There are studies that have demonstrated the role of pregabalin as a pre-emptic analgesic in the multimodal therapy for acute postoperative pain management. However, its use in more painful operative procedures like open cholecystectomy are limited and hence the present study was undertaken to evaluate the effectiveness of a single dose of preoperative oral pregabalin in attenuating the postoperative pain. In this randomized, controlled, prospective and double blind study, 80 patients (ASA I & II, aged 18-55 years and of both sexes) undergoing open cholecystectomy under GA were divided into two equal groups (n=40 each) to receive either oral pregabalin 150mg or placebo 1 hour before the surgery. Intraoperative hemodynamic variables, postoperative VAS scores, sedation scores, analgesic free time intervals, total dose of rescue analgesic, side effects etc. were recorded and compared for the first 24 hours postoperatively. VAS score distribution in the first 24 hours were significantly lower in the pregabalin group than the control group (P<0.05). The analgesia free time interval was longer and the number of rescue analgesic(inj. tramadol 50mg) was lesser in the pregabalin 150mg (P<.05). Preoperative pregabalin 150 mg administered 1 hour prior to surgery attenuates the postoperative pain thereby reducing opioid consumption. KEYWORDS:Pregabalin, open cholecystectomy, pre-emptic analgesia and postoperative pain. INTRODUCTION:Post-operative pain is the most common clinical problem in hospitals among surgical patients and is the main reason for overnight hospital stay in17-41% of surgical day care patients. 1 It has been managed with varieties of drugs and techniques such as combination of opioids, non-steroidal anti-inflammatory drugs (NSAIDS) or paracetamol, small dose ketamine, peri-operative administration of local anesthetics, interventional techniques like epidural and nerve blocks etc. which are associated with potential risks of serious complications. Thus, with the emerging concepts of pre-emptive analgesia, a drug that has analgesic properties, opioid sparing effects, possibly reduces opioid tolerance, relieves anxiety and is not associated with adverse effects typical for the traditional analgesic would be an attractive adjuvant for post-operative pain management. 2 Pregabalin and its developmental predecessor gabalin were originally developed as spasmolytic agents and adjuncts for the management of generalized or partial epileptic seizures resistant to conventional therapies. Pregabalin, like gabapentin is an amino-acid derivative of gamma amino butyric acid. It binds to the α2-δ (type I) receptor in the central nervous system. Binding of pregabalin to the α2-δ (type I) subunit of voltage gated calcium channels alter the kinetic and voltage dependence of calcium current. By reducing calcium influx at the nerve terminal pregabalin reduces the release of several neurotransmitters including glutamate, substance-P, noradrenaline and calcitonin gene related peptide. This accounts for the analgesic activity of pre...

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Introduction: Postdural Puncture Headache (PDPH) is the most common complication of dural puncture. Clinical studies have shown that use of small guage needles with pencil point tip is associated with lower incidence and severity of PDPH than with cutting tip needles. Aim: To compare the incidence and severity of PDPH between 25G cutting (Quincke) and 25G non cutting (Whitacre) needles. Materials and Methods: In this randomised controlled study conducted at Jawaharlal Nehru Institute of Medical SciencesImphal, Manipur, India from September 2019 to September 2021. A total of 150 patients of both sexes, age <60 years and American Society of Anaesthesiologists (ASA) grade I and II, undergoing lower abdominal or lower limb surgeries under spinal anaesthesia were enrolled for this study and divided into two groups with 75 patients in each group. Spinal anaesthesia was performed with 25G Quincke needle in one group and 25G Whitacre needle used in other group to compare the incidence and severity of PDPH (severity was determined by limitation of patient activity and treatment required). Results: Overall 14 patients (9.33%) developed PDPH – 2 in the Whitacre spinal needle (2.6%), and 12 in the Quincke spinal needle (16%), with p-value of 0.009. The incidence of failed spinal anaesthesia was significantly higher with Whitacre spinal needle 12 (16%) than with Quincke needle 4 (5.3%), with p-value of 0.03. Incidence of PDPH was more in female patients 12 (14.8%) compared with male patients 2 (2.9%),with p-value of 0.018. Severity of PDPH ranged from mild (n=10) to moderate (n=2) in Quincke needle group, whereas in Whitacre group patients had only mild form of PDPH (n=2). Conclusion: Incidence and severity of PDPH was significantly lower in 25G Whitacre spinal needle than 25G Quincke needle. Failure rate of spinal anaesthesia was more in Whitacre needle than in Quincke needle.