A randomized, double-blind, placebo-controlled study of prophylactic gabapentin for prevention of postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy.

Research Question: Can prophylactic use of Gabapentin prevent postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy? Objectives: 1) To evaluate the antiemetic effect of gabapentin in patients undergoing laparoscopic cholecystectomy. 2) To compare the incidence and severity of postoperative nausea and vomiting with placebo in laparoscopic cholecystectomy. Study Design: Randomized, double-blind, placebo-controlled study. Material & Methods: This study was carried out to evaluate the antiemetic efficacy of Gabapentin on incidence and severity of postoperative nausea and vomiting (PONV) in patients undergoing laparoscopic cholecystectomy under general anaesthesia. 100 patients of ASA I and II randomly assigned in two groups were given 600 mg of Gabapentin or matching placebo orally two hours before surgery. Patients were observed postoperatively for 24 hrs for PONV. Results: A complete response (no nausea or vomiting) was observed in 60% of patients in gabapentin group as compared to 38.2% in placebo group. The difference was statistically significant (P < 0.05). There was no difference in the severity of PONV amongst the two groups at Ist, 2nd, 6th, 12th and 24th hour. Thirty four percent of patients in Gabapentin group required rescue antiemetic medication as compared to 54% of patients in placebo group. The difference was statistically significant (P < 0.05). Conclusions: Our study reveals that oral Gabapentin, which is used as anticonvulsant and analgesic, may find its use as an antiemetic and its use in prevention of PONV needs further evaluation and research

Comparative study of intrathecal tramadol Administration on postoperative analgesia after transurethral resection of prostate using three different doses of tramadol.

Objectives: 1: To determine the optimal dose requirements of intrathecal Tramadol as the main postoperative Analgesic.2: To evaluate the side effect profile of various doses of Intrathecal Tramadol Study Design & Setting: Prospective Double Blind, Hospital based Study. Materials & Methods: 87 patients of status ASA I and II, aged between 50-70 years scheduled for TURP under spinal anesthesia, received 30 mg, (Group I), 40mg (Group II), and 50mg (Group III) of intrathecal tramadol hydrochloride with 2.5ml of 0.5% bupivacaine each. VAS score was assessed hourly for the first 8 hours after operation and every four hourly thereafter for a total of 24 hours. The duration of analgesia in three groups was obtained from the completion of spinal injection to the time of rescue analgesic administered on demand or when visual analogue score was =3 Results: There was a statistically significant difference in postoperative pain relief in group I (14.69±5.85 hours), group II (18.48±6.18 hours) and group III (19.45±4.626 hours). Incidence of vomiting in group III (34.5%), group II (17.2%) and group I (13.8%) was statistically significant. The Postoperative Visual Analogue Scale score is statistically significant among the three groups at different time periods. Conclusions: Tramadol hydrochloride is an effective analgesic agent when administered intrathecally for postoperative pain.40 mg is an optimum dose for postoperative analgesia given intrathecally without significant increase in side effects.50 mg of tramadol can be used with appropriate anti-emetics to reduce the incidence of nausea and vomiting associated with this dose

Epidural Tramadol: A dose finding study to evaluate the duration of postoperative analgesia in urological surgical patients.

Research Question: What dose of epidural tramadol provides maximum pain relief in postoperative period? Objectives: To evaluate relative efficacy of tramadol in 3 doses l mg/ kg, 2 mg/kg and 3mg/kg in providing pain relief in postoperative period in ureterolithotomy or pyelolithotomy surgical patients. Study Design & Settings: Prospective, double blind, randomized hospital based study. Material & Methods: 60 patients, ASA class I, II of either sex, age 20-60 years, scheduled for elective urological surgeries were divided into 3 groups, group I, II, III who received tramadol epidurally 1 mg/kg, 2 mg/kg and 3 mg/kg respectively. Tramadol was administered epidurally at the end of surgery in PACU, as per randomization when patients would complain of pain and VAS was more than 3. Patients were followed up to 24 hours postoperatively. Pain was assessed on the basis of visual analogue scale with ‘0’ cm - no pain and 10 cm - worst pain. Results: Mean time of first request for analgesia postoperatively was 6 hours, 14 hours and 21 hours in group I, II and III respectively. There was significant increase in postoperative nausea and vomiting in group III (40%) as compared to group I (10%) and group II (5%). Conclusions: Tramadol 2 mg/kg body weight is an optimum dose for postoperative analgesia given epidurally however 3 mg/kg body weight tramadol epidurally which gives pain relief for 21 hours can be used with appropriate antiemetic to reduce the incidence of nausea and vomiting associated with this dose