Using pregabalin for prevention of post anesthesia shivering

Background: post anesthesia shivering [PAS] is one of the most common complications after surgeries. There are two methods to reduce the shivering, including pharmacological and non-pharmacological methods

Aim of the study: the present study compared the efficacy and safety of 150 mg oral pregabalin premedication on preventing PAS, perioperative core body temperature changes, hemodynamic stability and postoperative complications

Patients and methods: this prospective, observational study consisted of 200 adult patients scheduled for general, orthopedic or ENT surgery. The patients were randomized into two groups of 100 patients each. Group I received 150 mg of oral pregabalin, group II received an oral placebo 60-90 min before operation. All patients were assessed for perioperative hemodynamic changes, Core body temperature changes, PAS, amount of pethidine used and postoperative side effects

Results: regarding the efficacy of the preoperative administration of oral pregabalin, the current study reports valuable preventive effect on shivering for pregabalin group [8.1%] compared to control group [44.3%], and there was highly significant difference between both groups according to incidence and scoring of shivering. On the other hand we found no significant difference between groups according to heart rate [HR], systolic blood pressure [SBP] and diastolic blood pressure [DBP]. However reduction in SBP and DBP was recorded in both groups after induction which became back up at the end of surgery. Also tympanic temperature reduction was recorded intraoperatively and came back up during recovery period with no statistically significant differences between groups. Postoperative nausea and vomiting were significantly lower with the administration of pregabalin compared with the placebo group. Additionally, pregabalin increased the incidence of dizziness, blurred vision and drowsiness

Conclusion: oral pregabalin premedication adequately prevent PAS but could not affect its timing nor mean dose of pethidine used. Additionally, oral pregabalin reduced postoperative nausea and vomiting but increased significantly the incidence of dizziness, blurred vision and drowsiness

Postoperative analgesia using epidural infusions of sufentanil-levobupivacine 0.125% versus sufentanil-ropivacaine 0.165% after lower limb operations

Levobupivacaine 0.125% provides satisfactory analgesia with lumbar and thoracic epidural catheter placement. Two studies performed in 1999 suggest that ropivacaine may be 40% less potent than bupivacaine whereas this difference is only 2% for levobupivacaine. Ninety-two patients undergoing total hip or knee replacement were selected to participate in double-blind randomized, study comparing ropivacaine 0.165% with levobupivacaine 0.125% to which was added sufentanil 1ug/ml for postoperative analgesia by the epidural route. The total dose of ropivacaine was 60% greater than that of levobupivacaine. The larger consumption of ropivacaine does not necessarily suggest that the potency difference between both newer local anesthestics is even more than the 25% assumed in the present study design. A shorter duration of action of ropivacaine may have caused a requirement for additional demand, although it would be unwise to believe that a 50% larger dose can be entirely explained by a difference in duration of action. Both local anaesthestics levobupivacaine and ropivacaine provided effective postoperative analgesia but, even in a 25% weaker concentration a small volume of levobupivacaine and opiate substance was consumed. These differences may be explained by a potency difference or by the duration of action of levobupivacaine

Comparative study of Inhalational and total intravenous anaesthesia effect on middle ear pressure and postoperative nausea and vomiting

Successful outcome in microsurgery of ENT depends on two important factors. Ther first is prevention of intraopertive and postoperative fluctuation of the middle ear pressure and scond factor is prevention of post operative nausea and vomiting. This study was conducted on 30 patients subjected to elective nasal surgery, the patients were randomly divided into two equal groups each of them 15 patients. Group I receivedd inhalational anaesthetic using halothane and Group II received total intravenous anaesthesia using propofol-Middle ear pressure was measured using tympanometry. The incidence of occurrence of post operative nausea and vomiting was studied in both groups. The blood pressure, heart rate were measured, the dose requirement of nitroglycerine and arterial blood gases [paO2, pacO2pH and Hco3] were assessed. It was found that, the measurements of the middle ear pressure increased in both groups as compared to base line. The inhalational group showed more increase than the propofol group. As regarding the incidence of PONV it was significantly lower after TIVA than after halothane. Arterial blood pressure was significantly lower propofol group than inhalational group and the dose requirment of nitroglycerine was significantly lower in propofol group than inhalational group, there were no significant changes in pH,paO2, pacO2 or Hco3. This work concluded that total intravenous anaesthesia using propofol was superior to inhalational anaesthesia using halothane in this type of surgery regarding to middle ear pressure and postoperative nausea and vomiting [PONV] and controlled hypotensive anaesthesia