Effects of a single-dose preemptive pregabalin on acute and chronic pain after inguinal hernia repair with mesh under spinal anaesthesia: A randomised controlled trial

Intravenously Administered Nonsteroidal Anti-Inflammatory Drugs in Clinical Practice: A Narrative Review

Intravenously administered nonsteroidal anti-inflammatory drugs (NSAIDs) constitute a crucial component of multimodal analgesia strategies in surgical settings. This narrative review aims to provide an up-to-date evaluation of the efficacy, safety, and clinical use of intravenous (IV) NSAIDs for perioperative pain management in adults and children. The NSAIDs and selective COX-2 inhibitors (coxibs) approved in Europe for the short-term symptomatic treatment of acute, moderate perioperative pain via IV infusion in adults and/or children have been influenced by US and global guidelines and practice: the drugs primarily reviewed here are ibuprofen, ketorolac, ketoprofen, naproxen, paracetamol, and acetylsalicylic acid. Furthermore, intravenous ibuprofen is authorized for the short-term symptomatic treatment of fever. In contrast to intravenous ketoprofen, intravenous ibuprofen is authorized for administration to children over 6 years of age or weighing more than 20 kg. Overall, IV ibuprofen had a more favorable profile with regard to peri- and postoperative opioid sparing and pain relief. Oral ibuprofen and IV ibuprofen have similar levels of efficacy, although IV ibuprofen has a shorter onset of action and is required in patients who are unable to take oral medications. The frequency of significant adverse events appears to be similar for ibuprofen and paracetamol. Systematic reviews and meta-analyses report that intravenous NSAIDs reduce postoperative opioid consumption by approximately 20-60%, improving pain management with fewer opioid-related side effects. In indications in infants, the choice of medication is limited, and the oral route is not always feasible; IV formulations of ibuprofen are preferred in this setting. Topics for further research should include head-to-head trials of IV NSAIDs.

Comparison of types 2 and 3 quadratus lumborum muscle blocks : Open inguinal hernia surgery in patients with spinal anesthesia

OBJECTIVE

The efficacy of quadratus lumborum muscle block (QLB) in abdominal surgery is known; however, the efficacy of different QLB types is unclear. The objective of this study was to investigate the effects of ultrasound-guided QLB type 2 and type 3 on postoperative opioid consumption and pain scores in patients undergoing inguinal hernia surgery.

MATERIAL AND METHODS

In this study 60 patients undergoing open inguinal hernia surgery were randomly assigned to 3 groups. Group QLB2 received ultrasound-guided QLB type 2 and group QLB3 received ultrasound-guided QLB type 3 with 0.25% 20 mL bupivacaine. In the control group (group C) no intervention was performed. Postoperative analgesia was performed intravenously with 1000 mg paracetamol every 6 h and patient-controlled analgesia with fentanyl. Postoperative visual analog scale scores (VAS), opioid consumption, and first analgesic requirement time were evaluated.

RESULTS

Fentanyl consumption was significantly higher in group C compared to the other groups at all time intervals (p < 0.05). Fentanyl consumption was significantly higher in group QLB2 compared to QLB3 at the 4-8 h, 8-24 h, and total 24 h. Passive VAS 4h and 8 h, active VAS 4h, 8h, and 12 h were significantly lower in group QLB3 compared to QLB2 (p < 0.05). The first analgesic time was significantly later in group QLB2 compared to group C (280.52 ± 89.20 min and 183.75 ± 42.79 min, respectively) and even later in group QLB3 compared to the other two groups (463.42 ± 142.43 min, p < 0.05).

CONCLUSION

The use of QLB2 and QLB3 decreased postoperative opioid consumption and pain scores in patients undergoing inguinal hernia surgery. Furthermore, QLB3 provided more effective and longer lasting postoperative analgesia and lower opioid consumption compared to QLB2.

The effect of pregabalin on tourniquet-induced ischemia-reperfusion injury: a prospective randomized study

Background/aim

The aim of this study was to investigate the efficacy of pregabalin on ischemia-reperfusion injuries.

Materials and methods

Fifty-four patients were randomly assigned into 2 groups. A 150-mg tablet of pregabalin was given the night before and then 1 h before the operation for patients in Group P (pregabalin group, n = 27). A placebo was given to patients in Group C (control group, n = 27) at the same times. After combined spinal-epidural anesthesia was performed, venous blood samples were taken before tourniquet inflation (t₁), just before tourniquet deflation (t₂), and 20 min after tourniquet deflation (t₃) for the analysis of total antioxidant status (TAS), total oxidant status (TOS), catalase (CAT), and ischemia-modified albumin (IMA).

Results

There was no significant difference in TAS levels between the groups for the t₃ period. However, the TAS in Group P was significantly higher in the t₃ period than the t₂ period (mean ± SD, 0.46 ± 0.1 vs. 0.38 ± 0.2 mmol of Trolox equivalent/L, respectively; P < 0.05). The CAT level in the t₃ period was significantly higher in Group P than Group C (mean ± SD, 53.04 ± 32.1 vs. 35.46 ± 17.2 µmol/formaldehyde, respectively; P < 0.05). In the t₃ period, the TOS was significantly lower in Group P than Group C (mean ± SD, 11.97 ± 5 vs. 18.29 ± 9.9 pg/mL, respectively; P < 0.05). The TOS in Group P was significantly lower in the t₃ period than the t₂ period (mean ± SD, 11.97 ± 5 vs. 18.98 ± 10.7 pg/mL, respectively; P < 0.0001).

Conclusion

Pregabalin has no marked antioxidant activity, but it contributes to the antioxidant defense system of an organism.

Effects of Single-Dose Preemptive Pregabalin and Intravenous Ibuprofen on Postoperative Opioid Consumption and Acute Pain after Laparoscopic Cholecystectomy

PURPOSE

Non-opioid medications as a part of multimodal analgesia has been increasingly suggested in the management of acute post-surgical pain. The present study was planned to compare the efficacy of the combination of pregabalin plus ıv ibuprofen.

METHODS

58 patients were included in this prospective, randomized, double-blinded study. The pregabalin group (Group P, n = 29) received 150 mg pregabalin, the pregabalin plus ibuprofen group (Gropu PI, n = 29) received 150 mg pregabalin and 400mg ıv ibuprofen before surgery. Postoperative fentanyl consumption, additional analgesia requirements and PACU stay were recorded. Postoperative analgesia was performed with patient-controlled IV fentanyl.

RESULTS

VAS scores in the group PI were statistically lower at PACU, 1and 2 hours at rest, at PACU, 1, 2, 4, 12 and 24 hours on movement compared to the group P (P < 0.05). Opioid consumption was statistically significantly higher in the group P compared to the group PI (130.17 ± 60.27 vs 78.45 ± 60.40 μq, respectively, P < 0.001) and reduced in the 4th 24 hours by 55% in group PI. Rescue analgesia usage was statistically significantly higher in the group P than in the group PI (16/29 vs 7/29, respectively, P < 0.001). Four patient in the group PI did not need any opioid drug. Besides, PACU stay was shorter in the group PI than the group P (10.62 ± 2.38 vs 15.59 ± 2.11 min, respectively, P < 0.001).

CONCLUSION

Preemptive pregabalin plus ıv ibuprofen in laparoscopic cholecystectomy reduced postoperative opioid consumption. This multimodal analgesic aproach generated lower pain scores in the postoperative period.

Effects of single-dose preemptive intravenous ibuprofen on postoperative opioid consumption and acute pain after laparoscopic cholecystectomy

BACKGROUND

Although studies involving intravenous (IV) ibuprofen are still limited, it has been shown to have a potential role in the treatment of postoperative pain. The primary objective of this study was to investigate the effects of preemptive IV ibuprofen on postoperative 24 hour opioid consumption and postoperative pain in patients undergoing laparoscopic cholecystectomy.

METHODS

Following ethical committee approval, 60 patients aged 18 to 65, American Society of Anesthesiology (ASA) I-II, and scheduled for laparoscopic cholecystectomy were included in this prospective, randomized, double-blinded study. Patients were randomly divided into 1 of 2 groups. The control group (n = 30) received 100 mL saline solution 30 minutes before surgery, while the ibuprofen group (n = 30) received 400 mg IV ibuprofen in 100 mL saline. The same general anesthesia protocol was applied in both groups, and all operations were performed by the same surgeon using the same technique. Postoperative analgesia was assessed using a visual analogue pain scale (VAS) with active and passive movements. Twenty-four hour postoperative fentanyl consumption with patient-controlled analgesia and additional analgesia requirements were recorded. Postoperative analgesia was established with 1000 mg paracetamol once every 6 hours and patient-controlled IV fentanyl.

RESULTS

Compared with the control group, VAS scores in the IV ibuprofen group were statistically lower at postoperative 30 minutes and 1, 2, 4, 8, 12, and 24 hours (P < 0.001). Twenty-four hour opioid consumption was statistically significantly higher in the control group compared to the ibuprofen group (553.00 ± 257.04 and 303.33 ± 132.08 μcq, respectively, P < 0.001). Additional analgesia use was statistically significantly higher in the control group than in the ibuprofen group (14/30 vs 5/30, respectively, P < 0.001). The rates of nausea and vomiting were higher in group control than in group ibuprofen (13/30 vs 5/30, respectively, P = 0.024). Other side-effects were similar between the groups.

CONCLUSION

A preemptive single dose of IV ibuprofen in laparoscopic cholecystectomy reduced postoperative opioid consumption in the 1st 24 hours by 45%. It generated lower pain scores in the postoperative period compared with placebo.