الفهرس 
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Abstract
Opioid analgesics, in spite of their side effects, continue to represent a cornerstone in postoperative pain control. Tramadol is a weak opioid agonist with equivalent potency to codeine. Tramadol also has adrenergic analgesic effects that complement opioid-mediated effects. It is not recommended for severe acute pain, but, is used for mild to moderate discomfort following surgery.
Pregabalin is a γ-aminobutyric acid analogue that binds to α2δ subunits of the voltage-gated calcium channels. It reduces the excitability of the dorsal horn neurones after tissue damage. The use of pregabalin for the management of postoperative pain is off-label, and therefore, there are no dosing guidelines for this indication. For other indications, the recommended starting dose is 150 mg day−1 in two to three divided doses, increased within 1 week to 300 mg day−1 with a maximum recommended dose of 600 mg day−1.
Studies investigating the perioperative use of pregabalin used doses ranging from 50 to 300 mg and daily doses ranging from 50 to 750 mg. The efficacy of perioperative administration of pregabalin was investigated in previous meta- analyses, with all showing better postoperative analgesia with pregabalin.
The aim of the work was to study the analgesic efficacy of pregabalin and tramadol for postoperative nociceptive and neuropathic pain, and assess their adverse effects in patients undergoing mastectomy.
The study was conducted at the Surgical Department Unit of the Medical Research Institute Hospital on 78 female patients between 20-60 years American Society of Anesthesiologists (ASA) physical status II, undergoing mastectomy with axillary lymphatic clearance under general anaesthesia. The patients were randomly divided into three groups using the closed envelope technique:
These three groups were: group I (control): (no. 26) received a placebo capsule orally 1 hour before anaesthetic induction and every day for seven days postoperatively. group II (tramadol): (no. 26) received a 100 mg tablets orally 1 hour before the anaesthetic induction and every day for seven days postoperatively. group III (pregabalin): (no. 26) received a 150 mg capsule orally 1 hour before the anaesthetic induction and every day for seven days postoperatively.
Our results summarized that:
- There was no statistical significant difference between group I and the other
studied groups and between group II and group III regarding age, weight, height, and the duration of surgery.
- The first request of analgesia per hours was less in group I compared to group II
and group III but was not significant.
- Regarding VAS, There was no statistical significant difference between groups I with group II at all periods. There was no statistical significant difference between groups I with group III at 1,2,4,6,12,18 hrs, and 2,3,4,5,6,7 days periods , while there was statistical significant decrease between the groups at
24hrs and 5 days period . There was no statistical significant difference between
groups II with group III at 1,2,4,6,12,18 hrs, and 2,3,4,6,7 days periods, while there was statistical significant difference between the groups at 24hrs.
- There was statistical significant difference between the three studied groups regarding the oral and IV ketorolac used for analgesia. It was less in group III in comparison to group I and group II.
- In this study comparison between the three studied groups regarding nausea and vomiting at different times demonstrated that, there was no statistical significant difference between group I and group II, between group I and group III and between group II and group III (P1, P2, P3 > 0.05) except after 1 hr (P1, P2, P3 < 0.05).
- Regarding the RAMSAY sedation score, there was no statistical significant difference between group I and group II, between group I and group III and between group II and group III at different times.
- Regarding the DN4 score, there was no statistical significant differences between the three groups before discharge but there was statistical significant differences between group I and group III at day 7 and between group II and group III at day 7, while there was no statistical significant difference between group I and group II.