A study of effectiveness of Intravenous Lidocaine and Gabapentin and their combination on postoperative analgesia for thyroid surgeries at tertiary health care center

 

K Vijay Kumar¹, N Sadanandam^2*

 

¹Sr. Resident, ²MICU Intensivist, Department of Anesthesiology, Gandhi Medical College, Secundrabad, INDIA.

Email: sada2k3@gmail.com

 

Abstract               Background: An ultimate goal of surgical treatment is approaching better recovery for a high quality of life without complications and sequelaes. More than 80% of surgical patients experience postoperative pain. Aims and Objectives: To Study Effectiveness of Intravenous Lidocaine and Gabapentin and Their Combination on Postoperative Analgesia for Thyroid Surgeries at tertiary health care center. Methodology: After approval from the institutional ethical committee this cross-sectional study was carried out in the department of anesthesiology during the two year period February 2013 to February 2014 in the patients undergoing thyroid surgeries. After written consent the patients were randomly enrolled into three different treatment group for the alleviation of post-operative pain i.e. L-Group- Lidocaine, G-Group- Gabapentin group, LG-Combination of both the groups. The post -operative 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. Result: The majority of the patients were in the age group of 40-50 i.e. 33.33%, followed by 50-60, 26.67%, 30-40-20.00%, 20-30-13.33%, >60 were 6.67%. The majority of the patients were Female i.e. 53.33% and Males were 46.67%. 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), 2 (P<0.05), 4 (P<0.05), 6 (P<0.01), 12(P<0.01), 18 (P<0.001),24 (P<0.05) hrs. 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.

Key Words: Lidocaine, Gabapentin, Thyroid surgeries, VAS (Visual Analogue Scale).

 

 

 

 

INTRODUCTION

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 health of individuals and the economic productivity of countries has aroused the attention of World Health Organization (WHO).¹ 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,² the under treatment of which results in a variety of negative consequences and remains a considerable problem worldwide.³ Persistent postsurgical pain (PPP), the incidence of which being up to 30–50%, originating from surgical intervention and acute postoperative pain without adequate management, has major negative effects on the individual’s quality of life and places a heavy burden to the society disturbing millions of people globally and challenges for perioperative physicians.^3–5 

 

MATERIAL AND METHODS

After approval from the institutional ethical committee this cross-sectional study was carried out in the department of anesthesiology during the two year period February 2013 to February 2014 in the patients undergoing thyroid surgeries. After written consent the patients were randomly enrolled into three different treatment group for the alleviation of post-operative pain i.e. L-Group- Lidocaine, G-Group- Gabapentin group, LG-Combination of both the groups. The post -operative 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.

 RESULT

 

Table 1: Distribution of the patients as per the Age

Age	No.	Percentage (%)
20-30	6	13.33
30-40	9	20.00
40-50	15	33.33
50-60	12	26.67
>60	3	6.67
Total	45	100.00

The majority of the patients were in the age group of 40-50 i.e.33.33%, followed by 50-60 26.67%, 30-40-20.00%, 20-30-13.33%, >60 were 6.67%.

 

Table 2: Distribution of the patients as per the sex

The majority of the patients were Female i.e. 53.33% and Males were 46.67%.

 

Table 3: Distribution of the patients as per severity pain postoperatively (VAS)

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), 2 (P<0.05), 4 (P<0.05), 6 (P<0.01), 12(P<0.01), 18 (P<0.001),24 (P<0.05) hrs. of post-operative time.

 

DISCUSSION

Thyroidectomy is a widely applied surgical procedure for management of thyroid diseases. Many patients may complain of moderate to severe postoperative pain following thyroid surgery particularly during the first postoperative day due to various causes including skin incision, extensive tissue dissection, pharyngolaryngeal discomfort after intubation, neck hyperextension, surgical manipulation and inflammation^6,7. Surgical manipulations and inadequate pain control can also induce perioperative complex stress response with neurohumoral, metabolic and immunological changes that may be manifested as an increase in heart rate and blood pressure, hyperglycemia and release of different cytokines⁸. Different techniques or medications including local anesthetics infiltration, non-steroidal anti-inflammatory drugs (NSAID) or opioids have been used for postoperative analgesia. Although (NSAID) may be beneficial analgesics, many surgeons do not prefer them in thyroidectomy patients to limit the risk of postoperative bleeding^9,10. On the other hand, opioids have been associated with some adverse events as respiratory depression and frequent postoperative nausea and vomiting^11,12. So it was necessary to find safe analgesic techniques for these patients by using either different adjuvant therapies or multimodal analgesia by combining different drugs and techniques with different modes of action to improve the quality of postoperative analgesia and to decrease the doses of systemic opioids and their related side effects^13,14. Lidocaine is a local anesthetic drug that produces an analgesic and antihyperalgesic effects by modifying the response of neurons in the dorsal horn to noxious stimuli, and it has an anti-inflammatory effect by inhibiting migration and metabolic activation of leukocytes¹⁵ Gabapentin (1-aminomethyl cyclohexane acetic acid) is related to the neurotransmitter gamma-amino butyric acid (GABA), its analgesic effect is mediatedby binding to the α2δ subunit of voltage-dependent calcium channels¹⁶. It was mainly used as an anticonvulsant drug, but it has been detected to be effective in diabetic neuropathy, neuropathic pain, and postherpetic neuralgia^17,18,19. Gabapentin may reduce or prevent acute nociceptive and inflammatory pain especially if given 1 - 2 hours preoperatively. A Previous study had shown synergism between gabapentin and morphine for postoperative analgesia²⁰. Some previous meta-analysis reviews stated that gabapentin was an effective adjunct for treatment of the postoperative pain in various procedures and it can be used in multimodal analgesia planes. In our study we have seen that The majority of the patients were in the age group of 40-50 i.e.33.33%, followed by 50-60, 26.67%, 30-40-20.00%, 20-30-13.33%, >60 were 6.67%. The majority of the patients were Female i.e. 53.33% and Males were 46.67%.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), 2 (P<0.05), 4 (P<0.05), 6 (P<0.01), 12(P<0.01), 18 (P<0.001),24 (P<0.05) hrs. of post-operative time, these findings are similar to Sahar El Shal²¹they found (LG) group had significant lower intraoperative fentanyl and lower postoperative tramadol consumption (p < 0.001) compared to (P), (L) and (G) groups, with prolonged time of first analgesic request (p < 0.001) compared to (P) and (L) groups, and lower VAS compared to other groups (p < 0.001 or p < 0.01).

 

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.

 

REFERENCES