RESUMO
One of the most common complaints after coronary artery bypass graft [CABG] is postoperative pain. Gabapentin is an anticonvulsant and antineuralgic agent. To evaluate the analgesic effect of preemptive gabapentin on post-operative pain and morphine consumption after cardiac surgery. A double-blind randomized clinical trial was conducted on 60 male candidates for CABG. The patients were divided into two groups-the gabapentin [n=30] and the control group [n=30]. The test group received 800 mg gabapentin orally two hours before the surgery followed by 400 mg of the drug two hours post-extubation. The control group received placebo instead. Then severity of pain was recorded according to an 11-point visual analog pain scale. The amount of morphine consumed, its side effects and hemodynamic changes were also recorded during and at 2, 6, 12, 18 and 24 hours after extubation. The mean +/- SD cumulative morphine consumption at the first 24 hours after extubation in gabapentin group was 0.9 +/- 1.5 mg while it was 1.5 +/- 4 mg for the control group. Therefore, gabapentin group consumed 38% less than the control group [P=0.01]. The pain scores during rest and coughing at 2, 6, and 12 hours after extubation were also significantly lower in the gabapentin group compared with the control group [P=0.02]. The mean +/- SD mechanical ventilation time was 5.4 +/- 1.7 hours for gabapentin group and 1.6 +/- 4.4 hours for the control group [P=0.035]. The other variables including hemodynamic changes [HR, SBP and DBP], and incidence of nausea, vomiting and respiratory depression showed no significant difference between the studied groups within 24 hours after extubation. Oral pre-medication with gabapentin before CABG significantly reduces post-operative pain and morphine consumption in adult cardiac surgery
RESUMO
Post operative shivering is a prevalent complication of general and spinal anesthesia. Many drugs were used for prevention and treatment of shivering. The objective of this study was the comparison of clonidin, pethedin and fentanyl for treatment of post spinal anesthesia shivering. In this double blind randomized clinical trial, we compared the effects of 3 drug regimens to treat post operative shivering after spinal anesthesia in 60 elective caesarian sections with ASA class 1. Patients were divided into 3 groups [20 patients for each group]. Each group received intravenously either pethedin 25 mg, clonidine 30 micro g or fentanyl 50 micro g. If a patient did not respond to the first dose, the same dose would be repeated up to a total of 3 times [with 5 minute intervals]. Homodynamic changes, treatment responses and side effects were recorded. Then the resulting data were analyzed by SPSS software and chi-square test. Considering control of shivering after first injection with pethedin 70%, clonidin 50% and fentanyl 30% with [p=0.04] major side effects in pethedin group were tachycardia 10%, nausea and vomiting 15%. In clonidine group the main side effects were dry mouth and drowsiness [16.7% and 3.3%] respectively. Fentanyl group had only 3.3% nausea vomiting accounting for the fewest number of side effects [p< 0.05]. Homodynamic was stable in fentanyl and clonidine groups. We concluded that, clonidine offers better thermodynamics along with modest failure rate but pethedin was most effective with more serious side effects