الفهرس 
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Abstract
Summary
Although postoperative pain is arguably the most common clinical problem in hospitals, it is often dismissed with an order for intermittent intramuscular analgesic injections to be given at the discretion of an overworked nursing staff. This generally results in patients waiting for pain relief, then a period of relief and perhaps drowsiness, and then the cycle is repeated. With this method, pain relief is only satisfactory (i.e. adequate relief without unwanted sedation) for about one-third of the time.
Good postoperative analgesic management probably carries benefits other than increased patient comfort. The magnitude of the neuro-endocrine stress response, postoperative pulmonary complications and the incidence of myocardial ischemia can be decreased. Early mobilization can be achieved and the patient can be discharged from hospital sooner.
Although opioids are suitable for intense postoperative pain, they have common side-effects, such as post-operative nausea and vomiting (PONV) and fatigue.
Recently accumulated experimental evidence supports an important role of melatonin (N-acetyl-5-methoxytryptamine) in anxiolysis and analgesia. Melatonin is a naturally occurring hormone in the human body that is secreted by the pineal gland in the dark and inhibited by exposure to light. The manufacturing and general use of exogenous melatonin remains unregulated because melatonin is not a Food and Drug Administration approved drug. Oral administration of 1–5 mg of melatonin results in plasma levels of 10–100 times more than the observed endogenous nighttime levels.
It has an excellent safety profile, and the minor adverse effects that may be associated with its use are drowsiness, headache, gastrointestinal disturbances, rash, and insomnia. In contrast to benzodiazepines, melatonin produces no residual effects or suppression of rapid eye movement sleep.
Tramadol has been in clinical use since the late 1970s and has proven effective in both experimental and clinical pain without causing serious cardiovascular or respiratory side effects. Moreover, the negligible abuse potential of tramadol has meant that it has never been a restricted drug, so, it is very quickly became the most popular analgesic of its class. Also several clinical studies have demonstrated that tramadol SR is an effective agent for moderate to severe chronic pain.
Inspite of side-effect profile of tramadol in comparison with other analgesics, tramadol may have a role in patients who are intolerant of conventional opioid and other non-opioid analgesics. But also, the effectiveness of melatonin in alleviating pain and reducing requirements for opioids in the postoperative period has been well-documented.
The present study was undertaken to compare the effect of melatonin tablet to tramadol sustained release tablet as a premedication on postoperative analgesia in patients undergoing abdominal hysterectomy surgeries.
This study was conducted on 88 female patients with an age ranged between (22-65 years) of ASA I or II scheduled for total abdominal hysterectomy. Patients were randomly divided into 4 groups (22 patients each). Group (T): each patient received tramadol sustained release 100 mg tablet. Group (M6): each patient received melatonin 6mg tablet. Group (M9): each patient received melatonin 9 mg tablets. Group (P): each patient received placebo tablets.
All patients of the 4 groups were supplemented postoperatively with intravenous fentanyl through PCA device. The PCA solution contained 10 μg/ml and the apparatus was programmed to deliver 25 μg of fentanyl as a demand dose with 10 min lockout time.
After instructing the patients about the drugs, its effects, probable side effects and how to use PCA apparatus and VAS, full history and examination of the patients were done.
One hour pre-operatively, baseline vital signs of each patient were taken in the ward and random administration of the study drug.
Comparison was based on:
All patients were assessed for 24 hours postoperatively for:
1) Vital signs of the patient including (mean arterial blood pressure, heart rate, respiratory rate).
2) Monitoring of the postoperative 1st request of analgesia using the PCA delivery system for I.V. fentanyl.
3) Monitoring of the total consumption of fentanyl over the 1st 24 postoperative hours.
4) Assessment of pain intensity was assessed according to Visual Analogue Scale (VAS) of pain score ranged between 0-10 where 0-3 means mild pain; 4-6 means moderate pain, 7-10 means intolerable pain.
The present study demonstrated significant post operative analgesic effects of the preoperative administration of either tramadol sustained release tablets compared to melatonin 6mg, melatonin 9mg or the placebo group. This was evident in the time to first request for supplemental analgesia was markedly shorter in the placebo group than in either tramadol and melatonin groups. Moreover, the total dose of supplemental fentanyl given in the first 24 postoperative hours was less with the tramadol SR and melatonin premedication than in the placebo group.
Additionally, pain intensity scores in the tramadol SR and melatonin groups were significantly lower than that of the placebo group. Lastly, there was hemodynamic stability in the patients of both tramadol sustained release and melatonin.