Dr. Manasa Vijay,
BACKGROUND Preventing and treating post-operative pain after TKR remains challenging as it plays an important role in early mobility, decreasing hospital stay and decreasing complications like DVT, pulmonary embolism, and nosocomial infections. Pre-emptive analgesia is where analgesia is initiated before surgery. This study was done to compare the pre-emptive efficacy of an NSAID alone and when combined with a GABA analogue and when GABA analogue is used alone with respect to duration of analgesia, reduction in total post-operative requirements of opioids and NSAIDS in acute post-operative period. METHODS Ninety patients of either sex in ASA grade I and II were randomly allocated to one of the three groups of thirty each. Patients in Group A were given single dose of pregabalin 150 mg with tab ketorolac 10 mg, whereas patients in Group B were administered only pregabalin 150 mg, and patients in group c were given only tab ketorolac 10 mg one hour prior to administration of spinal anaesthesia. Time from spinal anaesthesia to the first dose of rescue analgesia was noted. Pain was assessed by Visual Analogue Scale at 12 hr and 24 hrs. Total amount of NSAID (paracetamol) and opioid (butorphanol) required was compared between the 3 groups. RESULTS Pre-emptive analgesia with the combination of ketorolac and pregabalin are effective in decreasing the acute pain sensation after total knee replacement. Pregabalin alone has no role in acute post-operative period. Ketorolac when used alone has modest analgesic effect in acute post-operative period. We observed that the patients who were prescribed with pregabalin were not anxious while they were shifted to OT. Post operatively only one patient had dizziness. 4 patients in group A had bradycardia which got revived with treatment. No other adverse effects were observed. CONCLUSIONS Combined ketorolac and pregabalin when used as preemptive analgesia showed better analgesic adequacy in acute post-operative period. Ketorolac alone showed moderate analgesic adequacy and pregabalin alone has no role as analgesic in the acute post-operative period.
