Perioperative administration of gabapentin 1,200 mg day-1 and pregabalin 300 mg day-1 for pain following lumbar laminectomy and discectomy: a randomised, double-blinded, placebo-controlled study.

INTRODUCTION: Gabapentin and pregabalin have been compared in studies conducted on management of neuropathic and postoperative pain. In neuropathic pain studies, the analgesic effects of the two drugs were compared, and pregabalin has been found to be more potent. However, in postoperative pain studies, the effects of each drug were examined separately. This study compared the analgesic effects of pregabalin (300 mg day-1), gabapentin (1,200 mg day-1) and a placebo in managing postoperative pain following laminectomy and discectomy. METHODS: 90 patients were randomly assigned to three groups (pregabalin, gabapentin and placebo) of 30 patients each. Pregabalin 150 mg, gabapentin 600 mg and a placebo were administered every 12 hours, two times pre- and post surgery. Study data collected included morphine consumption, Visual Analogue Scale records, preoperative anxiety, patient satisfaction, adverse effects and observation notes. RESULTS: In the gabapentin and pregabalin groups, overall morphine consumption, preoperative anxiety, pruritus, postoperative shivering were significantly lower (p-value less than 0.05 for all), and patient satisfaction was significantly higher than those in the placebo group (p-value less than 0.05). CONCLUSION: This study showed that both pregabalin 300 mg day-1 and gabapentin 1,200 mg day-1 have more analgesic, anxiolytic and opioid-sparing effects, higher patient satisfaction and are more effective for preventing postoperative shivering than the placebo following lumbar laminectomy and discectomy. The findings revealed that pregabalin 300 mg day-1 had equivalent analgesic, adverse and opioid-sparing effects and patient satisfaction as gabapentin 1,200 mg day-1.

Pain on injection of propofol: comparison of metoprolol with lidocaine.

BACKGROUND AND OBJECTIVE: Pain is often experienced when propofol is injected, and intravenous lidocaine is often effective in preventing such pain. We decided to determine whether metoprolol, given before the injection of propofol, is as effective as lidocaine in reducing the incidence and severity of the pain. METHODS: Ninety patients scheduled for elective surgery under general anaesthesia were randomly allocated to one of three groups to receive either metoprolol 2 mg, lidocaine 20 mg or saline 2 mL before any propofol was injected. Each patient was given one of these agents intravenously via a 20-G cannula on the dorsum of the hand whilst the venous drainage was occluded manually, at the middle of the forearm, for 45 s. After the occlusion was released, propofol 2.0-2.5 mg kg(-1), at room temperature, was injected at 2 mL (20 mg) every 4 s. Pain was assessed verbally and scored as none (0), mild (1) or severe (2). RESULTS: The incidence of severe pain in the control group (56.7%) was significantly higher than in the metoprolol and lidocaine groups (16.6 and 10%, respectively). The number of patients who were free of pain was significantly higher in those who had been given either metoprolol or lidocaine. CONCLUSIONS: Pretreatment with intravenous metoprolol was equally as effective as lidocaine in reducing the pain associated with propofol injection.

Rocuronium combined with i.v. lidocaine for rapid tracheal intubation.

BACKGROUND: Rocuronium (ORG 9426) has been shown to have an onset of action more rapid than other nondepolarizing neuromuscular blocking agents and to provide intubating conditions similar to those of succinylcholine 60-90 s after administration. We compared the intubating conditions and hemodynamic changes after the administration of rocuronium 0.6 mg kg(-1) and lidocaine 1.5 mg kg(-1) with rocuronium alone and succinylcholine 60 and 90 s after administration. METHODS: One hundred and twenty-five adult patients of ASA physical status I or II scheduled for elective surgery were randomly divided into five groups. After propofol administration in all patients, patients in group Su (succinylcholine), group R60 (rocuronium) and group RL60 (rocuronium-lidocaine) were intubated within 60 s, while groups RL90 and R90 were intubated 90 s after the administration of rocuronium and succinylcholine. Laryngoscopy was performed and intubating conditions were graded by an experienced anesthetist blind to the muscle relaxant allocation. RESULTS: In this study, groups Su, RL60, R90 and RL90 had similar intubation scores, which were significantly better than that for group R60. Heart rate did not increase after intubation in groups Su, RL60 and RL90. CONCLUSION: The combination of lidocaine (1.5 mg kg(-1)) and low-dose rocuronium (0.6 mg kg(-1)) along with propofol is clinically equivalent to succinylcholine, improves intubating conditions in 60 s and effectively blocks increases in heart rate after intubation.

Comparison of intravenous metoprolol, verapamil and diltiazem on the attenuation of haemodynamic changes associated with tracheal extubation.

Changes in heart rate, systolic, diastolic and mean blood pressure were measured after extubation in 60 ASA Grade I and II patients to assess the effects of diltiazem (0.2 mg kg-1), verapamil (0.05 mg kg-1) and metoprolol (0.02 mg kg-1) given as a bolus 2 min before tracheal extubation. All the haemodynamic variables measured increased significantly after extubation in the control and diltiazem groups when compared with the base-line recordings (P < 0.05). Metoprolol effectively blocked the increases in heart rate after extubation and the increase in blood pressure in this group was less when compared with the control group (P < 0.05). Verapamil alleviated the increase in both heart rate and blood pressure. However, profound hypotension and bradycardia requiring therapy, occurred in the verapamil group. For this reason, careful observation is necessary when using verapamil and the routine use of this drug in patients with coronary artery disease requires further studies.

The use of esmolol to attenuate the haemodynamic response when extubating patients following cardiac surgery--a double-blind controlled study.

We have assessed the cardiovascular changes associated with emergence from anaesthesia, reversal of neuromuscular blockade and extubation in a group of 14 patients immediately after coronary artery bypass graft surgery had been completed. Patients were randomly allocated to receive either esmolol 500 micrograms.kg-1 over 1 min followed by 100 micrograms.kg-1.min-1 or placebo starting prior to reversal. Significant hypertension and tachycardia occurred in the placebo group, whilst these changes were prevented by the administration of esmolol.

A case of acute poisoning due to organophosphate insecticide.

A case of acute severe organophosphate poisoning by deliberate self administration is reported. The patient required intensive therapy for 30 days. Unusual features of the case were the avoidance of atropine, because of the high risk of ventricular fibrillation, and the ineffectiveness of pralidoxime.