The Effect Of Preemptive The Effect Of Preemptive Gabapentin On Postoperative Pain Gabapentin On Postoperative Pain And Opioid Requirement Following And Opioid Requirement Following Head And Neck SurgeriesHead And Neck Surgeries

Dr Nikhil M P Dr N R Bhat Dr Prashanth mallya Dr Ambareesha M

Introduction 1*Introduction 1*Postoperative pain is an acute

pain which begins with surgical trauma and ends with tissue healing

Introduction cont….2*Introduction cont….2*Importance of treating

postoperative pain adequately…..?????

Introduction cont…3*Introduction cont…3*

Role of anaesthesiologist ?

Preemptive analgesia 4*Preemptive analgesia 4*

An analgesic treatment given before the nociceptive stimuli reach the CNS,could prevent or reduce the subsequent pain.

Gabapentin 5* Gabapentin 5*

Possess antihyperalgesic and antiallodynia properties.

Aim 6*Aim 6*

To evaluate the effect of preemptive gabapentin on postoperative pain and opioid requirement following head and neck surgeries.

Materials and methods 7*Materials and methods 7*60 ASA grade I and II patients

were included in the study.18 to 60 years.2 groups Gabapentin group. Control group.Approval of institutional ethics

committee.

Materials and methods Materials and methods cont….8*cont….8*Informed and written consent.

Exclusion criteria.

Materials and methods Materials and methods cont….9*cont….9*Gabapentin 300 mg.

B- complex capsule.

Diazepam 0.2 mg/kg.

Materials and methods Materials and methods cont….10*cont….10*Standard anaesthesia monitors.Inj.pethidine 1 mg/kg IV.Propofol.Pancuronium.IntubationMaintanence

Materials and methods Materials and methods cont….11*cont….11*In PACU Pain scores assessed using

VAS hourly for 24 hours & average pain scores in 6th hourly intervals noted.

Inj.pethidine 1 mg/kg IM when pain score 4 or more and total pethidine requirement noted.

Materials and methods Materials and methods cont….12*cont….12*HR,SBP,DBP.

Nausea and vomiting.

Observation and results Observation and results 13*13*Quantitative data –Students

unpaired t-test

Qualitative data - Chi square test

Inter group comparison of pethidine using - Mann-whitney u test.

Intergroup comparison of pain scores Intergroup comparison of pain scores postoperatively for 24 hours following postoperatively for 24 hours following surgery at different time intervalssurgery at different time intervals

Time Group N Mean

Std.deviation

t p value

0-6 Control Case

30 30

3.16 1.69

0.34 0.47

13.8p=0.001

7-12 Control Case

30 30

2.35 2.05

0.67 0.53

2.094p=0.041

13-18 Control Case

30 30

1.85 1.45

0.76 0.53

2.4p=0.019

19-24 Control Case

30 30

1.39 1.003

0.76 0.40

2.5p=0.015

0

0.5

1

1.5

2

2.5

3

3.5

0-6 hr 7-12 hr 13-18 hr 19-24 hr

Mea

n V

AS

Sco

re

Control Study

Intergroup comparison of pain scores postoperatively for 24

hours at different time intervals

Intergroup comparison of pethidine Intergroup comparison of pethidine requirement postoperatively for 24 requirement postoperatively for 24 hours hours

Groups N Mean Std.deviation

Z

Control 30 163.16 39.7 6.67

Case 30 47.00 23.5 p=0.001

163.1667

47

0

20

40

60

80

100

120

140

160

180M

ea

n P

eth

idin

e

Control Gabapentin

Group

Intergroup comparison of pethidine requirement postoperatively for 24 hours

Intergroup comparison of heart Intergroup comparison of heart rate postoperatively for 24 hours rate postoperatively for 24 hours

Time Group N Mean Std.deviation

tP value

0 -6 control case

30 30

90.2 79.7

6.96 4.9

6.74P=0.001

7-12 controlcase

30 30

88.46 75.86

6.5 4.9

8.41P=0.001

13-18 controlcase

30 30

84.5 71.5

5.4 4.8

9.76P=0.001

19-24 controlcase

30 30

79.7 69.5

8.19 4.006

6.26P=0.001

Intergroup comparison of SBP Intergroup comparison of SBP postoperatively for 24 hours postoperatively for 24 hours

Time Group N Mea n std.deviation

t p value

0-6 control case

30 30

139.8131.2

9.03 5.18

4.52 p=0.001

7-12 control case

30 30

137.6129.0

8.77 3.14

5.09 p=0.001

13-18 control case

30 30

134.1125.3

8.51 4.43

5.01 p=0.001

19-24 control case

30 30

131.8121.2

8.37 3.87

4.51 p=0.001

Intergroup comparison of DBP Intergroup comparison of DBP postoperatively for 24 hours postoperatively for 24 hours

Time Group N Mea n std.deviation

t p value

0-6 control case

30 30

82.4 80.06

4.28 1.33

2.9 p=0.005

7-12 control case

30 30

82.2 79.9

5.12 1.23

2.41 p=0.019

13-18 control case

30 30

81.8 79.5

4.75 1.25

2.6 p=0.012

19-24 control case

30 30

81.06 78.4

5.1 3.37

2.35 p=0.022

5

25

4

26

0

5

10

15

20

25

30

Nu

mb

er

of

ca

se

s

Control Gabapentin

Nausea

Yes

No

Intergroup comparison of nausea postoperatively for 24 hours

3

27

2

28

0

5

10

15

20

25

30N

um

be

r o

f c

as

es

Control Gabapentin

Vomiting

Yes

No

Intergroup comparison of nausea postoperatively for 24 hours

Discussion 14*Discussion 14*Patients with significant

postoperative pain should be treated.

In addition to Insomnia Restlessness Anxiety Nausea and vomiting Life threatening

cardiovascular and respiratory complications.

Discussion cont…Discussion cont…Our study showed that

gabapentin 300 mg given orally 2 hours prior to surgery effectively reduced pain scores and pethidine requirement in the first 24 hours postoperatively.

Discussion cont..Discussion cont..Gabapentin administration 2

hours prior to surgery appears logical in order to attain maximum plasma concentration at the time of surgical stimuli.

Discussion cont..Discussion cont..Pandey CK et al showed that

gabapentin 300 mg given 2 hours prior to lumbar discoidectomy effectively reduced postoperative pain and fentanyl requirement in the first 24 hours postoperatively

Discussion cont..Discussion cont..Pirks J et al demonstrated analgesic

efficacy of gabapentin used preemptively in patients who underwent mastectomy.

Woolf CS et al concluded that the rationale for preemptive analgesia is to prevent hypersensitization

Various other studies have also proved anlagesic efficacy of gabapentin

Limitation Limitation Pain has no standard definition

and is a subjective phenomenon

Assessment of pain scores was done at rest

conclusionconclusionGabapentin 300 mg per oral

given preemptive 2 hours prior to head and neck surgeries effectively reduced postoperative pain and pethidine requirement in the first 24 hours postoperatively

conclusion cont….conclusion cont….Also reduced HR,SBPand DBP

postoperatively in the first 24 hours postoperatively with no much significant difference in nausea and vomiting

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