الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Despite recent advances in understanding of physiology of acute pain, development of new opioid and non-opioid analgesics and novel methods of drug delivery, and more widespread use of pain-reducing minimally invasive surgical techniques, pain after surgical procedures remains a challenge for many practitioners. Not surprisingly, recent surveys in the United States and Europe have emphasized the insufficient quality of postoperative pain management and the need for further improvements.
Postoperative analgesia could be achieved by many methods either systemic (pre-emptive, intra-operative or post-operative), neuroaxial or wound infiltration. None of them are optimal or without side effect.
This leads us to multimodal analgesic therapy, with the goal of obtaining synergistic or additive analgesia with fewer side effects by combining lesser amounts of each drug with different mechanisms of action. The addition of non-steroidal anti-inflammatory drugs (NSAIDs) has been shown to potentiate opioids effect, decrease opioids consumption and reduce side effects.
Meloxicam is one of the NSAIDs which preferentially inhibit the cyclooxygenase (COX)-2. The relative ratio of COX-1: COX-2 inhibition of meloxicam on humans was shown to be 1:10–13.
Gabapentin is an anti-epileptic drug that has demonstrated analgesic effect in neuropathic pain. Recently, it has been effectively used to reduce pain and opioid requirement during postoperative period of various kinds of surgery.
Aim of the work:
The aim of this work was to study the effects of preemptive gabapentin, meloxicam or their combination on postoperative pain after fixation of femoral fractures.
Patients:
The study was carried out on 60 adult patients 30 – 50 years old, ASA I or II underwent internal fixation of femoral fracture under general anesthesia in Hadara Hospital.
Patients were randomly categorized into three equal groups by the closed envelope technique, 20 patients each:
Group I: Patients received preoperative 1200 mg gabapentin orally (300 mg on the evening of surgery, and 900 mg two hours before induction) and continued postoperatively by a dose of 300 mg gabapentin every 8 hours for 48 hours.
Group II: Patients received preoperative 15 mg meloxicam orally two hours before induction and continued postoperatively by a dose of 15 mg meloxicam every 24 hours for 48 hours (at the morning of postoperative days 1 and 2).
Group III: Patients received a combination of gabapentin and meloxicam as follow;
• Preoperative 1200 mg gabapentin orally (300 mg on the evening of surgery, and 900 mg two hours before induction) and continued postoperatively by a dose of 300 mg gabapentin every 8 hours for 48 hours.
• Preoperative one tablets of 15 mg meloxicam preoperatively orally two hours before induction, and continued postoperatively by a dose of 15 mg meloxicam every 24 hours for 48 hours (at the morning of postoperative days 1 and 2).