EVALUATE THE EFFICACY OF INTRAVENOUS LIDOCAINE AND GABAPENTIN AND THEIR COMBINATION ON POSTOPERATIVE ANALGESIA IN THYROID SURGERIES.

Main Article Content

Dr. Atahar Shamim
Dr. Vidushi Sharma

Keywords

Thyroidectomy, Analgesia, Effectiveness, Lidocaine, Gabapentin, Post Operative Time, Thyroid surgeries, VAS (Visual Analogue Scale), intravenous

Abstract

Background:As described in the report of the Lancet Commission on Global Surgery, Global Surgery 2030, approximately 30% of the global burden of disease can be attributed to surgically treatable conditions, and the role of surgical and anesthesia care in improving the and the economic productivity of countries has aroused the attention of World Health Organization (WHO). An ultimate goal of surgical treatment is approaching better recovery for a high quality of life without complications and sequalae’s. More than 80% of surgical patients experience postoperative pain which results in a variety of negative consequences and remains a considerable problem worldwide


Aims and Objectives:To Evaluate the efficacy of intravenous Lidocaine and Gabapentin and their combination on postoperative analgesia in thyroid surgeries.


 Materials and Methods: Total 51 patients have been enrolled for the study, After approval from the institutional ethical committee this cross-sectional study was carried out in the department of anesthesiology during the one year period February 2022 to February 2023 in the patients undergoing thyroid surgeries. After written consent the patients were randomly enrolled into three different treatment group for the alleviation of post i.e. L-Group- Lidocaine, G-Group- Gabapentin group, LG-Combination of both the groups. The post pain was assed at 0, 2, 4, 6, 12, 18,24 hrs. by Visual Analogue Scale (VAS) it was tabulated as Mean ± SD analyzed by ANOVA test calculated by SPSS-19 version software.


Results and Observations:Out of 51 patients 17 patients were in each group,  L-group and G-Group, LG-Group,The majority of the patients were in the age group of 40 50 i.e. 17(33.33%), followed by 50-60 14(26.67%), 30-40 10(20%), 20-30 7(13.33%), >60 were 3(6.67%) . The severity of the pain as assessed by VAS score was significantly more in the L-Group and G group as  compared to LG -Group at 0 (P<0.05) 4(p<0.05), 6(p<0.01), 12(p<0.01), 18(p<0.001), 24 (p<0.05) hours. Of post operative time. 


Conclusion: The combination of Lidocaine and Gabapentin was found to be superior to individual each drug with respect to less VAS score at various durations of post-operative period


 

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References

1. Kalmovich, L.M., Cote, V., Sands, N., Black, M., Payne, R. and Hier, M. (2010) Thyroidectomy Exactly How Painful Is It? Journal of Otolaryngology - Head & Neck Surgery, 39, 277-283.
2. Rutledge, J., Siegel, E, Belcher, R., Bodenner, D. and Stack, B.C. (2014) Barriers to Same-Day Discharge of Patients Undergoing Total and Completion Thyroidectomy. Otolaryngology-Head and Neck Surgery, 150, 770-774. https://doi.org/10.1177/0194599814521568
3. Singh, M. (2003) Stress Response and Anesthesia Altering the Peri and PostOperative Management. Indian Journal of Anaesthesia, 47, 427-434.
4. Fourcade, O., Sanchez, P., Kern, D., Mazoit, J.X., Minville, V. and Samii, K. (2005) Propacetamol and Ketoprofen after Thyroidectomy. European Journal of Anaesthesiology, 22, 373-377. https://doi.org/10.1017/S0265021505000645
5. Mathiesen, O., Wetterslev, J., Kontinen, V.K., Pommergaard, H.C., Nikolajsen, L., Rosenberg, J., et al. (2014) Adverse Perioperative Paracetamol, NSAIDs, Glucocorticoids, Gabapentinoids and Their Combinations: A Topical Review. Acta Anaesthesiologica Scandinavica, 58, 1182-1198.
6. The Lancet Commission on Global Surgery. Global surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Available from: http://media.wix.com/ugd/346076_713dd3f8bb594 739810d84c1928ef61a.pdf (or http://who.int/surgery/en/). Accessed November 01, 2017.
7. Rawal N. Current issues in postoperative pain management. Eur J Anaesthesiol. 2016;33(3):160–171.
8. Wu CL, Raja SN. Treatment of acute postoperative pain. Lancet. 2011;377(9784):2215–2225.
9. Macrae WA. Chronic post-surgical pain: 10 years on. Br J Anaesth. 2008;101(1):77–86.
10. Kehlet H, Jensen TS, Woolf CJ. Persistent postsurgical pain: risk factors and prevention. Lancet. 2006;367(9522):1618–1625.
11. Kalmovich, L.M., Cote, V., Sands, N., Black, M., Payne, R. and Hier, M. (2010) Thyroidectomy Exactly How Painful Is It? Journal of Otolaryngology - Head and Neck Surgery, 39, 277-283.
12. Rutledge, J., Siegel, E, Belcher, R., Bodenner, D. and Stack, B.C. (2014) Barriers to Same-Day Discharge of Patients Undergoing Total and Completion Thyroidectomy. Otolaryngology-Head and Neck Surgery, 150, 770-774. https://doi.org/10.1177/0194599814521568
13. Singh, M. (2003) Stress Response and Anesthesia Altering the Peri and PostOperative Management. Indian Journal of Anaesthesia, 47, 427-434.
14. Fourcade, O., Sanchez, P., Kern, D., Mazoit, J.X., Minville, V. and Samii, K. (2005) Propacetamol and Ketoprofen after Thyroidectomy. European Journal of Anaesthesiology, 22, 373-377. https://doi.org/10.1017/S0265021505000645
15. Mathiesen, O., Wetterslev, J., Kontinen, V.K., Pommergaard, H.C., Nikolajsen, L., Rosenberg, J., et al. (2014) Adverse Perioperative Paracetamol, NSAIDs, Glucocorticoids, Gabapentinoids and Their Combinations: A Topical Review. Acta AnaesthesiologicaScandinavica, 58, 1182-1198. https://doi.org/10.1111/aas.12380
16. Motamed, C., Merle, J.C., Yakhou, L., Combes, X., Vodinh, J., Kouyoumoudjian, C., et al. (2006) Postoperative Pain Scores and Analgesic Requirements after Thyroid Surgery: Comparison of Three Intraoperative Opioid Regimens. International Journal of Medical Sciences, 3, 11-13. https://doi.org/10.7150/ijms.3.11
17. Porreca, F. and Ossipov, M.H. (2009) Nausea and Vomiting Side Effects with Opioid Analgesics during Treatment of Chronic Pain: Mechanisms, Implications, and Management Options. Pain Medicine, 10, 654-662. https://doi.org/10.1111/j.1526-4637.2009.00583.x
18. White, P.F. (2005) The Changing Role of Non OpioidAnalgesic Techniques in the Management of Postoperative Pain. Anesthesia and Analgesia, 101, S5- S22
19. Ziemann-Gimmel, P., Hensel, P., Koppman, J. and Robert, M. (2013) Multimodal Analgesia Reduces Narcotic Requirements and Antiemetic Rescue Medication in Laparoscopic Roux-en-Y Gastric Bypass Surgery. Surgery for Obesity and Related Diseases, 9, 975-980. https://doi.org/10.1016/j.soard.2013.02.003
20. Hollman, M. and Durieux, M.E. (2000) Local Anesthetics and the Inflammatory Response: A New Therapeutic Indication? Anesthesiology, 93, 858-875. https://doi.org/10.1097/00000542-200009000-00038
21. Maneuf, Y.P., Gonzalez, M.I., Sutton, K.S., Chung, F.Z., Pinnock, R.D. and Lee, K. (2003) Cellular and Molecular Action of the Putative GABA-Mimetic, Gabapentin. Cellular and Molecular Life Sciences, 60, 742-750. https://doi.org/10.1007/s00018-003-2108-x
22. Backonja, M., Beydoun, A., Edwards, K.R., Schwartz, S.L., Fonseca, V., Hes, M., et al. (1998) Gabapentin for the Symptomatic Treatment of Painful Neuropathy in Patients with Diabetes Mellitus: A Randomized Controlled Trial. JAMA, 280, 1831-1836. https://doi.org/10.1001/jama.280.21.1831
23. Rowbotham, M., Harden, N., Stacey, B., Bernstein, P. and Magnus-Miller, L. (1998) Gabapentin for the Treatment of Postherpetic Neuralgia: A Randomized Controlled Trial. JAMA, 280, 1837-1842. https://doi.org/10.1001/jama.280.21.1837
24. Eckhardt, K., Ammon, S., Hofmann, U., Riebe, A., Gugeler, N. and Mikus, G. (2000) Gabapentin Enhances the Analgesic Effect of Morphine in Healthy Volunteers. Anesthesia and Analgesia, 91, 185-191.
25. Hurley, R.W., Cohen, S.P., Williams, K.A., Rowlingson, A.J., Wu, C.L. (2006) The Analgesic Effects of Perioperative Gabapentin on Postoperative Pain: A MetaAnalysis. Regional Anesthesia and Pain Medicine, 31, 237-247
26. El Shal, S. (2017) A Comparative Study of Effect of Intravenous Lidocaine Infusion, Gabapentin and Their Combination on Postoperative Analgesia after Thyroid Surgery. Open Journal of Anesthesiology, 7, 296-314. https://doi.org/10.4236/ojanes.2017.79030.