EFFECT OF ADDITION OF PREOPERATIVE ORAL PREGABALIN TO PERIOPERATIVE INTRAVENOUS LIDOCAINE INFUSION ON POSTOPERATIVE PAIN AND PERIOPERATIVE STRESS RESPONSE IN PATIENTS UNDERGOING ELECTIVE LAPAROTOMY: A DOUBLE BLIND RANDOMISED CONTROLLED TRIAL
Jigish Ruparelia*1, Sarath C. Sistla1, Gomathi Shankar1, Pankaj Kundra2, Senthil 9. Kumar3
1Surgery, JIPMER, Pondicherry, Jamnagar, Gujarat, India; 2Anaesthesiology, JIPMER, Pondicherry, India; 3Biochemistry, JIPMER, Pondicherry, India
Introduction
Postoperative pain remains a significant problem in patients undergoing abdominal surgeries, and has a profound effect on patient recovery. High dose opioids hamper bowel motility and increase nausea and vomiting. Intravenous lidocaine has been used as part of a multimodal analgesia protocol for providing effective pain relief and attenuating surgery-associated inflammatory response. Preoperative pregabalin also has a beneficial effect in reducing pain.
This study was carried out to assess the efficacy of combining these drugs in reducing pain, paralytic ileus and stress response.
Methodology
All patients undergoing elective laparotomy and satisfying the study criteria were randomised into two groups. Group A patients received preoperative placebo and intraoperative lidocaine infusion. Group B patients received preoperative pregabalin and lidocaine. Pain was assessed using visual analogue scale at 2, 6, 18 and 24 hours postoperatively. Morphine consumption on a patient controlled analgesia pump was noted. Time to first passage of stools and flatus, and incidence of nausea and vomiting were noted. Surgical stress response was assessed by measuring perioperative total leucocyte count, interleukin-6 and C-reactive protein.
Results
Postoperative pain scores at 6, 18 and 24 hours were significantly lower in Group B patients who had received pregabalin. These patients also had lower morphine consumption and earlier bowel recovery as measured by first passage of stools. Perioperative inflammatory markers were similar in both groups.
Discussion
Preoperative pregabalin when used with intravenous lidocaine has a synergistic effect on reducing postoperative pain and opioid consumption. This also has beneficial effect on return of bowel function. However, it did not have a significant additional effect on attenuation of the inflammatory component of surgical stress response.
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