Post-operative Analgesic and Opioid-sparing Effect of a Single-dose Pre-operative Oral Pregabalin in Gynaecological Surgeries.

Background: Post-operative pain treatment is a major challenge in our environment. Opioids may cause respiratory depression post-operatively. Therefore, any combination of opioid and non-opioid analgesics that provides quality post-operative pain control and reduces opioid consumption with its attendant side effects will be highly desirable. Objectives: The aim of this article is to evaluate analgesic benefits and opioid-sparing effects of pre-operative oral pregabalin in patients who undergo abdominal gynaecological surgeries. Materials and Methods: A prospective randomized double-blind placebo-controlled study is carried out at University of Ilorin Teaching Hospital, Kwara State, Nigeria. Eighty-two patients scheduled for gynaecological surgeries were randomized into two equal groups. The patients in the control and study groups received a placebo drug and oral pregabalin 150 mg, respectively, 1 h before induction of general anaesthesia. Post-operative pain intensity using a five-point Verbal Rating Scale, time to first request for analgesia, and 24 h post-operative pethidine consumptions were assessed. Mean values were compared using Student's t-test. Categorical data were compared with the χ 2 test. Level of significance was set at 5% (0.05) and power of the study was 80%. Results: Demographic characteristics were comparable between the two groups. The median pain score was 0-2 (no pain-moderate pain) throughout the study. Post-operative static and dynamic pain scores at 1, 4, and 12 h were significantly higher in the placebo group (<0.001). Twenty-four hours post-operatively, there were no significant differences in static and dynamic pain scores between the two groups (P=0.131 and P=0.384, respectively). Time to first analgesic requirement and total pethidine consumed within 24 h post-operative were 47 ± 19 vs. 258 ± 137 min (P=0.001) and 326.19 ± 62.70 vs. 192.86 ± 55.84 mg (P=0.001) in the control and study groups, respectively. The pre-operative use of pregabalin reduced post-operative opioid requirement by 40.9% in the study group. Nausea and vomiting were more common in the placebo group, whereas dizziness, blurring of vision, and sedation were more common in the pregabalin group. Conclusion: A single pre-operative dose of 150 mg oral pregabalin had significantly greater analgesic effects compared with placebo and reduced post-operative opioid requirements in patients undergoing myomectomy or total abdominal hysterectomy. It should be considered an adjuvant in multimodal pain management regimens following gynaecological surgeries.

Effect of spinal anesthesia on QT interval: Comparative study of severe pre-eclamptic and normotensive parturients undergoing cesarean section.

Aim: This study aimed to compare the effect of spinal anesthesia on QT interval in severe pre-eclamptic and normotensive parturients who underwent cesarean section in a Nigerian tertiary hospital. Patients and Methods: Twelve-lead electrocardiogram (ECG) was obtained before, and at intervals after spinal anaesthesia on fifty severe pre-eclamptic (Group A) and fifty normotensive parturients (Group B) who underwent caesarean section. The effect of spinal anaesthesia on QT interval was compared. Results: The preoperative (baseline) mean QT interval was longer in group A than in group B; 453.10 ± 34.11 ms versus 399 ± 18.79 ms, P < 0.001. The prevalence of prolonged QT interval in the severe pre-eclamptic group before spinal anesthesia was 80% while in the normotensive group it was 0%, P < 0.001. At 5, 30, 60, and 120 min after the establishment of spinal anesthesia, the mean QT interval in the severe pre-eclamptic group was shortened and maintained within normal limits; 414.74 ± 28.05, 418.28 ± 30.95, 411.18 ± 19.21 and 401.36 ± 17.52 ms with P < 0.001 throughout. In the normotensive group, there was no significant change in the mean QT interval. Conclusions: This study demonstrated that the QT interval was more prolonged among the severe pre-eclamptic parturients. Spinal anesthesia using 0.5% hyperbaric bupivacaine normalized the QT interval and maintained it within normal limits during the study period.

Dose related effects of oral clonidine pre-medication on bupivacaine spinal anaesthesia.

INTRODUCTION: The duration of action of sub-arachnoid block is short, and one of the ways to overcome this is the use of oral clonidine. METHODS: 108 patients of ASA I and II, aged 18 to 65 years undergoing lower abdominal surgeries under spinal anaesthesia were randomized into three groups.. Control group A (n=36) no oral clonidine pre-medication, Group B (n=36) and group C (n=36) received 100 µg and 200 µg of oral clonidine pre-medication respectively, 1hr before spinal anaesthesia. Haemodynamic parameters were recorded. Sensory block, degree of motor blockage, and sedation were assessed. RESULTS: Clonidine prolonged the mean duration of motor block by 189.98±26.93 min (100µg) and 191.89±28.13 min (200µg) compared to 117.92±25.13 min in the control group p<0.05. The mean duration of analgesia was 188.19±35 min (100µg) and194±24.58 min (200µg) in the clonidine groups compared to 115.89±26.66 min in control group p<0.05. All the patients were awake in the control group while 71.43% and 100% were drowsy in groups B and C respectively. CONCLUSION: Oral clonidine produces better clinical effects on the onset and duration of Bupivacaine spinal anaesthesia.

The Correlation Between Body Mass Index On The Length From Skin To Lumbar Epidural Space In Nigerian Adults.

BACKGROUND: One of the factors that determine success of an epidural anaesthetic is correctly locating the epidural space. Being able to predict the skin to lumbar epidural space distance can serve as a guide to performing epidural anaesthesia and in turn increase the success rate. AIM: To determine the correlation between the BMI, gender and age on SLESD of adults scheduled for elective surgical procedure under lumbar epidural anaesthesia. DESIGN OF STUDY: It was across sectional descriptive study carried out on consenting patients scheduled for elective surgery under lumbar epidural anaesthesia. SETTING: The study was carried out in the main theatre complex and the obstetric theatre of the University of Ilorin Teaching Hospital, Ilorin, Nigeria. METHODOLOGY: One hundred and twenty patients of ASAI and II physical status between the ages of18-65years scheduled for elective surgical procedures under epidural anaesthesia were enrolled into the study. This was a cross sectional descriptive study involving both sexes. Using a septic technique epidural anaesthesia was established in the sitting position using the midline approach at L3/L4orL4/L5 interspace. The epidural space was identified by loss of resistance to air. TheSLESD in centimetres (cm) was rounded up to the nearest 0.25cm. Data were collected and analyzed using Spearman´s correlation to evaluate the relationship between BMI, weight, sex, age, height and the SLESD. RESULTS: The mean SLESD was 4.60±0.83 cm with a range of 3cm-8cm. The SLESD was significantly influenced by BMI and weight with both having positive correlation and P value of 0.001 and 0.004 respectively. We formulated a relationship between skin to lumbar epidural space and body mass index based on linear regression analysis: Depth cm= a + b × (BMI)Where a =3.33 and b =0.05.There was no correlation between SLESD and height, age or sex of the patients. CONCLUSION: There was positive linear correlation between the body mass index, body weight and the skin to lumbar epidural space distance. Whereas, the age, sex and height had no correlation with the skin to lumbar epidural space distance.

Accidental Decannulation OF TRACHEOSTOMY TUBES - Case Series.

Tracheostomy tube (TT) is usually removed in a planned manner once the patient ceases to have the condition that necessitated the procedure. Accidental decannulation or extubation refers to inadvertent removal of tracheostomy tube out of the stoma. It could prove fatal in an otherwise stable patient. We review a variety of unexpected and often-overlooked causes of accidental decannulation with suggestions on preventive measures. We therefore present three cases of accidental decannulation of tracheostomy tubes in order to report our experiences in the management of the condition. CONCLUSION: Accidental decannulation occurs both in hospitalized and patient on home care of their tracheostomy tubes. Reduction in neck circumference due to weight loss predisposes to accidental decannulation, which could be prevented by suturing the flange to the skin.