A comparative study of esmolol and dexmedetomidine on hemodynamic responses to carbon dioxide pneumoperitoneum during laparoscopic surgery.

BACKGROUND: Carbon dioxide pneumoperitoneum for laparoscopic surgery increases arterial pressures, heart rate (HR), and systemic vascular resistance. In this randomized, single-blind, placebo-controlled clinical study, we investigated and compared the efficacy of esmolol and dexmedetomidine to provide perioperative hemodynamic stability in patients undergoing laparoscopic cholecystectomy. METHODS: Sixty patients, of either sex undergoing elective laparoscopic cholecystectomy, were randomly allocated into three groups containing twenty patients each. Group E received bolus dose of 500 µg/kg intravenous (IV) esmolol before pneumoperitoneum followed by an infusion of 100 µg/kg/min. Group D received bolus dose of 1 µg/kg IV dexmedetomidine before pneumoperitoneum followed by infusion of 0.2 µg/kg/h. Group S (control) received saline 0.9%. RESULTS: Mean arterial pressure and HR in Group E and D were significantly less throughout the period of pneumoperitoneum in comparison to Group S. IV nitroglycerine was required in 45% (9 out of 20) patients in Group S to control intraoperative hypertension, and it was clinically significant in comparison to Group E and D. CONCLUSION: Both esmolol and dexmedetomidine attenuate the adverse hemodynamic response to pneumoperitoneum and provide hemodynamic stability during laparoscopic surgery.

A comparative study of efficacy and safety of lornoxicam versus tramadol as analgesics after surgery on head and neck.

To assess efficacy and safety of lornoxicam as analgesic after surgery on head and neck in comparison to tramadol. Forty five patients undergoing operations on head and neck were recruited and randomly assigned to two parallel groups-lornoxicam and tramadol, both given intramuscular on the first post-operative day followed by oral tablets for the consecutive 4 days. Treatment was given single blind. 10 cm visual analog scale (VAS) pain score and wound tenderness assessed by a 3-point ordinal scale were the primary efficacy parameters. Use of rescue medication and percentage of subjects having at least 50 % pain relief by 48 h were also compared as secondary parameters. The groups were comparable at baseline regarding age, sex and VAS score. There was steady decline in VAS pain score from baseline to study end in both the groups, indicating good analgesic efficacy with either drug. Between groups comparisons of VAS score showed no significant difference at any time point. Between groups comparisons of wound tenderness also showed no significant difference. Five patients on lornoxicam and one patient on tramadol experienced at least 50 % pain relief at 48 hours compared to baseline while five patients from the lornoxicam group and eight from the tramadol group required rescue medicine. The tolerability of lornoxicam appeared to be significantly superior to tramadol, with less number of patients experiencing adverse drug reactions. Lornoxicam is safe, effective and comparable to tramadol for relieving postoperative pain after operations on head and neck.

A comparative study of efficacy and safety of gabapentin versus amitriptyline as coanalgesics in patients receiving opioid analgesics for neuropathic pain in malignancy.

OBJECTIVE: To assess the efficacy and safety of gabapentin and amitriptyline along with opioids in patients suffering from neuropathic pain in malignancy. MATERIALS AND METHODS: Eighty-eight adult patients between 18 and 70 years of age with neuropathic pain in stage III malignant disease, matched for baseline charactistics, were randomly assigned to two groups. Group A received oral tramadol and gabapentin and group B received oral tramadol and amitriptyline. The treatment duration of each patient was 6 months. Visual analog scale (VAS) was the primary efficacy parameter. Verbal rating scale (VRS) score, percentage of pain relief (PPR), and global pain score (GPS) were the secondary efficacy parameters. Oral morphine tablets or fentanyl transdermal patch were used as rescue medication. Data analysis was carried out in Graph Pad instat. RESULTS: There was decline in VAS pain score from baseline in both the groups in the early phase of the study though there was no statistically detectable difference between them at any study point. Similar changes were seen in the secondary efficacy parameters too. Thus both the drugs were effective in providing relief to cancer patients with neuropathic pain though there was no statistically detectable difference in efficacy between them. Six patients in group A and eight patients in group B required rescue medication. A total of 12 subjects in the gabapentin group and 15 subjects in the amitriptyline group experienced adverse events which were of mild to moderate grades. CONCLUSIONS: Amitriptyline may be a suitable alternative for management of neuropathic pain in cancer patients although gabapentin is widely used for this purpose. The lower cost of amitriptyline may favor patient compliance with lesser number of drop-outs.

Suicidality and suicide attempt in a young female on long-term sertraline treatment.

A 22-year-old woman who was on sertraline 50 mg oral tablets once daily for 2 years for treatment of major depression took 30 such tablets (1500 mg) in a fit of rage, with a suicidal intent. She presented to the Emergency Department of a Tertiary Care Hospital with tachycardia, tachypnea, hypertension, tremors, agitation, confusion, vomiting, and hyperthermia. The patient was admitted and treated symptomatically, and sertraline therapy was discontinued. The unwanted effects subsided within 48 h and she recovered uneventfully within 72 h. This case report describes an unsuccessful attempt of suicide with sertraline overdose in a patient on long-term sertraline therapy and underlines the importance of close monitoring of such patients.