms in short-term studies in women with breast cancer. The evaluation of symptoms and their impact on quality of life, beyond the desire of the patient, are determinant in the choice of treatment. Regardless of the type of treatment indicated, changes in lifestyle should be recommended.(AU)

Uremic pruritus in hemodialysis patients: treatment with desloratidine versus gabapentin / Prurido urêmico em pacientes em hemodiálise: tratamento com desloratidina versus gabapentina

INTRODUCTION: Uremic pruritus is common among dialysis patients. Effective treatments are not readily available. Early evidence with antihistamines and gabapentin indicate variable effects. OBJECTIVE: To compare the efficacy and side effects of gabapentin and desloratadine in patients with dialysis pruritus. METHODS: Prospective, open-label, cross-over clinical trial in 22 patients on chronic hemodialysis with sustained pruritus over a period of at least 60 days. After a one-week run-in period, we assigned patients to three weeks of either gabapentin 300 mg thrice weekly or desloratadine 5 mg thrice weekly. After a one-week washout period, each patient crossed-over to the alternate regimen for three more weeks. The primary endpoint of the study was the change in the visual analogue pruritus score (VAS). RESULTS: Nineteen subjects completed the two treatment blocks and were available for analysis. VAS scores decreased with both treatments (5.95 to 4.6 with gabapentin, p = 0.07; 5.89 to 3.4 with desloratadine, p = 0.004), but only desloratadine reached statistical significance. There were no differences when comparing the final pruritus score with gabapentin and desloratadine (4.6 versus 3.4, p = 0.16) Excessive sedation was common with gabapentin. Desloratadine was well tolerated. CONCLUSION: Desloratadine provides significant relief of uremic pruritus compared with no therapy. gabapentin has marginal efficacy. Desloratadine is better tolerated than gabapentin.

INTRODUÇÃO: Prurido urêmico é comum entre pacientes em diálise. Tratamentos eficazes não estão disponíveis até o momento. Provas recentes com anti-histamínicos e gabapentina indicam vários efeitos. OBJETIVO: Comparar a eficiência e os efeitos colaterais da gabapentina e da desloratadina em pacientes com prurido na diálise. MÉTODOS: Estudo prospectivo, aberto e comparativo com 22 pacientes em hemodiálise crônica com prurido constante durante um período de pelo menos 60 dias. Após uma semana, submetemos os pacientes a três semanas de gabapentina 300 mg, três vezes por semana, ou desloratadina 5 mg três vezes por semana. Após um período de eliminação de uma semana, os pacientes trocaram de regime por mais três semanas. O objetivo primário do estudo foi a mudança na escala visual analógica (EVA) de prurido. RESULTADOS: Dezenove indivíduos completaram os dois tratamentos e foram submetidos à análise. Os escores da EVA caíram com ambos os tratamentos (5,95 para 4,6 com gabapentina, p = 0,07; 5,89 para 3,4 com desloratadina, p = 0,004), mas somente a desloratadina teve significância estatística. Nenhuma diferença foi observada ao comparar o escore final do prurido com gabapentina e desloratadina (4,6 versus 3,4, p = 0,16). Excesso de sedação foi comum com gabapentina. A desloratadina teve alto nível de tolerância. CONCLUSÃO: A desloratadina dá alívio significante do prurido urêmico quando comparada a nenhum tratamento. A gabapentina tem eficiência marginal. A desloratadina tem maior nível de tolerância em relação à gabapentina.

Effect of gabapentin on postoperative pain and operation complications a randomized placebo controlled trial / Efecto de la gabapentina en el dolor postoperatorio y complicaciones de la operación: un ensayo clínico, aleatorio, controlado con placebo

OBJECTIVE: Prevention and treatment ofpostoperative pain and operation complications such as nausea and vomiting are most important concerns in postoperative care. There are several mechanisms involved in postoperative pain. Gabapentin is a gamma aminobutyric acid analogue that is known as an anticonvulsant drug. This drug is tolerated well and has known effects on pain and anxiety. This study has compared the effect of gabapentin on postoperative pain, operation complications and haemodynamics. SUBJECTS AND METHODS: This randomized double blinded placebo controlled clinical trial was conducted on 61 patients divided randomly into two groups (30 as cases and 31 as controls). All patients had total abdominal hysterectomy. In the first group, the patients got 100 mg gabapentin in the night and 300 mg gabapentin orally (one capsule) two hours before surgery. The second group got one capsule of multivitamin orally. Then all patients were subjected to the same anaesthesia protocol and total abdominal hysterectomy. During the 24 hours after operation, the patients were assessed according to pain, nausea, vomiting, dizziness, systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse rate (PR) and morphine use at 1, 6, 12 and 24 hours. RESULTS: Mean age and weight of patients were 45.86 ± 4.06, 48.16 ± 4.48, 64.56 ± 13.29 and 68.8 ± 12.88 in the study population and control groups, respectively. Except in the first hour after operation (p = 0.02), there was no significant differences between the two groups in morphine use. There was no significant correlation between the groups according to postoperative complications and the haemo-dynamic parameters (PR, SBP and DBP). CONCLUSION: Results show that gabapentin can decrease the need for morphine use in the first hour after operation only and has no significant effect on operation complications. Thus, we suggest gabapentin for pain management, and not to decrease opium use.

OBJETIVO: La prevención y tratamiento de dolor postoperatorio y las complicaciones de la operación -tales como la náusea y el vómito - son problemas de suma importancia en el cuidado postoperatorio. Hay varios mecanismos implicados en el dolor postoperatorio. La gabapentina es un análogo del ácido gamma-aminobutírico, conocido como un medicamento anticonvulsivo. Este medicamento es bien tolerado, y tiene efectos conocidos sobre el dolor y la ansiedad. El presente estudio compara el efecto de la gabapentina sobre el dolor postoperatorio, las complicaciones de la operación, y la hemo-dinámica. SUJETOS Y MÉTODOS: Este ensayo clínico, aleatorio, doble ciego y controlado con placebo, se llevó a cabo con 61 pacientes divididos aleatoriamente en dos grupos (30 como casos y 31 como control). Todas las pacientes tuvieron histerectomia abdominal total. En el primer grupo, las pacientes recibieron via oral 100 mg de gabapentina por la noche y 300 mg de gabapentina (una cápsula) dos horas antes de la cirugía. El segundo grupo recibió una cápsula de multivitaminas por vía oral. Luego, todas las pacientes fueron sometidas al mismo protocolo de anestesia e histerectomía abdominal total. Durante las 24 horas después de la operación, las pacientes fueron evaluadas en relación con dolores, náusea, vómitos, vértigo, presión sanguínea sistólica (PSS), presión sanguínea diastólica (PSD), frecuencia de pulso (FP), y el uso de morfina a la 1, 6, 12 y 24 horas. RESULTADOS: La edad promedio y el peso de las pacientes fue 45.86 ± 4.06, 48.16 ± 4.48, 64.56 ± 13.29 y 68.8 ± 12.88 en la población de estudio y los grupos de control, respectivamente. Excepto en la primera hora tras la operación (p = 0.02), no hubo ninguna diferencia significativa entre los dos grupos en cuanto al uso de morfina. No hubo correlación significativa alguna entre los grupos sobre la base de las complicaciones postoperatorias y los parámetros hemodinámicos (FP, PSS, y PSD). CONCLUSIÓN: Los resultados muestran que la gabapentina sólo puede disminuir la necesidad del uso de morfina en la primera hora tras la operación, y no tiene efectos significativos en las complicaciones de la operación. Por lo tanto, se sugiere el uso de la gabapentina para el tratamiento del dolor, pero no para reducir el uso del opio.

The effects of preemptive pregabalin on attenuation of stress response to endotracheal intubation and opioid- sparing effect in patients undergoing off-pump coronary artery bypass grafting.

The clinical study was designed to evaluate and compare single preoperative dose of pregabalin to a placebo regarding hemodynamic responses to laryngoscopy and endotracheal intubation, to assess perioperative fentanyl requirement and any side-effects. It was a randomized, double-blind, placebo-controlled, parallel assignment, efficacy study. The study was done at a tertiary university hospital. This study was a comparison between two groups of 30 adult patients scheduled for elective off pump coronary artery bypass surgery. In the control group, the patients were given placebo capsules, and in the pregabalin group, the patients were given pregabalin 150 mg capsule orally 1 h before surgery. The patients were compared for hemodynamic changes before the start of the surgery, after induction, 1, 3, and 5 min after intubation. Additionally, fentanyl requirement during surgery and the first postoperative day was also compared. The present study shows that a single oral dose of 150 mg pregabalin given 1 h before surgery attenuated the pressor response to tracheal intubation in adults, but the drug did not show any effect on perioperative opioid consumption and was devoid of side-effects in the given dose.

Eye-related visual hallucinations: Consider ‘Charles Bonnet syndrome’.

The Charles Bonnet Syndrome (CBS) is typically characterized by visual hallucinations in elderly people without cognitive defects. This article presents the case of an 80-year-old male patient with a one-year history of visual hallucinations, secondary to glaucoma, in both eyes. Neither a dopamine agonist nor cholinesterase inhibitor therapy improved his symptoms. In this case, the hallucinations were gradually improved after administration of a GABAergic drug, pregabalin, for diabetic polyneuropathy. Placebo-controlled clinical trials would be needed to support this effect of pregabalin, as suggested by this association.

Anticonvulsants to treat idiopathic restless legs syndrome: systematic review / Anticonvulsivantes para a síndrome das pernas inquietas idiopática: revisão sistemática

BACKGROUND: Restless legs syndrome (RLS) is a sensory motor disorder characterized by a distressing urge to move the legs and sometimes also other parts of the body usually accompanied by a marked sense of discomfort or pain in the leg or other affected body part. Many treatments have been used to minimize the discomfort of the disease, among them the anticonvulsant therapy. AIM: This review aims to evaluate the efficacy and safety of anticonvulsant treatment for idiopathic RLS. METHOD: Systematic review of randomized or quasi-randomized, double blind trials on anticonvulsant treatment for RLS. Outcomes: relief of RLS symptoms, subjective and objective sleep quality, quality of life, and adverse events associated with the treatments. RESULTS: A total of 231 patients were randomized in three cross over studies and one parallel study. Three studies with carbamazepine, one with sodium valproate, and one with gabapentin, and they were very heterogeneous so we could not perform a metanalyses. CONCLUSIONS: There is no scientific evidence on RLS treatment with anticonvulsants for clinical practice.

CONTEXTO: A síndrome das pernas inquietas (SPI ) é uma desordem caracterizada por um impulso de mover as pernas e as vezes outras partes do corpo acompanhado geralmente por desconforto ou da dor nas pernas ou em outra parte afetada. Muitos tratamentos tem sido utilizados para aliviar o desconforto causado pela doença entre eles os anticonvulsivantes. OBJETIVO: Este estudo objetivou avaliar a eficácia e segurança do tratamento da SPI com as drogas anticonvulsivantes. MÉTODO: Revisão sistemática de ensaios clínicos randomizados ou quasi-randomizados, duplo-cegos para o tratamento com anticonvulsivantes para SPI. Desfechos: alívio dos sintomas da SPI, qualidade subjetiva e objetiva do sono, qualidade de vida e efeitos adversos relacionados ao tratamento. RESULTADOS: Um total de 231 pacientes foram randomizados em três estudos cross-over e um estudo paralelo. Três estudos avaliaram a carbamazepina, um estudo avaliou o ácido valpróico e o outro a gabapentina, eles eram muito heterogêneos, o que impossibilitou a metanálise dos resultados. CONCLUSÃO: Não existe evidência científica, que o tratamento da SPI com anticonvulsivantes é eficaz e seguro, para a prática clínica.

Gabapentin for refractory idiopathic trigeminal neuralgia.

Trigeminal neuralgia is sudden, usually unilateral, severe, stabbing, brief recurrent pain in the distribution area of one or more of the branches of trigeminal nerve. Various pharmacological agents including carbamazepine, oxcarbazepine, phenytoin, lamotrigine, baclofen and clonazepam have been tried with variable success rate. Here a case of idiopathic trigeminal neuralgia is presented. The patient presented in the emergency room with severe pain in the distribution area of maxillary branch of trigeminal nerve, resistant to conventional pharmacotherapy, managed successfully with gabapentin without untoward side-effects.

Benign fasciculations responsive to gabapentin

Fasciculations are symptoms present in a broad spectrum of conditions, ranging from normal manifestations to motor neuron diseases. They also represent the main picture of benign fasciculation syndrome. We report a case of such syndrome: a 48-years-old woman complaining about fasciculations for three decades who remained with the symptoms even after the compensation of a disclosed hyperthyroidism. The introduction of gabapentin rendered control of her fasciculations. The available data in the literature about the therapeutic approaches for fasciculations are revised, as long as the rare reports of evolution from patients with "benign" fasciculations to cases of amyotrophic lateral sclerosis, underlining the importance of following the patients with fasciculations.

Fasciculações são sintomas presentes em um amplo espectro de condições, desde manifestações normais até doenças do neurônio motor. Elas representam também o principal aspecto da síndrome de fasciculações benignas. Relatamos um caso desta síndrome: uma paciente de 48 anos com queixas de fasciculações por três décadas que, mesmo após a compensação de um quadro de hipertireoidismo, permaneceu com os sintomas. A introdução de gabapentina levou a controle das fasciculações. Os dados disponíveis na literatura sobre as abordagens terapêuticas para fasciculações são revisados, assim como os raros relatos de evolução de pacientes com fasciculações "benignas" para casos de esclerose lateral amiotrófica, salientando a importância do seguimento dos pacientes com fasciculações.

Nuevas alternativas farmacológicas para analgesia posoperatoria multimodal / New pharmacological alternatives for postoperative multimodal analgesia

El control del dolor en el período postoperatorio es una labor fundamental del anestesiólogo. Sin embargo, a pesar de nuestros progresos, el manejo de este síntoma sigue sin ser el óptimo: un número significativo de pacientes presenta dolor moderado a severo; por otra parte, del tratamiento del mismo se derivan síntomas secundarios considerables. Además, se ha reconocido al dolor crónico postoperatorio como un fenómeno mucho más frecuente de lo que se pensaba. Los nuevos conocimientos sobre la fisiología del dolor han permitido aumentar los recursos farmacológicos con drogas que actúan en sitios específicos de las vías nociceptivas. El tratamiento del dolor a distintos niveles debiera disminuir la frecuencia y severidad del dolor agudo postoperatorio y/o evitar el establecimiento de un dolor crónico post operatorio, con menos efectos adversos. Estos elementos constituyen la base del desarrollo de la analgesia multimodal. Entre las drogas que podrían tener alguna acción en la modulación del procesamiento del estímulo nociceptivo, tenemos a la ketamina, a la lidocaína y a la gabapentina. La ketamina ha demostrado ser una droga efectiva en disminuir el consumo de opioides y el dolor agudo postoperatorio con un bajo nivel de efectos adversos secundarios, pero se necesita caracterizar mejor las dosis y la vía de administración más adecuada. La administración de infusiones de lidocaína podría tener alguna utilidad en pacientes sometidos a cirugías con un gran componente de sensibilización central. Los estudios con gabapentina sugieren un rol en el manejo del dolor agudo postoperatorio; está pendiente definir qué pacientes son los que más se benefician con esta droga. Estas drogas (debido al mecanismo de acción de cada una de ellas) tendrían un rol en la prevención del establecimiento de dolor crónico postoperatorio, pero son escasos aun los trabajos en esta línea.

Pain management in the postoperatory period is a key labor for the anesthesiologist. However, despite our progress, control of this symptom is far from optimal: a significant number of patients present moderate to severe pain; moreover, substantial adverse effects derive from its management. Besides, postoperatory chronic pain has been recognized as a much more frequent phenomena than previously thought. Recent advances on pain physiology have permitted to enhance the pharmacological resources with drugs that work on specific sites in the nociceptive pathway. This way, management of pain at many levels should reduce the incidence and severity of postoperatory acute pain and/or prevent the installment of postoperatory chronic pain, with much less adverse effects. Among the drugs that could have some action in the modulation of the nociceptive stimulus there's ketamine, lidocaine and gabapentin. Ketamine has proved to be a drug effective in lowering the need for opioids and postoperatory acute pain with few adverse effects, but the optimal dose and route of administration are yet to be characterized. The administration of lidocaine in infusion could have some utility in patients undergoing surgeries which comprise great central sensitization. Studies with gabapentin suggest a certain role for it in acute postoperatory pain; however, it's necessary to define which patients benefit most from this drug. These drugs (due to each one's mechanism of action) could have a role in the prevention of postoperatory chronic pain, but there are still few papers on this subject.

Uso de gabapentina no tratamento da Síndrome SUNCT / Gabapentin in the treatment of SUNCT syndrome

Relatamos o caso clínico de duas mulheres com quadro compatível com síndrome SUNCT (cefaléia de curta duração, unilateral, neuralgiforme com hiperemia conjuntival e lacrimejamento). As duas apresentavam exames clínico e neurológico normais e RM com sinais de microangiopatia. A primeira apresentava cefaléia há três anos, que ocorria várias vezes por dia, sempre que mastigava ou bocejava. Havia feito uso várias medicações sem melhora. A dor foi controlada após o uso de 600 mg de gabapentina ao dia. A segunda paciente referia cefaléia há seis meses. A dor era diária, ocorrendo de 20-40 vezes por dia. Na ocasião da primeira avaliação no ambulatório, já fazia uso 600 mg de carbamazepina ao dia e 15 mg de clorpromazina, com melhora parcial. Após introdução de gabapentina- 1200 mg/ dia, a paciente evoluiu sem dor, porém com episódios de hiperemia conjuntival.

We report the cases of two women who presented a clinical condition compatible with the SUNCT (short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing) syndrome. Both presented normal clinical and neurological examination and MRI compatible with microangiopathy. The first one related headache attacks for three years, occurring several times a day when she masticated or yawned. She had a history of multiple failed therapies. The pain was controlled after the use of gabapetin (600 mg per day). The second one related she had daily headaches for six months that occurred from 20 to 40 times per day. At the first visit to the ambulatory, she related she was using carbamazepine (600 mg per day) and chlorpromazine (15 mg per day) having a partial response. Administration of gabapentin (1200 mg per day) led to complete resolution of the pain attacks, but the patient continue to have episodes of conjunctival injection.