Comparison Of Efficacy Of Oral Pregabalin And Oral Paracetamol As Pre-Emptive Analgesics In Patients Receiving Spinal Anesthesia For Lower Limb Surgeries

Abstract

BACK GROUND & AIM After any surgery patients continue to experience unacceptably high levels of pain post operatively, this is generated through multiple mechanisms. Effective management of postoperative pain leads to increased patient satisfaction; earlier mobilization and reduced hospital stay. One of the methods used for management of postoperative pain is pre-emptive analgesia -blockade of afferent nerve fiber before surgical stimulus. Based on the multimodal post-operative pain management concept, recent studies shows that use of pre-emptive Paracetamol or Pregabalin are an effective adjuvant in treatment of post-operative pain and decreases the post-operative opioid use. Aim of this study was to evaluate the efficacy of preemptive Pregabalin and Paracetamol and comparison between the two. MATERIALS AND METHODS The study was a prospective randomized comparative study, conducted at Shri B.M Patil Medical College Hospital, Vijayapur on 120 patients posted under spinal anaesthesia for lower limb surgeries from December 2017 to August 2019. a) Inclusion criteria: 1. Patients from age 20-65yrs undergoing elective surgery. 2. ASA grade I and II. b) Exclusión criteria : 1. Uncooperative and unwilling patient. 2. Hypersensitivity to drugs. 3. History of neurologic or seizure disorder.4. Surgeries lasting for more than 3 hours The study population of 120 patients of ASA grade I and ASA g rade II with age and sex matched were randomly selected and divided by computer generated random number tables in to two groups with 60 patients in each group. The study was initiated after obtaining clearance from ethical committee. Written informed conse nt was obtained from all the patients included in the study. Patients were explained about visual analogue score. GROUP PG- Received Pregabalin 150 mg orally 1 hour prior to surgery with 5ml of water. GROUP PA- Received Paracetamol 1gm orally 1 hour prior to surgery with 5ml of water. Spinal anaesthesia technique was standardized to all patients. Post operative pain was assessed with using visual analogue score at 2, 4, 6, 12, 24 hours after surgery. RESCUE ANALGESIA. If visual analogue score more than 3, rescue analgesia was given in the form of Inj. Tramadol 1mg/kg. Time of first rescue analgesic and total amount of analgesic given over 24 hours was noted. RESULTS In our study mean age distribution in group PG was 41.70±13.96 and in group PA 40.23±12.62. The age distribution was higher in group PG compared to group PA . The two groups were comparable on the basis of gender and ASA grade. Group PG has significantly less VAS score then group PA for 24 hours of Post operative period. The mean visual analog score for group PG at 2, 4, 6, 12, and 24 hours after surgery was lower as compared to the corresponding rates for the group PA. This difference in VAS scores was significant for all times except at time 4 hrs and 6 hrs after surgery (p<0.05).The time of first rescue analgesia (4.3±1.2 hrs Group PG vs. 3.3±1.1 Hrs Group PA) and total number of rescue analgesia in the 24 hours period post operatively in the form of tramadol 1mg/kg was significantly lesser for group PG compared to group PA (1.6±0.6 Group PG vs. 2.9±0.7 Group PA). We confronted nausea and vomiting in 9 cases of which, 6 were in group PG and 3 were in group PA. No other significant side effects were noted. CONCLUSIONS Based on the findings of the study, we can conclude that pre-operative administration of oral Pregabalin 150mg was an effective and a safe adjuvant for acute pain after surgery compared to oral Paracetamol 1000 mg. Pregabalin reduces the postoperative pain score and total analgesic consumption and there were no other significant side effects in the postoperative period.