Byline: Hesameddin. Modir, Behnam. Mahmoodiyeh, Mehran. Azami, Armita. Behnamimoghadam, Amir. Almasi-Hashiani
Background The effectiveness of postoperative pain relief regimens is well established and postulated to rely on diverse factors. Objective The aim of this study was to compare the effect of gabapentin and melatonin and dextromethorphan on postoperative pain control in patients undergoing hip fracture surgery under general anesthesia. Patients and methods In a double-blind controlled trial 125 patients requiring hip fracture surgery enrollment into the study after following ethical approval and informed participant consent. The patients were randomized to either each of the three regimens (gabapentin, melatonin, and dextromethorphan) by the block-randomization method. Outcome measurements were of foremost importance, patient's pain scores throughout the recovery time and scheduled postoperative time intervals (2, 4, 6, 12, 24 h), doses of opioid use (mg) in the initial 24 h, and at length, sedation levels using the Ramsay scoring system at the early postoperative time intervals. Moreover, complications including chills, nausea, vomiting, and decreased consciousness were recorded. Statistical data analysis conducted by analysis of variance, [chi]2, and repeated measurements through SPSS, version 20. Results Gabapentin-treated patients manifested the lowest blood pressures (P<0.05), with maximum pain relief being experienced, sedation level being greater (P<0.05), and opioid use being lower in the group (P=0.0001). Conclusion We have the impression that gabapentin could be connected with improving pain relief and sedation, whereas opioid use was observed comparatively lower in the initial 24 h, and hence inferentially. The premedication can be driven to be superior in creating favorable conditions for analgesia and sedation and effective in preventing complications requiring treatment within 24 h postoperatively versus baseline and promisingly suggested to be continued for postoperative pain management, procedural sedation quality improvement, and opioid use reduction within the initial 24 h.
The effectiveness of postoperative pain relief regimens is well established and postulated to rely on diverse factors covering the mental status, patient type of personality, consumption or nonconsumption of alcohol and drugs before surgery, age, and surgery type ,. The multimodal combination of ketamine analgesia was corroborated to be novel and potential for postoperative pain improvement and complication reduction . Notwithstanding currently it being the most effective in managing intraoperative and postoperative pain relief, the use of opioids may be coupled with side effects limiting their use, chiefly drowsiness, apnea, nausea, and vomiting ,,. Since a smaller dose of premedication needed to be frequently administered to reduce these side effects is not able to properly provide adequate pain management; growing attention was directed toward other drugs capable of being employed along with opioids (not as a substitute) to help improve pain relief, whose adjuvant effect will cause a smaller dose of opioids to suffice to provide pain relief, with minimal side effects .
Among various effective premedication agents ,, gabapentin is believed to be a third-generation antiepileptic drug structurally similar to a-aminobutyric acid, and pharmacologically described as [1-Aminomethyl]-cyclohexaneacetic acid ,. Melatonin (N-acetyl-5-methoxytryptamine) is a hormone naturally produced in the brain, secreted by the pineal gland , whose receptors are found to...