Bafna Usha, Rajarajeshwaran Krishnamoorthy, Khandelwal Mamta, Verma Anand Prakash
Department of Anesthesiology, SMS Medical College, Jaipur, Rajasthan, India.
J Anaesthesiol Clin Pharmacol. 2014 Jul;30(3):373-7. doi: 10.4103/0970-9185.137270.
Preemptive analgesia is an antinociceptive treatment that prevents establishment of altered processing of afferent input. Pregabalin has been claimed to be more effective in preventing neuropathic component of acute nociceptive pain of surgery. We conducted a study to compare the effect of oral gabapentin and pregabalin with control group for post-operative analgesia.
A total of 90 ASA grade I and II patients posted for elective gynecological surgeries were randomized into 3 groups (group A, B and C of 30 patients each). One hour before entering into the operation theatre the blinded drug selected for the study was given with a sip of water. Group A- received identical placebo capsule, Group B- received 600mg of gabapentin capsule and Group C - received 150 mg of pregabalin capsule. Spinal anesthesia was performed at L3-L4 interspace and a volume of 3.5 ml of 0.5% bupivacaine heavy injected over 30sec through a 25 G spinal needle. VAS score at first rescue analgesia, mean time of onset of analgesia, level of sensory block at 5min and 10 min interval, onset of motor block, total duration of analgesia and total requirement of rescue analgesia were observed as primary outcome. Hemodynamics and side effects were recorded as secondary outcome in all patients.
A significantly longer mean duration of effective analgesia in group C was observed compared with other groups (P < 0.001). The mean duration of effective analgesia in group C was 535.16 ± 32.86 min versus 151.83 ± 16.21 minutes in group A and 302.00 ± 24.26 minutes in group B. The mean numbers of doses of rescue analgesia in the first 24 hours in group A, B and C was 4.7 ± 0.65, 4.1 ±0.66 and 3.9±0.614. (P value <0.001).
We conclude that preemptive use of gabapentin 600mg and pregabalin 150 mg orally significantly reduces the postoperative rescue analgesic requirement and increases the duration of postoperative analgesia in patients undergoing elective gynecological surgeries under spinal anesthesia.
超前镇痛是一种抗伤害感受治疗，可防止传入输入的改变处理的建立。加巴喷丁已被宣称在预防手术急性伤害性疼痛的神经病理性成分方面更有效。我们进行了一项研究，比较口服加巴喷丁和普瑞巴林与对照组在术后镇痛方面的效果。
总共90例拟行择期妇科手术的ASA I级和II级患者被随机分为3组（A组、B组和C组，每组30例患者）。在进入手术室前1小时，将为该研究选定的盲法药物与一小口水一起给予。A组接受相同的安慰剂胶囊，B组接受600mg加巴喷丁胶囊，C组接受150mg普瑞巴林胶囊。在L3-L4间隙进行脊髓麻醉，并通过25G脊髓穿刺针在30秒内注入3.5ml 0.5%重比重布比卡因。观察首次补救镇痛时的视觉模拟评分（VAS）、镇痛起效的平均时间、5分钟和10分钟间隔时的感觉阻滞水平、运动阻滞的起效时间、镇痛的总持续时间以及补救镇痛的总需求量作为主要结局。记录所有患者的血流动力学和副作用作为次要结局。
与其他组相比，C组观察到有效镇痛的平均持续时间明显更长（P<0.001）。C组有效镇痛的平均持续时间为535.16±32.86分钟，而A组为151.83±16.21分钟，B组为302.00±24.26分钟。A组、B组和C组在术后24小时内补救镇痛的平均剂量数分别为4.7±0.65、4.1±0.66和3.9±0.614。（P值<0.001）。
我们得出结论，在脊髓麻醉下接受择期妇科手术的患者中，口服600mg加巴喷丁和150mg普瑞巴林进行超前镇痛可显著降低术后补救镇痛的需求量，并延长术后镇痛的持续时间。
