Comparative Pre-Emptive Analgesic Efficacy Study of Novel Antiepileptic Agents Lamotrigine and Topiramate in Patients Undergoing Major Surgeries at a Tertiary Care Hospital: A Randomized Double Blind Clinical Trial

Overview

Journal Ann Neurosci

Publisher Sage Publications

Specialty Neurology

Date 2016 Oct 11

PMID 27721585

Citations 4

Authors

Ankush Gupta

Uma A Bhosale

Priyank Shah

Radha Yegnanarayan

Shalini Sardesai

Affiliations

Soon will be listed here.

Abstract

Background: Central nervous sensitization, following surgical injury, leads to postoperative pain hypersensitivity due to lowered pain threshold in peripheral nociceptors and increased excitability of spinal neurons. Pre-emptive analgesia is intended to decrease pain perception and overall analgesic need by use of drug regimen, seizing CNS sensitization before exposure to painful stimuli. Few studies support pre-emptive analgesic efficacy of novel antiepileptic agent Gabapentin. Though Topiramate and Lamotrigine have been proven analgesic in animal models of chronic pain and clinical studies of Gabapentin-resistant neuropathic pain, literature search revealed scarce data on its pre-emptive analgesic efficacy.

Purpose: This study is designed to study and compare the pre-emptive analgesic efficacy of Lamotrigine, Topiramate, and Diclofenac sodium in postoperative pain control.

Methods: This randomized clinical trial included 90 patients of either sex, between 18 and 70 years undergoing major surgeries. Patients were randomly allocated to control and test groups and received respective treatment 30 min before induction of anesthesia. Aldrete's and pain scores were recorded using the Visual Analog Scale, Facial and Behavioral Rating Scale at awakening and at 1, 2, 4, 6, and 24 h. Postoperative rescue analgesic consumption for 24 h was recorded.

Results: Significantly higher pain scores were observed in the Topiramate group postoperatively for 2 h on all pain scales (p < 0.05), whereas in the control group it was significantly higher at 1 h (p < 0.05). Lamotrigine-treated patients were more comfortable throughout the study with significantly less (p < 0.05) postoperative analgesic requirement.

Conclusions: Study results strongly suggest the pre-emptive analgesic efficacy of a single oral dose of Lamotrigine over Diclofenac and Topiramate in postoperative pain control.

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References

Woolf C, Shortland P, Coggeshall R . Peripheral nerve injury triggers central sprouting of myelinated afferents. Nature. 1992; 355(6355):75-8. DOI: 10.1038/355075a0. View

Porreca F, Ossipov M, Gebhart G . Chronic pain and medullary descending facilitation. Trends Neurosci. 2002; 25(6):319-25. DOI: 10.1016/s0166-2236(02)02157-4. View

Vinik A, Tuchman M, Safirstein B, Corder C, Kirby L, Wilks K . Lamotrigine for treatment of pain associated with diabetic neuropathy: results of two randomized, double-blind, placebo-controlled studies. Pain. 2006; 128(1-2):169-79. DOI: 10.1016/j.pain.2006.09.040. View

Bhosale U, Khobragade R, Naik C, Yegnanarayan R, Kale J . Randomized, double-blind, placebo-controlled study to investigate the pharmacodynamic interaction of 5-HT3 antagonist ondansetron and paracetamol in postoperative patients operated in an ENT department under local anesthesia. J Basic Clin Physiol Pharmacol. 2014; 26(3):217-22. DOI: 10.1515/jbcpp-2014-0070. View

Kissin I . Preemptive analgesia. Anesthesiology. 2000; 93(4):1138-43. DOI: 10.1097/00000542-200010000-00040. View

Krarup C . An update on electrophysiological studies in neuropathy. Curr Opin Neurol. 2003; 16(5):603-12. DOI: 10.1097/01.wco.0000093104.34793.94. View

Parikh H, Dash S, Upasani C . Study of the effect of oral gabapentin used as preemptive analgesia to attenuate post-operative pain in patients undergoing abdominal surgery under general anesthesia. Saudi J Anaesth. 2010; 4(3):137-41. PMC: 2980657. DOI: 10.4103/1658-354X.71409. View

Canbay O, Karakas O, Celebi N, Peker L, Coskun F, Aypar U . The preemptive use of diclofenac sodium in combination with ketamine and remifentanil does not enhance postoperative analgesia after laparoscopic gynecological procedures. Saudi Med J. 2006; 27(5):642-5. View

Panah Khahi M, Yaghooti A, Marashi S, Nadjafi A . Effect of pre-emptive gabapentin on postoperative pain following lower extremity orthopaedic surgery under spinal anaesthesia. Singapore Med J. 2011; 52(12):879-82. View

10.

Ji R, Kohno T, Moore K, Woolf C . Central sensitization and LTP: do pain and memory share similar mechanisms?. Trends Neurosci. 2003; 26(12):696-705. DOI: 10.1016/j.tins.2003.09.017. View

11.

Shank R, Maryanoff B . Molecular pharmacodynamics, clinical therapeutics, and pharmacokinetics of topiramate. CNS Neurosci Ther. 2008; 14(2):120-42. PMC: 6494007. DOI: 10.1111/j.1527-3458.2008.00041.x. View

12.

Woolf C, Chong M . Preemptive analgesia--treating postoperative pain by preventing the establishment of central sensitization. Anesth Analg. 1993; 77(2):362-79. DOI: 10.1213/00000539-199377020-00026. View

13.

Dahl J, Moiniche S . Pre-emptive analgesia. Br Med Bull. 2004; 71:13-27. DOI: 10.1093/bmb/ldh030. View

14.

Kashefi P, Honarmand A, Safavi M . Effects of preemptive analgesia with celecoxib or acetaminophen on postoperative pain relief following lower extremity orthopedic surgery. Adv Biomed Res. 2013; 1:66. PMC: 3587127. DOI: 10.4103/2277-9175.100197. View

15.

Markman J, Dworkin R . Ion channel targets and treatment efficacy in neuropathic pain. J Pain. 2006; 7(1 Suppl 1):S38-47. DOI: 10.1016/j.jpain.2005.09.008. View

16.

Grover V, Mathew P, Yaddanapudi S, Sehgal S . A single dose of preoperative gabapentin for pain reduction and requirement of morphine after total mastectomy and axillary dissection: randomized placebo-controlled double-blind trial. J Postgrad Med. 2010; 55(4):257-60. DOI: 10.4103/0022-3859.58928. View

17.

Thomas S, Nandhra H, Jayaraman A . Systematic review of lamotrigine augmentation of treatment resistant unipolar depression (TRD). J Ment Health. 2010; 19(2):168-75. DOI: 10.3109/09638230903469269. View

18.

Zamponi G, Lewis R, Todorovic S, Arneric S, Snutch T . Role of voltage-gated calcium channels in ascending pain pathways. Brain Res Rev. 2009; 60(1):84-9. PMC: 2692704. DOI: 10.1016/j.brainresrev.2008.12.021. View

19.

Paudel K, Bhattacharya S, Rauniar G, Das B . Comparison of antinociceptive effect of the antiepileptic drug gabapentin to that of various dosage combinations of gabapentin with lamotrigine and topiramate in mice and rats. J Neurosci Rural Pract. 2011; 2(2):130-6. PMC: 3159347. DOI: 10.4103/0976-3147.83577. View

20.

Campbell W, Kendrick R, Patterson C . Intravenous diclofenac sodium. Does its administration before operation suppress postoperative pain?. Anaesthesia. 1990; 45(9):763-6. DOI: 10.1111/j.1365-2044.1990.tb14450.x. View