ADDITION OF DEXAMETHASONE INJECTION TO PREEMPTIVE ORAL PREGABALIN DOES NOT IMPROVE POSTOPERATIVE ANALGESIA OVER PREGABALIN ALONE FOR ABDOMINAL HYSTERECTOMY UNDER GENERAL ANAESTHESIA.

Corresponding Author:
Dr. Subhrajyoti Chattopadhyay,
C/o. Mr. Satyajit Chakroborty,
Trinayani Apartment (2nd Floor),
Taltala, Arabinda Pally,
Siliguri-734006,
West Bengal.
E-mail: drsubhra1972@gmail.com

ABSTRACT

BACKGROUND

Effective control of postoperative pain reduces nociception-induced responses and morbidity in the postoperative period.  The aim of this study is to evaluate whether the prophylactic use of pregabalin 300 mg along with dexamethasone 8 mg and paracetamol 1000 mg improves analgesia after abdominal hysterectomy operation.

METHODOLOGY

All the participants were randomly allocated to receive either oral pregabalin + injection dexamethasone (group-A, n=25) or pregabalin + placebo injection (Group-B, n=25) or placebo capsules and placebo injection (Group-C, n=25) 1 hr before surgery.

General anaesthesia with endotracheal intubation was provided for surgery and subsequently reversed following a standard protocol. After surgery patients were monitored for the next 24 hours in the recovery room where they received 1000 mg of paracetamol 8 hourly. Episodes of pain were treated with intravenous fentanyl 25 mcg (rescue analgesic) at 10 minutes interval until pain subsides or any complication started or maximum allowable dose (100 mcg/hr.) exceeds. The patients were assessed postoperatively at 1, 4 and 24 hours. The intensity of pain was assessed using visual analogue scale at rest and with movement. Levels of postoperative nausea, vomiting, sedation and any occurrence of headache and light-headedness were recorded during this period.

RESULTS

A significant reduction of fentanyl consumption (33%) was observed in the first 24 postoperative hours with single dose of 300 mg pregabalin. Reduced VAS scores (in mm) were observed in patients receiving pregabalin+dexamethasone combination or pregabalin alone compared with placebo at 1^st hour [18.81±5.89 vs. 22.86±9.94 vs. 42.95±9.21]; at 4^th hour [8.81±3.12 vs. 8.81±4.44 vs. 26.36±8.05] and at 24^th hours [9.05±3.75 vs. 8.10±4.02 vs. 15.00±5.35] of postoperative period [group-wise data represented respectively]. Sedation remained the most significant adverse effect among patients receiving pregabalin.

CONCLUSION

Addition of single dose injection dexamethasone 8 mg has no discernible effect on postoperative analgesia achieved with pre-emptive oral pregabalin except some alleviation of postoperative nausea and vomiting.

KEYWORDS

Multimodal Analgesia, Pregabalin, Dexamethasone, Paracetamol, Postoperative Pain, Abdominal Hysterectomy.