Effect of Multimodal Perioperative Analgesia on Stress Response to Surgery and on Post-Operative Pain Score

• Main Author: K .S, Savitha
• Format: Dissertation
• Language: English
• Published: ProQuest Dissertations & Theses 01-01-2016
• Subjects: Anesthesia; Back surgery; Medicine; Nitric oxide; Surgery
• ISBN: 9798380224628

BackgroundThe multimodal analgesic drugs act at all four levels of pain pathway, as it having synergistic effects, it is effective in preventing and treating acute pain.AimThe aim of the study was to assess the effect of MMA on random serum cortisol, random blood sugar, propofol requirement for induction, and to compare post extubation sedation and VAS score between the two groups.Patients and methodsIt was a prospective , double blind, randomized clinical trial involving 42 patients belonging to the American Society of Anaesthesiologists Class I and II scheduled to undergo elective lumbar spine surgery were allocated into two groups of 21 each. Group A (study group) received injection diclofenac sodium, paracetamol, clonidine, and skin infiltration with bupivacaine adrenaline and Group B (control group) received paracetamol and skin infiltration with saline adrenaline. Pre-emptive analgesia was practiced in both the groups. BIS guided induction was done with incremental doses of Inj propofol. Two 2 ml blood samples were drawn; one just before tracheal tube placement and another one 30 min following skin incision for random serum cortisol and random blood sugar. Post operative sedation and pain score were assessed.Statistical Methods:The difference in random serum cortisol and random blood sugar were computed. Normally distributed data between the two groups (control and study groups) were compared using independent sample t-test, within each study group using paired t-test. Repeated Measure Analysis of Variance (RMANOVA) was used to compare the outcomes between control and study group with change over time. The difference in propofol requirement for induction between control and study group was computed using independent sample t-test. All categorical data between groups were compared using Chi square test. The data that was not normally distributed were compared between the groups using Mann-Whitney U test.ResultsRandom serum cortisol, random blood sugar and postoperative sedation score between the groups were comparable. Total dose requirement of propofol for induction and requirement per kg body weight were significantly low in the MMA group. All patients in the MMA group had mild pain whereas in the control group 85.7% of the patients had moderate pain. No side effects were noted in the study group.ConclusionPre-emptive MMA when judiciously administered targeting all the four elements of the pain pathway reduce consumption of anaesthetic drugs and provided optimal surgical conditions by ensuring intense analgesia with minimal adverse effects.