Objective To study the effect of Antioxidants supplementation in reducing oxidative stress induced in acute amitriptyline poisoning cases. Design and methods We compared the effect of supplementation of treatment of acute amitriptyline poisoning cases with alpha lipoic acid alone or with vitamin C, with that of those receiving only routine standard treatment (RST) as a control group. A total of 132 subjects divided into 5 groups were selected from IMCU (Intensive Medical Care Unit) and Toxicology Ward, Govt. General Hospital, Chennai, India. The study was restricted to grade 1 coma in poisoned subjects per the Edinburg scale. Each of the subjects was in the groups were supplemented with either placebo, RST, RST with vitamin C, RST with ALA, or RST with vitamin C and ALA. Acute anti-depressant poisoning (especially with amitriptyline) induced oxidative stress caused lipid peroxidation. Plasma cholinesterases (chE) play a major role in combating this effect. A determination of the level of cholinesterase (chE) acts as an indirect indicator of the level of oxidative stress and a measure of the efficacy of antioxidant supplementation. Plasma cholinesterase estimation was done by colorimetric method. The change in color of the indicator bromothymol blue caused by the liberated acetic acid from cholinesterase read by spectrophotometer at 620 nm was used to determine the levels of cholinesterase. Result A decrease in the level of oxidative stress was observed among those supplemented with either alpha lipoic acid alone or along with vitamin C, with a slightly more decrease in oxidative stress in the latter group. A p-value of <0.001 is considered significant statistically. The percentage of the benefit of treatment on supplementation with vitamin C and alpha lipoic acid showed a marked increase in group V (26.9%) cases after supplementation with both in combination. Conclusion The results provide evidence that the oxidative stress induced by acute amitriptyline poisoning is comparatively decreased by supplementation with antioxidants like alpha lipoic acid and vitamin C, than those only on routine standard treatment.

Background: Perioperative pain is an outcome of inflammation produced by tissue trauma or direct nerve injury. Approximately 70% of patients suffer from moderate to severe pain during the perioperative period. The purpose of this study was to compare the effect of NSAIDs with opioids and NSAIDs with TCAs in the perioperative pain management of orthopedic patients. Method: This was a prospective observational study conducted for six months at the Inpatient Unit Department of Orthopedics of tertiary care Hospital. The participants were randomly divided into two groups each consisting of 40 patients. Group I treated with opioids and Group II treated with TCAs. The pain intensity of perioperative patients was assessed using the visual analogue scale (VAS). Pain outcome was evaluated using the pain outcome questionnaire (POQ). Results: A total of 80 participants were enrolled in this study, of which 54% were males and 46% were females. No significant differences in gender and age were observed between two groups (P>0.05). Each group have shown notable improvement in the pain outcome. Both the study groups have disclosed similar levels of patient satisfaction. Combination regimen proved to be more efficacious in both groups compared to individual regimen (p<0.05). Conclusion: We conclude that both opioids and TCAs have similar potential to manage perioperative pain. Frequency of adverse events was more in patients receiving opioids than TCAs. Addition of NSAID in postoperative management should be increased to reduce the dose of opioids. Hence TCAs are of better choice.

The fundamental aim of this study is to establish the role of anti-oxidant supplementation in alleviating acute amitriptyline induced oxidative stress. The effect of supplementation was compared on treatment of acute amitriptyline intoxication cases for pain management, with Alpha lipoic acid (ALA) alone or with vitamin C, with that of healthy individuals (Group I), and those receiving only routine standard treatment (RST) as control (Group II). Total of 132 human subjects divided into 5 groups were supplemented with either placebo, RST, RST with Vitamin C, RST with ALA, or RST with Vitamin C and ALA. Results of this study revealed that the decrease in the level of oxidative stress and enzyme activity was observed among those supplemented with either Alpha lipoic acid alone or along with vitamin C, with a slightly more decrease in the latter group. P value < 0.001 was considered statistically signi cant. The percentage of bene t of treatment on supplementation with vitamin C and Alpha lipoic acid showed a marked increase in-group V cases after supplementation with both in combination. The results provided that the oxidative stress induced by acute amitriptyline poisoning is comparatively decreased by supplementation with antioxidants like Alpha lipoic acid and Vitamin C, than those only on routine standard treatment.