Effect of intravenous vitamin C on postoperative pain in uvulopalatopharyngoplasty with tonsillectomy.

BACKGROUND: Postoperative pain is a common problem in hospitals. Adults undergoing uvulopalatopharyngoplasty (UPPP) with tonsillectomy experience an unacceptable level of intense postoperative pain, especially during the first 24 h after surgery. This study investigated the analgesic effects of vitamin C in patients undergoing UPPP and tonsillectomy. METHOD: This study was done on forty patients that were evaluated in a randomised double-blinded clinical trial. Patients included in the study were within the age range of 25-50 years with BMI<35, physical status I,II according to the American Society of Anesthesia (ASA) and who underwent uvulopalatopharyngoplasty and tonsillectomy. Patients with epilepsy, BMI>35, any neuropsychiatric disorders, a history of chronic pain, liver and/or renal disease, drug allergy, and drug abuse were excluded from the study. All patients underwent the same method of anaesthesia and surgical procedure. During the first 30 min after the beginning of the surgery, group C (vitamin C) received infusion of 3 g vitamin C in 500 mL of Ringer and group P received 6 mL normal saline in 500 mL of Ringer. Measurements of systolic blood pressure, diastolic blood pressure, mean arterial blood pressure and heart rate were recorded before and during anaesthesia and at intervals of 0,15,30 and 60 min after extubation. Pain severity was recorded according to VAS score at intervals of 0 (recovery room), 6, 12 and 24 h after the procedure, request for analgesic drugs (iv paracetamol or pethedine) according to total number of times of analgesic request and time of the first dose of analgesic use and dose of pethidine were also recorded by questionnaire. RESULTS: There was a significant difference in evaluations for mean pain severity between the two groups at recovery room, 6, 12 and 24 h after surgery (P-value = 0.001). There was a significant difference in mean times that patient requested an analgesic, time of first dose of analgesic and pethidine dose between the two groups (P-value< 0.05). There was no significant differences in measurements of systolic blood pressure, diastolic blood pressure, mean arterial blood pressure and heart rate in different times between the two groups (P-value> 0.05). Blood loss was similar in the two groups (P-value> 0.05). CONCLUSION: According to this study, administration of vitamin C 3 g IV intraoperative reduced postoperative pain without increased side-effects in patients undergoing UPPP and tonsillectomy.

Effect of warm bupivacaine on the sensory onset of epidural anaesthesia in lower limb orthopaedic surgery: a double-blind randomized clinical trial.

PURPOSE OF THE STUDY: In this study we evaluated the effect of warm bupivacaine on the onset time of sensory block in patients undergoing lower limb surgery with epidural anaesthesia METHODS: After approval by the Ethics Committee and written informed consents, 60 ASA physical status I and II patients, aged 18 to 75 years, undergoing elective lower limb surgery were studied in this randomized double-blind clinical trial. The patients having spinal anesthesia were divided into two groups. Group 1 received warm bupivacaine and group 2 was given bupivacaine at room temperature. The onset time and the level of sensory block were evaluated by a blind observer. Side effects (nausea, vomiting, shivering, headache, low back pain) were evaluated during surgery and in the post-operative period. RESULTS: One patient was excluded from the study because of incomplete block; therefore 59 patients in two groups (29 patients in group 1 and 30 patients in group 2) were compared. The groups were matched on gender, age, weight and BMI. The onset time of sensory block at the levels of T12, L3 and L4 in group 1 was significantly shorter than in group 2 (p < 0.001). The difference in the onset time of sensory block at the upper levels of the spine between the two groups was not significant (p = 0.21). The incidence of side effects did not differ significantly (p = 0.18) between the two groups. CONCLUSIONS: Warming bupivacaine can decrease the onset time of sensory block in epidural anaesthesia without any side effects in patients undergoing lower limb orthopaedic surgery.

Effect of gabapentin on postoperative pain and operation complications: a randomized placebo controlled trial.

OBJECTIVE: Prevention and treatment of postoperative pain and operation complications such as nausea and vomiting are most important concerns in postoperative care. There are several mechanisms involved in postoperative pain. Gabapentin is a gamma aminobutyric acid analogue that is known as an anticonvulsant drug. This drug is tolerated well and has known effects on pain and anxiety. This study has compared the effect of gabapentin on postoperative pain, operation complications and haemodynamics. SUBJECTS AND METHODS: This randomized double blinded placebo controlled clinical trial was conducted on 61 patients divided randomly into two groups (30 as cases and 31 as controls). All patients had total abdominal hysterectomy. In the first group, the patients got 100 mg gabapentin in the night and 300 mg gabapentin orally (one capsule) two hours before surgery. The second group got one capsule of multivitamin orally. Then all patients were subjected to the same anaesthesia protocol and total abdominal hysterectomy. During the 24 hours after operation, the patients were assessed according to pain, nausea, vomiting, dizziness, systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse rate (PR) and morphine use at 1, 6, 12 and 24 hours. RESULTS: Mean age and weight of patients were 45.86 +/- 4.06, 48.16 +/- 4.48, 64.56 +/- 13.29 and 68.8 +/- 12.88 in the study population and control groups, respectively. Except in the first hour after operation (p = 0.02), there was no significant differences between the two groups in morphine use. There was no significant correlation between the groups according to postoperative complications and the haemodynamic parameters (PR, SBP and DBP). CONCLUSION: Results show that gabapentin can decrease the need for morphine use in the first hour after operation only and has no significant effect on operation complications. Thus, we suggest gabapentin for pain management, and not to decrease opium use.

Effect of gabapentin on postoperative pain and operation complications a randomized placebo controlled trial / Efecto de la gabapentina en el dolor postoperatorio y complicaciones de la operación: un ensayo clínico, aleatorio, controlado con placebo

OBJECTIVE: Prevention and treatment ofpostoperative pain and operation complications such as nausea and vomiting are most important concerns in postoperative care. There are several mechanisms involved in postoperative pain. Gabapentin is a gamma aminobutyric acid analogue that is known as an anticonvulsant drug. This drug is tolerated well and has known effects on pain and anxiety. This study has compared the effect of gabapentin on postoperative pain, operation complications and haemodynamics. SUBJECTS AND METHODS: This randomized double blinded placebo controlled clinical trial was conducted on 61 patients divided randomly into two groups (30 as cases and 31 as controls). All patients had total abdominal hysterectomy. In the first group, the patients got 100 mg gabapentin in the night and 300 mg gabapentin orally (one capsule) two hours before surgery. The second group got one capsule of multivitamin orally. Then all patients were subjected to the same anaesthesia protocol and total abdominal hysterectomy. During the 24 hours after operation, the patients were assessed according to pain, nausea, vomiting, dizziness, systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse rate (PR) and morphine use at 1, 6, 12 and 24 hours. RESULTS: Mean age and weight of patients were 45.86 ± 4.06, 48.16 ± 4.48, 64.56 ± 13.29 and 68.8 ± 12.88 in the study population and control groups, respectively. Except in the first hour after operation (p = 0.02), there was no significant differences between the two groups in morphine use. There was no significant correlation between the groups according to postoperative complications and the haemo-dynamic parameters (PR, SBP and DBP). CONCLUSION: Results show that gabapentin can decrease the need for morphine use in the first hour after operation only and has no significant effect on operation complications. Thus, we suggest gabapentin for pain management, and not to decrease opium use.

OBJETIVO: La prevención y tratamiento de dolor postoperatorio y las complicaciones de la operación -tales como la náusea y el vómito - son problemas de suma importancia en el cuidado postoperatorio. Hay varios mecanismos implicados en el dolor postoperatorio. La gabapentina es un análogo del ácido gamma-aminobutírico, conocido como un medicamento anticonvulsivo. Este medicamento es bien tolerado, y tiene efectos conocidos sobre el dolor y la ansiedad. El presente estudio compara el efecto de la gabapentina sobre el dolor postoperatorio, las complicaciones de la operación, y la hemo-dinámica. SUJETOS Y MÉTODOS: Este ensayo clínico, aleatorio, doble ciego y controlado con placebo, se llevó a cabo con 61 pacientes divididos aleatoriamente en dos grupos (30 como casos y 31 como control). Todas las pacientes tuvieron histerectomia abdominal total. En el primer grupo, las pacientes recibieron via oral 100 mg de gabapentina por la noche y 300 mg de gabapentina (una cápsula) dos horas antes de la cirugía. El segundo grupo recibió una cápsula de multivitaminas por vía oral. Luego, todas las pacientes fueron sometidas al mismo protocolo de anestesia e histerectomía abdominal total. Durante las 24 horas después de la operación, las pacientes fueron evaluadas en relación con dolores, náusea, vómitos, vértigo, presión sanguínea sistólica (PSS), presión sanguínea diastólica (PSD), frecuencia de pulso (FP), y el uso de morfina a la 1, 6, 12 y 24 horas. RESULTADOS: La edad promedio y el peso de las pacientes fue 45.86 ± 4.06, 48.16 ± 4.48, 64.56 ± 13.29 y 68.8 ± 12.88 en la población de estudio y los grupos de control, respectivamente. Excepto en la primera hora tras la operación (p = 0.02), no hubo ninguna diferencia significativa entre los dos grupos en cuanto al uso de morfina. No hubo correlación significativa alguna entre los grupos sobre la base de las complicaciones postoperatorias y los parámetros hemodinámicos (FP, PSS, y PSD). CONCLUSIÓN: Los resultados muestran que la gabapentina sólo puede disminuir la necesidad del uso de morfina en la primera hora tras la operación, y no tiene efectos significativos en las complicaciones de la operación. Por lo tanto, se sugiere el uso de la gabapentina para el tratamiento del dolor, pero no para reducir el uso del opio.