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Acute and Chronic Pain Management

opioids for acute pain treatment in adults undergoing surgery.

Materials and Methods: This meta-analysis was performed according to the
PRISMA statement and the recommendations of the Cochrane Collaboration.
The systematic literature search was performed in MEDLINE, EMBASE and
CENTRAL. Following data ex traction relative risks (RR; 95% confidence intervals (CI)) were calculated for dichotomous outcomes, while for continuous
outcomes mean dif ferences (MD; 95% CI) were estimated.
Results and Discussion: This meta- analysis finally included 29 randomized
controlled trials including 1460 patients. Patients treated with DEX reported
lower postoperative pain intensity (MD1h postop: -1.59 U (NRS: 0-10) 95%CI:
-2.37 - -0.82; p=0.000001) and showed a lower postoperative opioid consumption (MD24h postop: -17.24mg; 95%CI: -24.38 - -10.10; p=0.00001) compared to placebo. Additionally the DEX group showed a lower RR for opioid
related adverse events (e.g. RRPONV (early): 0.53 (95%CI: 0.37 - 0.76; p=0.0006).
The most common adverse event in patients treated with DEX was intraoperative bradycardia with a RR of 2.66 (95%CI: 1.54 - 4.58; p=0.00004) compared
to placebo. Due to limited included data only a very low number of outcomes
for the comparison with opioids could be pooled.
Our data provide ample evidence that DEX administration compared to placebo is an ef fective intervention for postoperative pain treatment. The most
common adverse ef fect was intraoperative bradycardia following DEX administration. Thus caution might be warranted in patients with a higher risk for
a stroke or myocardial infarction; this should be investigated in large trials
focusing on safety issues of intraoperative DEX coadministration. Evidence
regarding the comparison of DEX with opioids is currently less clear and renders further research.
Conclusion(s): Adults treated with intraoperative dexmedetomidine infusion
reported lower postoperative pain intensities, consumed less postoperative
opioids and showed less opioid-related adverse events compared to placebo.

14AP6-10

Retrospective study comparing continuous preperitoneal

versus epidural local anesthetics infusion for abdominal
surgery
Polo Gil M., Zugasti O., Pavon A., Perez Bergara E., Baldeon E., Dufur M.
Complejo Hospitalario de Navarra, Dept of Anaesthesiology, Pamplona, Spain
Background and Goal of Study: Pre-peritoneal catheters (PPC) for local anesthetic infusion have been associated with shorter length of stay (LOS)1.
We compare the analgesic ef ficacy and complications of PPC versus thoracic
epidural (TE) in midline laparotomy.
Materials and Methods: Age, gender, surgical procedure, emergency of
surgery, 24, 48 and 72 hours pain scores, supplementary analgesia, sideef fects(nausea-vomiting and local anesthetics toxicity), complications (peristalsis recovery, wound infection), and LOS of patients who underwent midline laparotomy throughout one year were retrospectively reviewed.
Numeric rating scale (0-11) was utilized to measure pain. Pain scores were
subsequently classified into severe (10-7), moderate (6-4), mild (3-1) and no
pain (0) categories.
All the PPC elastomers delivered 5 ml h-1 0,375% levobupivacaine. TE elastomers contained 0,125% levobupivacaine that was infused at a variable rate of
5-12 ml h-1. Intravenous paracetamol 1gr/6 h, and dexketoprophen, 50 gr/8h
were prescribed. Tramadol was administered on patient request.
Dif ferences in pain category frequencies were tested with Pearsons 2. T
Student was used to work out dif ference in hospital LOS.
Results and Discussion: Two hundred twenty-seven laparotomies were reviewed. 50,7% patients received epidural, 28,6% intravenous PCA with morphine, and 20,7% PPC. Infusion times for TE and PPC ranged from 24 to 96
hours. Urgent surgery was significantly more frequent in PPC group (45% vs
12,8%) The reasons to use PPCs were contraindication or technical impossibility to place an epidural catheter in 70%, and laparoscopy conversion to
open surgery in 30% of the cases.
Both techniques showed similar ef fectiveness for postoperative pain management. Zero pain was more frequent in TE. No patient in either group had
severe pain 48 h af ter surgery, however tramadol was demanded 6% more
frequently by patients carrying PPC.
Complication rate was similar in both groups (21,3% vs 26%).
LOS was longer in PPC group (15,8 vs 12,7 days).
Conclusion(s): PPC was an ef fective alternative analgesic approach for those
patients in whom epidural catheter insertion is either impossible or contraindicated. A bigger sample size, enrolling a greater percentage of scheduled
procedures would be needed to confirm the impact on LOS.
References:
1. Gross ME et al. Am J Surg 2011:202:765-770

14AP6-11
Ef ficacy of ketorolac vs. tramadol in the treatment of
postoperative pain in orthognatic surgery
Gecaj-Gashi A., Nikolova Z., Uka S., Bruqi B., Krasniqi I., Hashimi M.
Universit y Clinical Center of Kosovo, Dept of Anaesthesiology & Intensive
Care, Prishtina, Albania
Background and Goal of Study: The first objective of this study was to assess analgesic ef ficacy of ketorolac and tramadol administered IV in treatment of postoperative pain. Secondary objectives were the evaluation of the
incidence of side ef fects and patient satisfaction.
Materials and Methods: Af ter their informed consent, 64 patients ASA I-II,
aged 18- 65 years, undergoing orthognatic surgery, were enrolled in this
double blind, randomized clinical study. The patients were randomly allocated
in two equal groups: group KTR n=32 received ketorolac (Eumat, Epifarma
S.r.l.) 30 mg IV and group TMD n=32 tramadol (Tramadol Basi, Laboratrios
Basi -S.A.)100 mg IV. The time of the first administration of both drugs was at
the time of skin closure and repeated every 8 hrs in first 24 hrs postoperatively.
Morphine Sulphate 3-5 mg IV was used as a rescue analgesic. Analgesic efficacy was assessed using a visual analog scale VAS from 1-10, in 2(T0),4(T1),
6(T2),8(T3),12(T4),and 24 (T5)hours from the end of surgery. The side ef fects:
nausea, vomiting, allergic reactions, itching, headache, disorientation were
assessed and recorded at T0, T1, T2,T3,T4 and T5.Patient satisfaction was
assessed through Satisfaction Rating Scale -SRS (0=not satisfied,1=not very
satisfied,2=quite satisfied, 3=satisfied,4=very satisfied).
Results and Discussion: There were no significant dif ferences between the
groups with respect to demographic data and duration of anesthesia. Good
postoperative analgesia was recorded in both groups. There is no dif ference
between K RT and TRD groups in the pain scores measured, except at the
T1.VAS score (KTR vs. TRD) were (4.1vs 5.0, p=NS at T0, (2.8 vs. 5.9, p<
0.05) at T1, (2.2 vs. 2.6, p=NS) at T2, (2.0 vs. 2.5, p=NS) at T3, (2.7 vs. 2.4,
p=NS) at T4, (1.1 vs. 1.2, p=NS) at T5.Only a 3 patients in TRD group at T3
required morphine administration to achieve adequate analgesia.
Side ef fects were reported in 54% of patients of TRD group and in 8.0% of
patients of KTR group (p < 0.005). Treatment with ketorolac was considered
satisfactory by patients average score with the SRS > 3 at T0, T1, T2, T3, T4,
and T5, whereas with tramadol SRS was >3 at T0, T1, and < 2 at T2, T3, T4,
and T5 (p< 0.05).
Conclusion(s): Ketorolac and tramadol produced comparable ef fective postoperative analgesia, but ketorolac showed significant advantage over tramadol considering side ef fects.

14AP7-1

Ef fect of oral pregabalin on opioid-induced hyperalgesia in

patients undergoing laparo-endoscopic single-site urologic
surgery
Cheol L., Yoon-Kang S.
Wonk wang Universit y College of Medicine, Dept of Anaesthesiology & Pain
Medicine, Iksan, Korea, Republic of
Background: Pregabalin is an antiepileptic drug that is ef fective for treating
postoperative pain, neuropathic pain, anxiety, and hemodynamic instability.
The aim of this study was to investigate the ef fect of a single preoperative
dose of pregabalin in patients with opioid-induced hyperalgesia (OIH).
Materials and Methods: Ninety ASA I-II patients undergoing laparoendoscopic single-site urologic surgery were randomly assigned to one of the following three groups that received either pregabalin or placebo 1 h before
anesthesia and an intraoperative remifentanil infusion. Group plL received
placebo and 0.05 g/kg/min remifentanil, group plH received placebo and 0.3
g/kg/min remifentanil, and group prH received 300 mg pregabalin plus 0.3
g/kg/min remifentanil. The primary endpoint was pain intensity upon movement 1, 6, 12, and 24 h af ter surgery. Secondary endpoints were the area
of hyperalgesia and mechanical hyperalgesia threshold 24 h af ter surgery,
time to first postoperative analgesic requirement, and cumulative postoperative volume of morphine administered via a patient-controlled analgesia (PCA)
pump over 24 h.
Results and Discussion: The time to first postoperative analgesic requirement in group plH was significantly shorter than that in group plL. The injected
PCA volume was significantly greater in group plH than that in the other two
groups. Postoperative pain intensity in group plH was significantly greater
than that in the other two groups at 6, 12, and 24 h af ter surgery. The mechanical hyperalgesia threshold and the area of hyperalgesia around the
surgical incision 24 h af ter surgery in group plH dif fered significantly from
those in the other two groups, which were not significantly dif ferent. Adverse
ef fects were comparable among groups. Taken together, pregabalin alone