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Introduction 2

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  • 1. The Effect Of Preemptive Gabapentin On Postoperative Pain And Opioid Requirement Following Head And Neck Surgeries Dr Nikhil M P Dr N R Bhat Dr Prashanth mallya Dr Ambareesha M
  • 2. Introduction 1*
    • Postoperative pain is an acute pain which begins with surgical trauma and ends with tissue healing
  • 3. Introduction cont….2*
    • Importance of treating postoperative pain adequately…..?????
  • 4. Introduction cont…3*
    • Role of anaesthesiologist ?
  • 5. Preemptive analgesia 4*
    • An analgesic treatment given before the nociceptive stimuli reach the CNS,could prevent or reduce the subsequent pain .
  • 6. Gabapentin 5*
    • Possess antihyperalgesic and antiallodynia properties.
  • 7. Aim 6*
    • To evaluate the effect of preemptive gabapentin on postoperative pain and opioid requirement following head and neck surgeries.
  • 8. Materials and methods 7*
    • 60 ASA grade I and II patients were included in the study.
    • 18 to 60 years.
    • 2 groups
    • Gabapentin group.
    • Control group.
    • Approval of institutional ethics committee.
  • 9. Materials and methods cont….8*
    • Informed and written consent.
    • Exclusion criteria.
  • 10. Materials and methods cont….9*
    • Gabapentin 300 mg.
    • B- complex capsule.
    • Diazepam 0.2 mg/kg.
  • 11. Materials and methods cont….10*
    • Standard anaesthesia monitors.
    • Inj.pethidine 1 mg/kg IV.
    • Propofol.
    • Pancuronium.
    • Intubation
    • Maintanence
  • 12. Materials and methods cont….11*
    • In PACU
    • Pain scores assessed using VAS hourly for 24 hours & average pain scores in 6 th hourly intervals noted.
    • Inj.pethidine 1 mg/kg IM when pain score 4 or more and total pethidine requirement noted.
  • 13. Materials and methods cont….12*
    • HR,SBP,DBP.
    • Nausea and vomiting.
  • 14. Observation and results 13*
    • Quantitative data –Students unpaired t-test
    • Qualitative data - Chi square test
    • Inter group comparison of pethidine using - Mann-whitney u test.
  • 15. Intergroup comparison of pain scores postoperatively for 24 hours following surgery at different time intervals Time Group N Mean Std.deviation t p value 0-6 Control Case 30 30 3.16 1.69 0.34 0.47 13.8 p=0.001 7-12 Control Case 30 30 2.35 2.05 0.67 0.53 2.094 p=0.041 13-18 Control Case 30 30 1.85 1.45 0.76 0.53 2.4 p=0.019 19-24 Control Case 30 30 1.39 1.003 0.76 0.40 2.5 p=0.015
  • 16. Intergroup comparison of pain scores postoperatively for 24 hours at different time intervals
  • 17. Intergroup comparison of pethidine requirement postoperatively for 24 hours Groups N Mean Std.deviation Z Control 30 163.16 39.7 6.67 Case 30 47.00 23.5 p=0.001
  • 18. Intergroup comparison of pethidine requirement postoperatively for 24 hours
  • 19. Intergroup comparison of heart rate postoperatively for 24 hours Time Group N Mean Std. deviation t P value 0 -6 control case 30 30 90.2 79.7 6.96 4.9 6.74 P=0.001 7-12 control case 30 30 88.46 75.86 6.5 4.9 8.41 P=0.001 13-18 control case 30 30 84.5 71.5 5.4 4.8 9.76 P=0.001 19-24 control case 30 30 79.7 69.5 8.19 4.006 6.26 P=0.001
  • 20. Intergroup comparison of SBP postoperatively for 24 hours Time Group N Mea n std. deviation t p value 0-6 control case 30 30 139.8 131.2 9.03 5.18 4.52 p=0.001 7-12 control case 30 30 137.6 129.0 8.77 3.14 5.09 p=0.001 13-18 control case 30 30 134.1 125.3 8.51 4.43 5.01 p=0.001 19-24 control case 30 30 131.8 121.2 8.37 3.87 4.51 p=0.001
  • 21. Intergroup comparison of DBP postoperatively for 24 hours Time Group N Mea n std. deviation t p value 0-6 control case 30 30 82.4 80.06 4.28 1.33 2.9 p=0.005 7-12 control case 30 30 82.2 79.9 5.12 1.23 2.41 p=0.019 13-18 control case 30 30 81.8 79.5 4.75 1.25 2.6 p=0.012 19-24 control case 30 30 81.06 78.4 5.1 3.37 2.35 p=0.022
  • 22. Intergroup comparison of nausea postoperatively for 24 hours
  • 23. Intergroup comparison of nausea postoperatively for 24 hours
  • 24. Discussion 14*
    • Patients with significant postoperative pain should be treated.
    • In addition to Insomnia
    • Restlessness
    • Anxiety
    • Nausea and vomiting
    • Life threatening cardiovascular and respiratory
    • complications.
  • 25. Discussion cont…
    • Our study showed that gabapentin 300 mg given orally 2 hours prior to surgery effectively reduced pain scores and pethidine requirement in the first 24 hours postoperatively.
  • 26. Discussion cont..
    • Gabapentin administration 2 hours prior to surgery appears logical in order to attain maximum plasma concentration at the time of surgical stimuli.
  • 27. Discussion cont..
    • Pandey CK et al showed that gabapentin 300 mg given 2 hours prior to lumbar discoidectomy effectively reduced postoperative pain and fentanyl requirement in the first 24 hours postoperatively
  • 28. Discussion cont..
    • Pirks J et al demonstrated analgesic efficacy of gabapentin used preemptively in patients who underwent mastectomy.
    • Woolf CS et al concluded that the rationale for preemptive analgesia is to prevent hypersensitization
    • Various other studies have also proved anlagesic efficacy of gabapentin
  • 29. Limitation
    • Pain has no standard definition and is a subjective phenomenon
    • Assessment of pain scores was done at rest
  • 30. conclusion
    • Gabapentin 300 mg per oral given preemptive 2 hours prior to head and neck surgeries effectively reduced postoperative pain and pethidine requirement in the first 24 hours postoperatively
  • 31. conclusion cont….
    • Also reduced HR,SBPand DBP postoperatively in the first 24 hours postoperatively with no much significant difference in nausea and vomiting
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