Diclofenac Consumption Research Articles

Clinical Study Evaluating Pregabalin Efficacy and Tolerability for Pain Management in Patients Undergoing Laparoscopic Cholecystectomy

To evaluate the efficacy and tolerability of pregabalin in postoperative pain management after laparoscopic cholecystectomy (LC). A prospective, randomized, placebo, controlled, double-blinded study was conducted at Anesthesia Department, Laparoscopy Surgery Unit, Ain Shams University Hospital. Ninety patients with ASA physical status I-II scheduled for elective LC under general anesthesia were included. Patients were randomly assigned to the following groups (n=30 each): pregabalin group (P), received 150 mg pregabalin capsules 2 hours preoperatively, 12 hours postoperatively, and twice daily for 2 days; gabapentin group (G), received 1200 mg gabapentin capsules (400 mg, ×3) 2 hours preoperatively, 12 hours postoperatively, and 400 mg three times daily for 2 days; and control group (C), received placebo capsules. Postoperative pain scores were recorded on a visual analogue scale. The following data were recorded: total daily pethidine and diclofenac consumption, numeric sedation score, and the postoperative nausea, vomiting, and dizziness scores. The 24-hour pethidine consumption was significantly lower (P<0.001) in both pregabalin and gabapentin groups versus control. Both groups had significantly less (P<0.001) patients with postoperative nausea, vomiting, sedation, and dizziness versus control. Overall patient satisfaction with pain management was significantly higher (P<0.001) in pregabalin group versus gabapentin or control groups. Gabapentin 1200 mg and pregabalin 150 mg are effective and safe analgesics for reducing postoperative pain in LC. The perioperative oral administration of pregabalin 150 mg in patients undergoing LC is an effective and safe method of analgesia with a low incidence of adverse effects and reduces postoperative pethidine consumption.

Bupivacaine-soaked absorbable gelatin sponges in caesarean section wounds: effect on postoperative pain, analgesic requirement and haemodynamic profile

BackgroundPain is a common distressing adverse effect in the early postoperative period following caesarean section. The aim of this study was to investigate the effect on postoperative pain, analgesic requirement and haemodynamic profile of placing a suprafacial bupivacaine-soaked absorbable gelatin sponge in the caesarean section wound. MethodsA total of 164 healthy patients scheduled to undergo general anaesthesia for elective caesarean section were randomised to a study group (n=81) or a control group (n=83). In the study group, a bupivacaine-soaked absorbable gelatin sponge was placed subcutaneously in the caesarean section wound. Intramuscular diclofenac 75mg was given to all patients at 8-h intervals during the first 24h. Postoperatively, visual analogue scale pain scores, requirement for pethidine and diclofenac and changes in blood pressure and heart rate were compared between groups. ResultsPain scores were lower in the study group compared to the control group at all assessments (P<0.001). During the first eight hours after surgery, fewer patients in the study group required rescue pethidine compared with the control group (4 vs. 33, P<0.001). In the study group, total opioid and diclofenac consumption was lower (P<0.001), and blood pressure and heart rate were lower (P<0.001) compared to the control group. ConclusionSuprafascial wound placement of a bupivacaine-soaked absorbable gelatin sponge improved postoperative analgesia and decreased opioid consumption following caesarean section.

Estudio comparativo, aleatorizado y doble ciego, de la petidina y del ketoprofeno como adyuvantes de la lidocaína en la anestesia regional intravenosa

Background and objectivesA review of all the adjuncts for intravenous regional anaesthesia concluded that there is good evidence to recommend NonSteroidal Anti-Inflammatory agents and pethidine in the dose of 30mg dose as adjuncts to intravenous regional anaesthesia. But there are no studies to compare pethidine of 30mg dose to any of the NonSteroidal Anti-Inflammatory agents. MethodsIn a prospective, randomized, double blind study, 45 patients were given intravenous regional anaesthesia with either lignocaine alone or lignocaine with pethidine 30mg or lignocaine with ketprofen 100mg. Fentanyl was used as rescue analgesic during surgery. For the first 6h of postoperative period analgesia was provided by fentanyl injection and between 6 and 24h analgesia was provided by diclofenac tablets. Visual analogue scores for pain and consumption of fentanyl and diclofenac were compared. ResultsThe block was inadequate for one case each in lignocaine group and pethidine group, so general anaesthesia was provided. Time for the first dose of fentanyl required for postoperative analgesia was significantly more in pethidine and ketoprofen groups compared to lignocaine group (156.7±148.8 and 153.0±106.0 vs. 52.1±52.4min respectively). Total fentanyl consumption in first 6h of postoperative period was less in pethidine and ketoprofen groups compared to lignocaine group (37.5±29.0mcg, 38.3±20.8mcg vs. 64.2±27.2mcg respectively). Consumption of diclofenac tablets was 2.4±0.7, 2.5±0.5 and 2.0±0.7 in the control, pethidine and ketoprofen group respectively, which was statistically not significant. Side effects were not significantly different between the groups. ConclusionBoth pethidine and ketoprofen are equally effective in providing postoperative analgesia up to 6h, without significant difference in the side effects and none of the adjuncts provide significant analgesia after 6h.

Estudo comparativo, randômico e duplo‐cego de petidina e cetoprofeno como adjuvantes de lidocaína em anestesia regional intravenosa

Background and objectivesA review of all the adjuncts for intravenous regional anaesthesia concluded that there is good evidence to recommend NonSteroidal Anti‐Inflammatory agents and pethidine in the dose of 30mg dose as adjuncts to intravenous regional anaesthesia. But there are no studies to compare pethidine of 30mg dose to any of the NonSteroidal Anti‐Inflammatory agents. MethodsIn a prospective, randomized, double blind study, 45 patients were given intravenous regional anaesthesia with either lignocaine alone or lignocaine with pethidine 30mg or lignocaine with ketprofen 100mg. Fentanyl was used as rescue analgesic during surgery. For the first 6h of postoperative period analgesia was provided by fentanyl injection and between 6 and 24h analgesia was provided by diclofenac tablets. Visual analogue scores for pain and consumption of fentanyl and diclofenac were compared. ResultsThe block was inadequate for one case each in lignocaine group and pethidine group, so general anaesthesia was provided. Time for the first dose of fentanyl required for postoperative analgesia was significantly more in pethidine and ketoprofen groups compared to lignocaine group (156.7±148.8 and 153.0±106.0 vs. 52.1±52.4min respectively). Total fentanyl consumption in first 6 h of postoperative period was less in pethidine and ketoprofen groups compared to lignocaine group (37.5±29.0 mcg, 38.3±20.8mcg vs. 64.2±27.2mcg respectively). Consumption of diclofenac tablets was 2.4±0.7, 2.5±0.5 and 2.0±0.7 in the control, pethidine and ketoprofen group respectively, which was statistically not significant. Side effects were not significantly different between the groups. ConclusionBoth pethidine and ketoprofen are equally effective in providing postoperative analgesia up to 6h, without significant difference in the side effects and none of the adjuncts provide significant analgesia after 6h.

Efficacy of ketamine as an adjunct to lidocaine in intravenous regional anesthesia.

This study aims to compare and evaluate the effect of adding ketamine as an adjunct to lidocaine for intravenous regional anesthesia (IVRA) on intraoperative and postoperative analgesia, the onset and recovery times of sensory and motor block, and tourniquet pain. Forty patients undergoing surgery of the hand or forearm under IVRA were randomly assigned to receive lidocaine 3 mg/kg (group 1) or lidocaine 3 mg/kg plus ketamine 50 mg (group 2) diluted to 40 mL with normal saline. Assessment parameters included the onset and recovery times of sensory and motor block, tourniquet pain, intraoperative hemodynamics, surgeon and patient satisfaction, postoperative pain, time of first analgesic request, total analgesic consumption, and adverse effects in the first 24 hours postoperatively. Groups 1 and 2 were comparable in demographic and surgical parameters. There were no differences between groups in intraoperative hemodynamics, onset and recovery times of sensory and motor block, or surgeon satisfaction index. Compared with group 1, group 2 patients showed less tourniquet pain, prolonged time to first request for postoperative rescue analgesia (5.5 ± 1.3 vs 20.4 ± 3.7 hours, P < 0.001), lower postoperative diclofenac consumption (120.00 ± 45.23 vs 55.1 ± 0.00 mg, P < 0.001), lower scores for postoperative pain as measured by the Verbal Rating Scale, higher patient satisfaction index, and a nonsignificant difference in the incidence of postoperative adverse effects between groups. The addition of ketamine to lidocaine in patients receiving IVRA significantly reduced intraoperative and postoperative analgesic requirements and improved patient satisfaction without causing significant adverse effects.

Preemptive analgesic efficacy of gabapentin and nimesulide in the functional endoscopic sinus surgery

Preemptive analgesia is an important factor in controlling the postoperative pain and avoiding the stress response caused by the surgery. We aim to compare impact of gabapentin and nimesulide on postoperative analgesic consumption on the visual analog scale (VAS) as well as any potential side effects, to those of the placebo group. Ninety patients aged 18-70 under ASA I-II risk, who were to undergo Functional Endoscopic Sinus Surgery (FESS), were included in the study. Patients were randomized into three groups. One hour before the surgery, oral placebo capsules were administered to Group I patients, Gabapentin 1200 mg to Group II patients and Nimesulide 100 mg to Group III patients. Perioperative hemodynamic parameters were measured for all patients. During the first 24 hours of the postoperative period, side effects such as nausea, vomiting, hypotension, hypertension, bradycardia, tachycardia were noted, and the time from end of the surgery to the first diclofenac need was recorded in addition to VAS scores. In all of the follow-ups for 24 hours of the postoperative period, time from end of the surgery until the first diclofenac requirement; Group 2 > Group 3 > Group 1. Total diclofenac consumption of group 2 was found to be significantly lower than Group 1 and Group 3 on a statistical basis. Postoperative VAS score in Group 2 was lower than Group 1 and Group 3. To conclude, we believe that gabapentin or nimesulide may be safely used preemptively for the purposes of postoperative analgesia after FESS procedures.

Increased cartilage volume after injection of hyaluronic acid in osteoarthritis knee patients who underwent high tibial osteotomy

PurposeHigh tibial osteotomy (HTO) is a surgical procedure used to correct abnormal mechanical loading of the knee joint; additionally, intra-articular hyaluronic acid injections have been shown to restore the viscoelastic properties of synovial fluid and balance abnormal biochemical processes. It was hypothesized that combining HTO with intra-articular hyaluronic acid injections would have benefit to improve the cartilage volume of knee joints.MethodsForty patients with medial compartment knee osteoarthritis (OA) were randomly placed into 1 of 2 groups. The study group (n = 20) received 2 cycles (at 6-month intervals) of 5 weekly intra-articular hyaluronic acid injections after HTO operation. The control group (n = 20) did not receive any intra-articular injections after HTO surgery. Cartilage volume (primary outcome) was assessed by magnetic resonance imaging (MRI) pre-operatively and 1 year post-operatively. Treatment efficacy (secondary outcomes) was evaluated with the Western Ontario and McMaster Universities OA Index (WOMAC) and by the comparison of the total rescue medication (paracetamol/diclofenac) used (weeks 6, 12, 24, 48).ResultsMRI studies showed a significant increase in total cartilage volume (p = 0.033), lateral femoral cartilage volume (p = 0.044) and lateral tibial cartilage volume (p = 0.027) in the study group. Cartilage volume loss was detected at the lateral tibial plateau in the control group. There were significant improvements after surgery in both groups for all subscales of WOMAC scores (p < 0.001) compared to the baseline. However, no difference was found between the two groups. The study group had significantly lower amounts of diclofenac consumption (p = 0.017).ConclusionBased on the findings of the present study, intra-articular hyaluronic acid injections may be beneficial for increasing total cartilage volume and preventing the loss of lateral tibiofemoral joint cartilage after HTO.Level of evidenceTherapeutic study, Level I.

A randomized, double blind comparison of pethidine and ketoprofen as adjuvants for lignocaine in intravenous regional anaesthesia

Background and objectivesA review of all the adjuncts for intravenous regional anaesthesia concluded that there is good evidence to recommend NonSteroidal Anti-Inflammatory agents and pethidine in the dose of 30mg dose as adjuncts to intravenous regional anaesthesia. But there are no studies to compare pethidine of 30mg dose to any of the NonSteroidal Anti-Inflammatory agents. MethodsIn a prospective, randomized, double blind study, 45 patients were given intravenous regional anaesthesia with either lignocaine alone or lignocaine with pethidine 30mg or lignocaine with ketprofen 100mg. Fentanyl was used as rescue analgesic during surgery. For the first 6h of postoperative period analgesia was provided by fentanyl injection and between 6 and 24h analgesia was provided by diclofenac tablets. Visual analogue scores for pain and consumption of fentanyl and diclofenac were compared. ResultsThe block was inadequate for one case each in lignocaine group and pethidine group, so general anaesthesia was provided. Time for the first dose of fentanyl required for postoperative analgesia was significantly more in pethidine and ketoprofen groups compared to lignocaine group (156.7±148.8 and 153.0±106.0 vs. 52.1±52.4min respectively). Total fentanyl consumption in first 6h of postoperative period was less in pethidine and ketoprofen groups compared to lignocaine group (37.5±29.0mcg, 38.3±20.8mcg vs. 64.2±27.2mcg respectively). Consumption of diclofenac tablets was 2.4±0.7, 2.5±0.5 and 2.0±0.7 in the control, pethidine and ketoprofen group respectively, which was statistically not significant. Side effects were not significantly different between the groups. ConclusionBoth pethidine and ketoprofen are equally effective in providing postoperative analgesia up to 6h, without significant difference in the side effects and none of the adjuncts provide significant analgesia after 6h.

English

Introduction Surgical procedures have been improved to reduce trauma, morbidity, mortality and hospital stay, with consequent reduction in healthcare costs. Patients undergoing laparoscopic procedures do experience postoperative pain, especially in upper and lower abdomen and back and shoulder regions. Intraperitoneal injections of local anaesthetic have been proposed to minimize postoperative pain after laparoscopic surgery. Therefore, this randomized, placebocontrolled study was conducted to compare the effectiveness of intraperitoneal ropivacaine with or without fentanyl for postoperative analgesia after laparoscopic surgery. Materials and methods Patients were randomized into three groups (n = 50) using a computergenerated table of random numbers. All surgeries were carried out under general anaesthesia, and patients were instructed preoperatively about grading the intensity of pain in the postoperative period as per visual analogue scale and verbal rating scale. The drug was injected intraperitoneally before the removal of trocar at the end of surgery. Results Visual analogue scale scores immediately postoperatively were 44.00 ± 19.16 (vs 22.20 ± 5.06 vs 23.20 ± 8.67; p < 0.001) and at 6th hour 35.40 ± 9.52 (vs 29.40 ± 4.24 vs 27.80 ± 5.0; p < 0.001). Similarly, verbal rating scale score (2.60 ± 0.88 vs 1.96 ± 0.74 vs 1.62 ± 0.56) was signiϐicantly reduced immediately postoperatively in Group 3. At the 6th hour verbal rating scale scores were 2.32 ± 0.79 vs 1.94 ± 0.42 vs 1.80 ± 0.49, which showed signiϐicantly less pain in patients receiving ropivacaine with fentanyl. Total analgesic consumption was also signiϐicantly lower in Group 3 patients (p < 0.001) in comparison to Group 1 and Group 2. In Group 1, the total analgesic (diclofenac) consumption was 149 ± 42 mg; in Group 2, 97 ± 47 mg; and in Group 3, 84 ± 25 mg. Conclusion Intraperitoneal instillation of ropivacaine with fentanyl reduces not only the intensity of visceral, parietal and shoulder pain but also the total rescue analgesic dose consumption.

The conservation of Accipitridae vultures of Nepal: a review

Of the nine Accipitridae vulture species found within Nepal the IUCN categorises White-rumped, Indian Vulture, Slender-billed and Red-headed Vultures as Critically Endangered and Egyptian Vulture as Endangered. Dramatic declines have occurred since the mid 1990s with the White-rumped Vulture, Indian Vulture and Slender-billed Vulture population declining by over 97%. The remaining species are listed as Near Threatened or Least Concern. Veterinary use of the non-steroidal anti-inflammatory drug (NSAID) diclofenac has been proven to be a key threat in the region for Gyps vultures and appears likely that it may also affect other Accipitridae vultures. The drug is transferred to vultures via consumption of dead livestock carcass. Ingestion of the drug causes visceral gout and kidney failure, which leads to the birds death. Consumption of diclofenac and the majority of other non-steroidal anti-inflammatory drugs are fatal to individuals. Only one NSAID, meloxicam, has been tested and proven safe for vultures. There are other factors such as food shortage in local scale, habitat loss, climate change and pesticides/poisoning that play some role on population decline. Managing vulture conservation across Nepal can be problematic just as it is throughout the Indian subcontinent due to the variable level of protection afforded to vultures through legislation and enforcement in each political region particularly regarding NSAID regulation and use. However, great gains have been made on removing diclofenac from sale within the Indian subcontinent. Continuing and enhancing the holistic conservation approach between all stakeholders, government and non-government organisations, across the species range is required to conserve them for future generations. Indeed, it is likely that a number of species will become extinct if a greater conservation effort is not forthcoming in the very near future.

Comparison of paravertebral and interpleural block in patients undergoing modified radical mastectomy

Background:Paravertebral and inter pleural blocks (IPB) reduce post-operative pain and decrease the effect of post-operative pain on lung functions after breast surgery. This study was designed to determine their effect on lung functions and post-operative pain in patients undergoing modified radical mastectomy.Materials and Methods:A total of 120 American Society of Anesthesiologists physical status 1 and 2 patients scheduled to undergo breast surgery were randomly allocated to receive IPB (Group IPB, n = 60) or paravertebral block (PVB) (Group PVB, n = 60) with 20 ml of 0.5% bupivacaine pre-operatively. A standard protocol was used to provide general anesthesia. Lung function tests, visual analog scale (VAS) for pain at rest and movement, analgesic consumption were recorded everyday post-operatively until discharge.Results:Lung functions decreased on 1st post-operative day and returned to baseline value by 4th post-operative day in both groups. VAS was similar in both groups. There was no significant difference in the consumption of opioids and diclofenac in both groups. Complete block was achieved in 48 patients (80%) in paravertebral group and 42 patients (70%) in inter pleural group.Conclusion:To conclude, lung functions are well-preserved in patients undergoing modified radical mastectomy under general anesthesia supplemented with paravertebral or IPB. IPB is as effective as PVB for post-operative pain relief. PVB has the added advantage of achieving a more complete block.

Preincisional peritonsillar vs. intravenous lornoxicam for posttonsillectomy analgesia: A clinical and platelet aggregometry comparative study

BackgroundLornoxicam is a fairly new short-half oxicam with an improved tolerability profile. Our objective was to investigate the safety and efficacy of intravenous and peritonsillar infiltration of 8 mg lornoxicam on pain relief in children undergoing tonsillectomy.MethodsIn a double-blinded, placebo-controlled trial, 60 children were randomized into three groups; intravenous group (n = 20), received lornoxicam 8 mg iv., infiltration group (n = 20) received lornoxicam 8 mg peritonsillar infiltration, and placebo controls (n = 20). The verbal rating pain scale, time to first postoperative analgesic request, total analgesic consumption during 1st 24 h postoperative, platelet aggregometry before, 15 min, 2 and 24 h after study drug administration, intraoperative blood loss, postoperative bleeding, and adverse effects were evaluated.ResultsThe time to first postoperative analgesic request was significantly prolonged in intravenous (318.75 ± 67.37 min) and infiltration (214.50 ± 43.06 min) groups compared with placebo group (66.75 ± 26.95 min). A significantly lower mean postoperative VRS scores and significantly reduced 1st day postoperative diclofenac consumption were recorded in iv. group (44.73 ± 9.31 mg), compared with infiltration (69.80 ± 38.71 mg) and placebo (87.8 ± 24.40 mg) groups. An increased intraoperative blood volume losses and intraoperative bleeding complains were observed in infiltration group (34.25 ± 11.93 ml), rather than in iv. (28.85 ± 10.01 ml) and placebo (24.75 ± 8.70 ml) groups. The (%) of platelet aggregation with ADP, collagen, and arachidonic acid was significantly reduced 15 min and 2 h after study drug administration with highest decreases in iv. group compared with infiltration and placebo groups. No patients reported postoperative bleeding or GIT adverse effects in the study.ConclusionIntraoperative preincisional intravenous lornoxicam enhanced postoperative analgesia after tonsillectomy in children. In comparison, the analgesic efficacy of locally applied lornoxicam was inferior to intravenous administration and was associated with increased incidence of intraoperative bleeding.

Examining the cytokine profiles of whole blood and autologous protein solution of patients with osteoarthritis: preliminary results

surgery) and total used of rescue medication (acetaminophen/diclofenac). Cartilage volume measurements were assessed by Magnetic Resonance Imaging (MRI) at preoperative period and 1 year after operation. Results: All patients completed 1 year of study period. After the surgery, all subscales of WOMAC scores in both groups were significantly improved (p<0.001) when compare to baseline levels. However, there were no differences between the two groups. Patients who received intra-articular hyaluronic acid injections had significantly reduce the amount of diclofenac consumption (p¼0.017). MRI studies showed significantly increase of the total cartilage volume (p¼0.033), lateral femoral volume (p¼0.044) and lateral tibial volume (p¼0.027) in the study group compared to the control group. In addition, loss of lateral tibial plateau cartilage volume was showed only in the control group. There were no severe adverse events in both groups. Conclusion: This study demonstrated positive synergistic effect for using continuous intra-articular hyaluronic acid injection in patients with osteoarthritis of the knee who underwent high tibial osteotomy. Base on our finding, intra-articular hyaluronic acid may beneficial to increased total cartilage volume and prevented the loss of cartilage at lateral tibiofemoral joint after high tibial osteotomy. Further long term studies with larger number of patients are warranted.

Intrapleural Analgesia Using Ropivacaine for Postoperative Pain Relief after Minimally Invasive Thoracoscopic Surgery

to evaluate the efficacy and safety of intrapleural analgesia (IPA) using ropivacaine after thoracoscopic surgery, compared with thoracic epidural analgesia (TEA) using ropivacaine. forty patients undergoing thoracoscopic bullectomy for spontaneous pneumothorax were randomly assigned to one of two groups. IPA group (n = 20) received intermittent bolus injection of 0.375% ropivacaine into intrapleural space two times; at the end of operation and one more time as the pain increased. TEA group (n = 20) received continuous epidural analgesia with 0.375% ropivacaine. Transrectal diclofenac was administered as an additional analgesic. Pain was assessed on the basis of additional analgesics requirements and by using a visual analog scale (VAS). the time courses of VAS scores along the postoperative time course were not significantly different (p = 0.175). Consumption of transrectal diclofenac was significantly smaller in IPA group (p = 0.025). No major complications appeared in both groups, and incidence of adverse symptoms was not different. in IPA group, pain was managed with less consumption of additional analgesics. IPA could be one of the good choices after thoracoscopic surgery for its efficacy, safety, and benefit of easy placement of the catheter.

The efficacy of 0.75% levobupivacaine versus 0.75% ropivacaine for peribulbar anesthesia in vitreoretinal surgery.

Background:We evaluated the anesthetic efficacy and the postoperative analgesic effects of 0.75% levobupivacaine versus 0.75% ropivacaine for peribulbar anesthesia in patients undergoing primary vitreoretinal surgery.Methods:We investigated 120 patients subjected to vitreoretinal surgery under peribulbar anesthesia. They were randomized into two equal groups according to the local anesthetic (LA) used, namely, 0.75% levobupivacaine or 0.75% ropivacaine, both with the addition of hyaluronidase. Nerve block was carried out by injection of 5–7 mL of the LA using single injection percutaneous peribulbar anesthesia with a short needle.Results:When compared with 0.75% ropivacaine, 0.75% levobupivacaine provided more successful akinesia at 10 min after block (P=0.026), fewer supplementary injections (P=0.026), and less volume (mL) was used (P=0.031). Also, levobupivacaine provided significantly longer motor block duration (342±27 min versus 206±40 min, P=0.001) and significantly longer sensory block duration (513±24 min versus 394±11 min, P=0.001) when compared with ropivacaine. In the postoperative period, the patients in the levobupivacaine group achieved lower values of verbal numeric rating scale of pain compared with patients in the ropivacaine group among the period from 4 to 12 h. Also, there were significantly (P=0.001) lower diclofenac consumption (mg) and the percentage of patients who required tramadol rescue medication were significantly less (P=0.034) in the levobupivacaine group compared with the ropivacaine group.Conclusion:We are concluding that, at equipotent doses and concentrations, 0.75% levobupivacaine provides more effective peribulbar anesthesia and more effective postoperative analgesia for vitreoretinal surgery compared with 0.75% ropivacaine.

A randomized controlled trial to compare pregabalin with gabapentin for postoperative pain in abdominal hysterectomy

Background:Pregabalin is a potent ligand for alpha-2-delta subunit of voltage-gated calcium channels in the central nervous system, which exhibits potent anticonvulsant, analgesic and anxiolytic activity. The pharmacological activity of pregabalin is similar to that of gabapentin and shows possible advantages. Although it shows analgesic efficacy against neuropathic pain, very limited evidence supports its postoperative analgesic efficacy. We investigated its analgesic efficacy in patients experiencing acute pain after abdominal hysterectomy and compared it with gabapentin and placebo.Methods:A randomized, double-blind, placebo-controlled study was conducted in 90 women undergoing abdominal hysterectomy who were anaesthetized in a standardized fashion. Patients received 300 mg pregabalin, 900 mg gabapentin or placebo, 1–2 hours prior to surgery. Postoperative analgesia was administered at visual analogue scale (VAS) ≥3. The primary outcome was analgesic consumption over 24 hours and patients were followed for pain scores, time to rescue analgesia and side effects as secondary outcomes.Results:The diclofenac consumption was statistically significant between pregabalin and control groups, and gabapentin and control groups; however, pregabalin and gabapentin groups were comparable. Moreover, the consumption of tramadol was statistically significant among all the groups. Patients in pregabalin and gabapentin groups had lower pain scores in the initial hour of recovery. However, pain scores were subsequently similar in all the groups. Time to first request for analgesia was longer in pregabalin group followed by gabapentin and control groups.Conclusion:A single dose of 300 mg pregabalin given 1–2 hours prior to surgery is superior to 900 mg gabapentin and placebo after abdominal hysterectomy. Both the drugs are better than placebo.

Consumption of non-steroidal anti-inflammatory drugs in Serbia: a comparison with Croatia and Denmark during 2005–2008

To analyze the amount and pattern of use of non-steroidal anti-inflammatory drugs (NSAIDs) in Serbia and to compare these parameters with those in Croatia and Denmark. The prescribing pattern of NSAIDs in Serbia as a direct indicator of physicians' knowledge of these agents was also assessed. The use of NSAIDs in Serbia, Croatia, and Denmark was analyzed during a 4-year period (2005-2008). Data were retrieved from the annual reports of the Agency for Drugs and Medical Devices of Serbia, Croatia, and Denmark. Data on prescribing behavior were obtained from the Health Insurance Fund of Serbia and represent NSAIDs issued by prescription between 2005 and 2008. Results were expressed as the number of defined daily doses/1000 inhabitants/day. The drug utilization 90% method was also used. The total consumption of NSAIDs in Serbia was higher than that in Croatia and Denmark. Diclofenac accounted for approximately 50% of NSAID consumption during the observation period, followed (in much smaller quantities) by ibuprofen. The most commonly prescribed medicine was diclofenac, followed, in much smaller amounts, by ibuprofen. There was no trend of a reduced consumption of diclofenac or of an increased use of ibuprofen during the study period These data suggest that factors other than evidence-based medicine have a dominant effect on the use of NSAIDs in Serbia. Targeted education from independent sources in the prescribing, dispensing, and use of drugs is important to improve the quality of the prescribing behavior and the use of NSAIDs.

Ondansetron added to lidocaine for intravenous regional anaesthesia

The aim of this study was to evaluate the effect of ondansetron when added to lidocaine for intravenous regional anaesthesia (IVRA). Thirty patients undergoing hand surgery were randomly assigned to two groups. IVRA was achieved with 3 mg kg lidocaine 2% w/v diluted with saline to a total volume of 40 ml in the control group or with 4 mg ondansetron 2 mg ml plus 3 mg kg lidocaine 2% w/v diluted with saline to a total volume of 40 ml in the ondansetron group. Sensory and motor block onset and recovery times, tourniquet pain score according to a visual analogue scale (VAS), intraoperative analgesic requirements and anaesthesia quality were recorded. Postoperative VAS pain score, time to first analgesic requirements and total diclofenac consumption in the first 24 h were noted. Onset times were slightly but significantly shorter [1.4 min (95% confidence interval (CI) 0.5-2.3) and 1.5 min (95% CI 0.45-2.55)] and recovery times were slightly but significantly prolonged [2.6 min (95% CI 1.66-3.54) and 2.8 min (95% CI 1.83-3.78)] in patients receiving ondansetron. Tourniquet pain scores according to the VAS were slightly but significantly lower at 10, 15, 20 and 30 min, the time to intraoperative analgesic rescue was prolonged (35.0 +/- 7.1 min vs. 18.9 +/- 8.9 min, P = 0.043), a significantly lower number of patients (2 vs. 9) required additional analgesic and significantly less supplemental fentanyl was given [0 microg (0-0) vs. 59 microg (0-76), P = 0.015] in the ondansetron group. First intake of analgesic intake was longer (172 +/- 51 vs. 85 +/- 35 min, P = 0.0001), number of patients (7 vs. 15) requiring postoperative diclofenac was significantly lower and diclofenac requirements [0 mg (0-75) vs. 75 mg (75-150), P = 0.002) was significantly lower in the ondansetron group. Postoperative VAS scores were lower for the first 4 h in the ondansetron group. Addition of ondansetron to lidocaine may improve the quality of IVRA and prolong postoperative analgesia in patients undergoing hand surgery.

Melatonin Improves Tourniquet Tolerance and Enhances Postoperative Analgesia in Patients Receiving Intravenous Regional Anesthesia

Melatonin has anxiolytic and potential analgesic effects. We assessed the efficacy of melatonin premedication in reducing tourniquet-related pain and improving analgesia in patients receiving IV regional anesthesia (IVRA). Forty patients undergoing elective hand surgery under IVRA were randomly assigned into two groups (20 patients each) to receive either melatonin 10 mg (melatonin group) or placebo (control group) as oral premedication. IVRA was achieved with lidocaine, 3 mg/kg, diluted with saline to a total volume of 40 mL. Anxiety scores, hemodynamic changes, sensory and motor block onset and recovery times, tourniquet pain, the quality of intraoperative anesthesia, time to first analgesic request, and 24 h analgesic requirements were recorded. After premedication, the anxiety scores were significantly reduced in the melatonin group (P=0.023). During surgery, patients who received melatonin premedication had better tourniquet tolerance (lower verbal pain scores at 30, 40, and 50 min after tourniquet inflation, P<0.05), lower rescue fentanyl requirements (15.6+/-21.9 vs 45.7+/-33.4 microg, P=0.002), longer time to the first postoperative analgesic request (145.4+/-20.2 min vs 74.6+/-12.8, P<0.001) and lower postoperative diclofenac consumption at 24 h (86.3+/-27.5 mg vs 116.3+/-38.3 mg, P=0.007) compared with the control group. Melatonin is an effective premedication before IVRA since it reduced patient anxiety, decreased tourniquet-related pain, and improved perioperative analgesia.

Post-herniorrhapy infiltration of tramadol versus bupivacaine for postoperative pain relief: a randomized study.

BACKGROUND AND OBJECTIVESInguinal hernia repair is frequently associated with persistent postoperative discomfort and pain and late discharge from the hospital. We evaluated the postoperative analgesic effect of local wound infiltration with tramadol following herniorrhaphy among adult patients.PATIENTS AND METHODSForty-three adult male patients were randomly assigned to two groups; group T (n=23) received tramadol 1 mg/kg in 10 mL 0.9% normal saline and group B (n=20) received 10 mL of 0.25% bupivacaine, both as a local wound infiltration prior to skin closure. Postoperatively, pain severity, time to first analgesic requirement, analgesic consumption, and incidence of side effects were recorded.RESULTSDuring the first postoperative day, there was a significant difference between the two groups in the recorded visual analog scale rating higher in group B (P<.05) and the time to first analgesic requirement (6.6±0.99 hours in group B vs 3.7±0.74 hours in group T; P<.05). There was no difference in the incidence of side effects among the two groups. Postoperative consumption of fentanyl and diclofenac was higher in group B than group T (65% vs 18% and 80% vs 21.7%, respectively, P≤.005).CONCLUSIONSLocally infiltrated tramadol prior to herniorrhaphy wound closure provides better pain relief compared to bupivacaine in adult patients.