Pre emptive use of Gabapentine for Reducing Early Post operative Pain and Analgesic Requirement in Laparoscopic Cholecystectomy
Keywords:Pain, Peripheral sensitization, Central sensitization, Hypersensitivity, Preemptive analgesia, Gabapentin, Hyperalgesia, Laparoscopic cholecystectomy, Pethidine, Numerical pain score
Background: Pain,the oldest symptoms of human existance,is thought to be inadequetly treated in most of the surgical patients. Surgical stimulation leads to peripheral sensitization(a reduction in the threshold of nociceptor afferent peripheral terminals) and central sensitization (an activity dependent increase in the excitability of spinal neurons) Prevention and treatment of postoperative pain is a major challenge in postoperative care and plays an important role in the early mobilization and well-being of the surgical patient.The optimal form of treatment is that applied pre,intra and postoperatively to preempt the establishment of pain hypersensitivity during and after surgery. Gabapentin, an anti-epileptic drug that has demonstrated analgesic effect in diabetic neuropathy, post-herpetic neuralgia and neuropathic pain, has shown anti-hyperalgesic properties, possibly by reducing central sensitization. Use of Gabapentin has more recently extended into the management of more acute conditions, particularly in the perioperative pain. Objective: To study the efficacy of gabapentin used preemptively for reduction of early post operative pain & analgesics requirement in laparoscopic cholecystectomy patients. Materials & Methods: A prospective randomised control trial was done in Department of Surgery,TUTH, on 121 consecutive patient selected for laparoscopic cholecystectomy.All patients were randomised into two groups. Study group (N=60) was given gabapentine 300mg orally 2 hrs before surgery and to control group (N=58) no preoperative drugs was given. All procedures were performed under general anesthesia. As a post operative analgesics both group were given inj. pethidine 1mg/kg/dose I.M. as when pain score 4 or more and on demand basis. Post-operative pain score was monitored by using numerical pain score, 0-10; 0= no pain, 10= worst possible pain. Pain score was taken at different time interval 2 hourly for 1st 6 hoursthen 6 hrly upto 24 hrs.Adverse effects of drugs were recorded in both groups. Results: Patients in gabapentine group had significantly lower pain scores (2.40±0.78, 2.91±1.14, 3.58±1.21, 3.58±1.11,2.13±0.85) in comparison to no preemptive drug group (5.33±1.77, 4.12±1.85, 5.28±1.25, 4.67±1.33, 3.45±1.11) at all time interval (0 hr,0 6hr,6 12hr,12 18hr.18 24hr).The requirement of pethidine also significantly less in study group (115±26.52 mg) compare to control group (198±31.21 mg) p<0.05. It was seen that Nausea, Vomiting and Retching were more in control group 36% (n=21) than in study group 31% (n=19). But dizziness and sedation were more common in study group 27% (n=16) than control group 20% (n=12). Conclusion: Preemptive use of gabapentine significantly decreases post operative pain and pethidine requirement in laparoscopic cholecystectomy without any significant adverse effect.
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Copyright (c) 2021 Prabal Karmahapatra, Charanjeet Rai, Mrinalkanti Karmakar, Sukanta Sen, Ramesh Sahu
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