الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 196 |  |  |
| | | from | 196 | | |
Abstract
Postoperative nausea and vomiting (PONV) is an important clinical problem that still affects patients undergoing surgery with general anaesthesia. With no prior prophylaxis, approximately 30% of all patients suffer from nausea and vomiting in the post-anaesthetic period, whereby the highest incidence can be found in the first 6 hours after surgery.
Compared to the many studies about PONV, little attention has been paid to nausea and vomiting occurring during or after regional anaesthesia. These techniques gain increasing attention. Nowadays, about 7% of all surgical procedures worldwide are caesarean sections (CSs) and the majority of them are performed with neuraxial blockades.
Especially in these patients, nausea and vomiting are also present during the surgical procedure causing discomfort for the parturient, impair surgical conditions for the obstetrician and can lead to medical side effects such as aspiration of gastric content, enhanced intra and postoperative pain and even bleeding or surgical trauma.
Pain is the worst fear of women undergoing caesarean delivery. Post-caesarean delivery pain hinders the mother’s ability to care for and feed her newborn infant. Hence, the traditional separation between the acute and chronic pain is unproven because the acute pain may quickly turn into chronic pain which is associated with higher rates of depression, anxiety and sleep disturbance. Also, the intensity of acute postoperative pain is a significant predictor of chronic postoperative pain. Preventing central sensitization with multimodal analgesic interventions could reduce the intensity or even eliminate acute postoperative pain, hyperalgesia and chronic pain after surgery. Furthermore, pain control after caesarean delivery improve the general condition of the patient and infant rooming in times of breastfeeding.
Gabapentin is a drug with chemical structure that mimics that of the neurotransmitter GABA (gamma amino butyric acid) and acts on the same brain receptors. However, the mode of action is not fully understood. Among other mechanisms like decrease in the synthesis of the neurotransmitter glutamate, gabapentin acts by binding to the a2d subunit of voltage-dependent ca+2 and Na channels. It has introduced as antiepileptic drug but proved to be effective in controlling neuropathic pain.
Recently, gabapentin has been used to reduce pre-operative anxiety, acute postoperative pain, postoperative opioid requirements and postoperative nausea, vomiting and delirium.
Midazolam, a short-acting benzodiazepine, has been used widely for pre-medicating patients because of its anxiolytic quality. It has also been used as a co-induction agent for spinal anaesthesia because of its amnestic properties, and it has also been reported to have benefits with regard to nausea and vomiting by reducing anxiety via lowering dopaminergic input to chemoreceptor trigger zone (CTZ).
Moreover, midazolam may offer the benefits of lower cost and fewer side effects, such as headaches and extra-pyramidal symptoms, that have been reported with other antiemetics. In several studies, traditional antiemetics did not provide superior benefits or outcomes compared with midazolam.
Granisetron is a selective 5-HT3 receptor antagonist and has more potent and longer-acting properties than ondansetron for the treatment of cisplatin-induced emesis. Recently, granisetron has been found to have a prophylactic antiemetic effect on PONV in patients undergoing surgery under general anaesthesia.
The aim of this study is to compare between Gabapentin, Midazolam and Granisetron safety and efficacy in managing PONV.
Evaluating target drugs in sedation, amnesia and pain control for a parturient undergoing a caesarean section under spinal anaesthesia.
And assess the efficacy of target drugs to reduce the hazards of polypharmacy in order to reach maximum benefit for the parturient and neonate.
In this study, 90 patients were randomly divided into 3 equal groups; Gc: control group had received Granisetron 40 ug/kg intravenous immediately before induction of anaesthesia and group Gm: Midazolam group had received Midazolam 20ug/kg intravenous immediately before induction of anaesthesia and group Gg: Gabapentin group
had received a capsule of 600 mg orally one hour before induction of anaesthesia and a syringe of isotonic saline intravenously immediately before induction of anaesthesia to ensure the blindness of the anaesthetist.
This study showed that Gabapentin and midazolam offered management of PONV for parturients just like the control drug (Granisetron). Regarding pain the Gabapentin offered analgesia all through the postoperative 8 hours compared to the midazolam which offered analgesia for only 4 hours postoperatively but the two drugs gave the same results in decreasing the analgesic requirements all through the postoperative period. Regarding amnesia the Midazolam was distinct in offering amnesia compared to the two other groups which offered no amnestic effects. In contrast all three groups showed no remarkable sedation or effect on neonatal well-being.