الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Postoperative pain is the most undesired consequence of surgery, and if not managed adequately, can lead to delayed recovery and increased hospital stay. Postoperative pain is insufficiently managed throughout the first world, let alone in the Third World. Yet, adequate treatment of postoperative pain remains challenging.
The use of an analgesia before surgical incision may offer one of the most innovative and promising strategies for better pain control throughout the perioperative period. Pre-emptive analgesia refers to pharmacological intervention initiated prior to a painful stimulus in order to inhibit nociceptive mechanisms before they are triggered. Different agents and techniques have been used to study pre-emptive analgesia.
Gabapentin, an anticonvulsant used extensively in the
treatment of chronic neuropathic pain, reduces postoperative pain
if given preoperatively. It has anti-hyperalgesic actions that
selectively affect central sensitization and deacreasing
postoperative pain through binding to alpha-2-delta subunit of
voltage-dependent calcium channels. On the other hand, its use is
associated with higher postoperative sedation levels. Selective cyclooxygenase-2 inhibitors (coxibs) are antipyretics, analgesics and anti-inflammatory drugs used in treatment of acute pain conditions, inflammatory disorders and in reducing the risk of the incidence of colon cancer. They are used to provide similar postoperative analgesia to non-specific NSAIDs without increasing the risk of bleeding.
Acetaminophen is among the most widely used over the counter antipyretic and analgesic drug. Unlike NSAIDs it is almost considered to have no anti-inflammatory activity. It is considered as a safe alternative to NSAIDs for the relief of mild to-moderate pain beacause of its lack of interference with platelet function.
This study compared the postoperative analgesic effect of oral premedication with gabapentin, acetaminophen and celecoxcib on eighty (80) adult patients of both sexes belonging to American Society of Anesthesiologists physical status I and II undergoing upper limb surgery under general anesthesia. The patients were divided randomly into four equal groups. All patients received oral medication 30 minutes before induction of standardized general anesthesia for all groups. UGroup G: Gabapentin group (GG):U (n=20)
These patients received oral gabapentin 1200 mg.
UGroup A: Acetaminophen group (AG):U (n=20)
These patients received oral acetaminophen 1000 mg.
UGroup C: Celecoxib group (CG):U (n=20)
These patients received oral celecoxib 400 mg.
UGroup P: Placebo group (PG):U (n=20)
These patients received oral placebo.
The following parameters were monitored during the 24 hours of the study: blood pressure, heart rate, Oxygen saturation, pain score, sedation score, rescue analgesia consumption, incidence of any episoid of nausea/ vomiting, duration of hospital stay after surgery and serum glucose & lactate levels.
The study showed that perioperative administration of gabapentin, celecoxib or acetaminophen is effective in reducing postoperative pain, postoperative analgesic consumption, as well as opioid-related adverse effects. Their use has no effect on postoperative vital data, incidence of PONV or the length of hospital stay.
Preemptive administration of oral gabapentin shows better control of postoperative pain than the other two agents yet resulting in higher postoperative sedation levels.