RESUMO
Background and aims: Wound infiltration as a pre-emptive measure to relieve post-operative pain is a common practice following laparoscopic procedures. The addition of adjuvants like opioids to local anesthetics can facilitate the prolongation of postoperative analgesia. Our primary aim was to compare the analgesic efficacy of peri-portal infiltration of Ropivacaine alone versus Ropivacaine with Fentanyl in patients undergoing laparoscopic operations. Methods: The study was conducted on 80 ASA physical status I and II patients, aged 18 to 65 years, undergoing surgical procedures under general anesthesia. Group R was infiltrated with Ropivacaine (0.5%) (18ml+2ml saline) while in Group RF, Ropivacaine(18ml) with Fentanyl 2ml (100礸)] was infiltrated around ports, before wound closure. At the end of the surgery, one of our study drug solutions was infiltrated, to which the patient as well as the assessor were blinded. Postoperative pain was assessed by the VAS (visual analog scale) score. Injection Tramadol 100mg was given as a rescue analgesic if the VAS score was ? 3. Student抯 t-test and Fischer抯 exact test were applied for continuous and categorical variables; Kruskal Wallis and Mann Whitney U test for nonparametric data. The entire statistical analysis was done using STATA 13[ STATA CORP. TEXAS, USA] software. Results: The mean duration of analgesia was significantly longer in group RF, with a requirement of fewer doses of rescue analgesics, compared to group R. Conclusion: The addition of Fentanyl to Ropivacaine for periportal infiltration was found to be superior to Ropivacaine alone in providing effective postoperative analgesia as well as reducing the requirement of rescue analgesics.
RESUMO
Background and Objective: Clinical trials have shown the potential use of 5-HT3 receptor antagonists like Ondansetron, Tropisetron and Zacopride in a number of disorders of gastrointestinal tract and the central nervous system such as cancer chemotherapy induced vomiting, anxiety, depression, schizophrenia and migraine. Various experimental and clinical studies also point the usefulness of Ondansetron in neuropathic pain. Therefore, the present study was conducted to find out whether Ondansetron could be used as an alternative to a standard drug, Amitriptyline in the treatment of peripheral neuropathy. Methodology: A randomized double blind prospective clinical study was conducted on Original Research Article British Journal of Medicine & Medical Research, 4(26): 4444-4454, 2014 4445 thirty six patients of peripheral neuropathy divided into two groups of equal number of patients. Group 1 received Ondansetron 8 mg per day while Group 2 received Amitriptyline 25 mg per day. Patients were being evaluated on the basis of improvements (decrease) in LANSS (Leeds Assessment of Neuropathic Symptoms and Signs), VAS (Visual Analogue Scale) and NCV (Nerve Conduction Velocity) for six weeks. Student’s ttest and/or repeated measure ANOVA followed by Bonferoni correlation was used to compare sets of paired observations. The Friedman test followed by multiple comparisons was used to compare the data which was not normally distributed. Results: LANSS and VAS scores showed significant improvements in the 1st and 2nd visit in both the groups. NCV showed improvement in Ondansetron group with less number of adverse effects compared to that of Amitriptyline. NCV in Amitriptyline group demonstrated significant increase in one of the parameters, F-waves, indicating a worsening in left tibial nerve (p=0.036), whereas no such change was found in the group treated with Ondansetron. Conclusion: Ondansetron has beneficial role in peripheral neuropathy by improving its sensory component as it significantly decreased LANSS and VAS scores. Our results also demonstrated that Ondansetron was at least as efficacious as Amitriptyline in the treatment of peripheral neuropathy with lesser adverse effects.