Dinkum Journal of Medical Innovations (DSMI)

Publication History

Submitted: December 05, 2022
Accepted: December 20, 2022
Published: January 01, 2023

Identification

D-0094

Citation

Nimra Naseem, Rubab Zahra, Umm-e-Aimen & Tahir Rana (2023). Literature Review on Comparison of the effect of Single Oral Dose 150 Mg Pregabalin Premedication to Single Oral Dose 100mg Tramadol in Elective Inguinal Hernia Surgery. Dinkum Journal of Medical Innovations, 2(01):01-11.

Copyright

© 2023 DJMI. All rights reserved

Literature Review on Comparison of the effect of Single Oral Dose 150 Mg Pregabalin Premedication to Single Oral Dose 100mg Tramadol in Elective Inguinal Hernia SurgeryReview Article

Nimra Naseem 1*, Rubab Zahra 2, Ume e Aimen 3, Tahir Rana 4           

  1. Allama Iqbal Medical College, Lahore, Pakistan; nimranaseem@gmail.com
  2. Allama Iqbal Medical College, Lahore, Pakistan; zhra202312@gmail.com
  3. Kinnaird College for Women University, Lahore; aimen17032019@gmail.com
  4. Allama Iqbal Medical College, Lahore, Pakistan; successfulrana21@gmail.com

*             Correspondence: nimranaseem@gmail.com

Abstract: Spinal anesthesia is a type of regional anesthesia in which local anesthetic is administered into subarachnoid space. Many adjuvants have been utilized to prolong spinal anaesthesia,. Pregabalin and Tramadol are two such adjuvants used pre-emptively to prolong duration of spinal anesthesia. No study has investigated if tramadol premedication prolongs the motor and sensory blocks during spinal anaesthesia.Moreover,no comparison has been made between Tramadol and Pregabalin in terms of spinal block duration. It has been reviewed that both Tramadol and Pregabalin are equally effective in prolonging the duration of spinal anesthesia as compared to placebo. Both Tramadol and pregabalin have analgesic effect significantly better than placebo and both drugs have comparable analgesic effect. Both Tramadol and Pregabalin increase the time for first analgesic request as compared to placebo and both have comparable effect in this regards. Both Tramadol and Pregabalin decrease the requirement of rescue analgesia as compared to placebo and both drugs have comparable opioid-sparing effects. The frequency of side effect of dry mouth is highest in Tramadol group but the frequency of nausea, vomiting is highest in placebo group. Pregabalin has least frequency of side effects in all groups. In a nutshell, Pregebalin and Tramadol are equally effective in prolonging the duration of spinal anesthesia but Pregabalin is preferable to Tramadol as it has lesser side effects.

Keywords: pregabalin, premedication, single oral dose, tramadol, elective inguinal hernia surgery

  1. INTRODUCTION

Spinal anesthesia is a commonly used method of the regional anaesthesia in which local anesthetic is administered into subarachnoid space. It is commonly used for orthopedic and vascular surgeries involving lower limb; repair of inguinal hernia; hemorrhoidectomy; transurethral resection of prostate; hysterectomy and caesarean sections. Commonly used local anesthetic is Bupivacaine. Many adjuvants have been utilised to prolong spinal anaesthesia, lowering postoperative analgesic doses and delaying the postoperative discomfort [1]. The aim in post-operative management of pain is to achieve adequate analgesia with minimal dose of analgesic drugs to avoid side effects as well as to cut down on cost [2 3]. This also leads to early post-surgical mobilization & shortened hospital stay. Multimodal or preemptive analgesia are used to attain this goal [4]. Multimodal approach utilizes drugs like paracetamol, opioids, non-steroidal anti-inflammatory drugs (NSAIDs), and perioperative administration of local anesthetics. All these drugs have their own side effects. For example, opioids cause drowsiness, respiratory depression, pruritis, nausea, vomiting and urinary retention. Non-steroidal anti-inflammatory cause gastrointestinal tract ulcers, nephrotoxicity and platelet dysfunction. Local anesthetics administered intrathecally or in epidural space for pain relief carry their own cons like additional work, local anesthetic systemic toxicity and hypotension [4]. On the other hand, preemptive analgesia means administration of analgesics prior to the beginning of painful stimuli [5]. Premeptive analgesia alters the central processing of afferent input thus decreasing the incidence of post op pain, allodynia and hyperalgesia [5]. The various methods and drugs employed for preemptive analgesia include but limited to epidural analgesics, local anesthetic infiltration, NSAID, opioids and NMDA receptor antagonists. Pregabalin and Tramadol are two adjuvants used pre-emptively to prolong duration of spinal anesthesia. Pregabalin given as premedication provide beneficial relief in postoperative pain and reduces the need of the other analgesics administered parentally. A 150 mg Pregabalin dose has the better analgesic effect than 75mg dose [6]. Pregabalin binds to the α2-δ protein subunit of the voltage gated calcium channel and inhibits release of the excitatory neurotransmitters like glutamate, norepinephrine, substance-P, and calcitonin gene related peptide in the central and peripheral nervous system. Overexcited neurons are inhibited and returned to normal state [7]. Tramadol is opioid analgesic that is commonly used to treat the chronic moderate to severe pain, like oncologic and postoperative pain [8]. Just like codeine, Tramadol is also a prodrug. CYP2D6 isoenzyme of cytochrome P450 metabolizes it to an active metabolite. Its usual dose is 50 to 100mg every four to six hourly up to 400 mg, the bioavailability is about seventy percent and the elimination half-life is 5.5 hours. Successful management of pain requires adequate dosage and patient compliance [9]. Tramadol inhibits pain in a number of mechanisms. It’s an opioid 1 receptor agonist and an MAO inhibitor. It causes inhibition of serotonin (5-HT) transporter and norepinephrine (NE) transporter [10, 11]. Administration of the oral analgesics is favorable for the postoperative pain relief as compared to IV form of analgesics. It has many advantages such as easy administration, low cost, ready availability of drugs and drug reactions are generally less severe [12]. For example, serious side effects of administration of IV tramadol (like agitation, hallucinations, fever, overactive reflexes) have been reported, [13, 14]. Oral premedication can be given with one sip of water so that it doesn’t interfere with NPO requirement. Pregabalin oral pre-medication has been reported to prolong duration of motor and sensory blocks under the spinal anesthesia and to reduce early post-operative pain [15]. Similarly, oral tramadol premedication has been also shown to decrease early post-operative pain [16]. However, no clinical investigation has looked into whether tramadol premedication affects the motor and sensory blocks during spinal anaesthesia, and no comparison has been made between these effects and those of the pregabalin. In this review, we compare the effect of single oral dose of 150 mg pregabalin premedication to single oral dose of 100mg Tramadol on duration of the sensory blockade of spinal bupivacaine anesthesia.

  1. LITRERATURE REVIEW

Hernias are one of humanity’s earliest recorded ailments. A hernia is organ or portion of organ that extravasates through body wall that encloses it. Groin hernias are the combination of femoral and inguinal hernias. Inguinal hernias are more common than femoral, umbilical and epigastric hernias but femoral hernias are more likely to cause problems. Inguinal hernias were the third most common reason for the visit of ambulatory care for the symptoms of gastrointestinal, and visit rates had remained relatively constant since 1975. In the United States, the inguinal hernias prevalence is believed to be between 5 and 10%. The incidence of femoral hernia is only 10% of groin hernias but they are more likely than inguinal hernias to be incarcerated or strangulated. Men are more likely than women to get hernias.(17) Groin hernias can be classified as inguinal or the femoral hernias. In the clinical evaluations: Inguinal hernias reasons for 96% of groin hernias, whereas femoral hernias account for 4%. The most frequent groin hernia in the both sexes is indirect inguinal hernia [17-19]. According to Swedish survey, the incidence of indirect inguinal hernia repairs in females was 49% and in males 54%. In men, direct inguinal hernia reasons for the 30 to 40% of groin hernias, but in women, it reasons for 14 to 21% of groin hernias. In female population, it was found that the incidence of inguinal hernia was associated with increased height and rural habitation [20]. It was found that if the BMI was <20,especially in female population, the incidence of strangulated or irreducible femoral hernia was high. In the low BMI group, 30% of groin repairs were done of female patients even though females has only 8% incidence of all groin hernias. Overweight patients represent difficulty in diagnosing groin hernias but interestingly, the available data illustrates that obesity is a not a risk factor for groin hernia in either gender [20]. An extensive data registery outlined involving 49,092 patients found that groin hernias were less prevalent in obese patients than in general population (5 versus 10%) [21]. Groin hernias are divided into two types based on their genesis (acquired vs. congenital) and the anatomic location. Congenital hernias are most commonly found in the groin, although they can also develop in the umbilicus or the femoral canal. Groin hernias could also be classified as indirect and direct inguinal hernias. Hernias are categorized according to their etiology, which determines whether hernia is congenital or acquired. Congenital hernia is caused by faulty development, while acquired hernia is the caused by changes in normally formed tissues that result in weakness or disruption. Anatomic development of tissues in the groin differs between boys and girls, affecting the type of hernia that each develops. The inability of processus vaginalis to obliterate causes congenital inguinal hernia. In men, processus vaginalis is a folding of the parietal peritoneum that exists before the testicles migrate and descend. Females have the same folding but it generally disappears around the eighth month of pregnancy. The part of processus vaginalis in inguinal canal is called ‘Canal of Nuck’ in females [22]. The superior part of gubernaculum degenerates as development proceeds, leaving the inferior part as the scrotal ligament, which attaches the testicle to the inferior part of the scrotum and inhibits its mobility. The internal ring is obliterated once descent of testicle is complete. This obliteration can take place during childhood but sometimes it’s delayed [23]. Migration of Gubernaculum is not seen in females. In females, the superior portion of the gubernaculum constitutes the ovary’s suspensory ligament, while the inferior portion adopts an angular shape and creates round ligament of ovary. Thus, the round ligament stays in females whereas the inguinal component of gubernaculum obliterates in the males [24 25]. Internal rings are smaller in women and thus the incidence of inguinal hernia is also lower. The round ligament is often misread as the ligamentous tissue seen within inguinal hernia sac in female patients. However, vigilant observation identifies this tissue as the ovary’s suspensory ligament, that’s why the fallopian tube or ovary can sometimes be viewed in herniated sac among women [26]. Acquired hernias occur when fibromuscular walls weaken or disrupts, enabling contents of intra-abdominal organs to the protrude through defect. Inherited connective tissue anomalies, persistent abdominal wall damage, and perhaps medication side effects can all cause groin hernias to form [27]. Metabolic or biochemical disorders can disrupt the collagen formation and hence make the connective tissues in the body walls, weak [28]. In the patient’s family history, an inclination for hernia defects may be visible. Groin hernia is connected to the aortic aneurysmal disease that is caused by aberrant connective tissue [29]. Hernias can be caused by a variety of inborn metabolic errors, such as anomalies in collagen type III and I production, however this is an uncommon occurrence. Tissue thinning can also be caused by pharmaceutical actions. Chronic glucocorticoid treatment is linked to skin thinning and soft tissue weakness, both of which can lead to hernia formation. Other variables that impact connective tissue integrity include getting older. Persistently raised intra-abdominal pressure or over distension of abdominal wall can be a contributing factor to formation of hernia. Pressure within the abdomen can be raised due to multiple factors including chronic cough, constipation, intense exercise/activity, and pregnancy In athletes, direct hernias occur at a very high rate [30 31]. Inguinal hernias are the most frequently observed type in both genders. Indirect hernias bulge through the internal inguinal ring. Internal inguinal ring is the site through which spermatic cord (in men) and round ligament (in women) exit the abdomen. The hernia sac begins to form at the site of the inferior epigastric artery. Right sided indirect hernias are more frequent among both the males and the females. This observation is due to the late descent of the right testicle as compared to left testicle and in females, due to asymmetry of the pelvis. It’s seen that the indirect inguinal hernias seen in adults start off at birth even if it may not be obvious at this early a stage. An open processes vaginalis is due to inability of a physiological safety mechanism that shuts off the internal inguinal ring [32]. A combination of raised pressure within the abdomen and diminished tone in the abdominal muscles can push the abdominal content into the inguinal canal through the internal ring thus causing the hernia. In the vast majority of instances, an inguinal or femoral hernia may be diagnosed solely on the patient’s physical examination and medical history alone, without the need for further testing [33]. General physical examination of a patient by a surgeon can lead to detection of inguinal hernia. Thus GPE is 75% sensitive and 96% specific in diagnosing inguinal hernia [34]. Imaging can assist discover occult hernia, separate inguinal from the femoral hernia, and also differentiate hernia when its diagnosis is not clear. Imaging is also helpful in determining whether or not a patient has hernia problems [35]. In the absence of suspected intra-abdominal complications, groin ultrasound is recommended as the first diagnostic modality because it is noninvasive and inexpensive, and it has a high specificity and sensitivity for hernia, especially in the presence of a palpable mass, which distinguishes hernia from other inguinal and scrotal pathologies [36]. Imaging techniques like Herniography,MRI and CTScan can aid in diagnosis of hernia but it has variable precision [37]. Bowel obstruction owing to bowel imprisonment or strangling should be considered in patients who arrive with abdominal distention, vomiting and nausea with a history of groin discomfort or mass. For most patients with incarcerated hernia and/or strangulation, additional imaging is generally not necessary prior to surgical exploration and repair. Surgical treatment is recommended for individuals who have “moderate-to-severe” symptoms from inguinal hernia. Symptomless hernia can be treated either by conservative management or elective surgery for patient satisfaction. A truss is the only nonsurgical treatment for groin hernia in males. A truss is a supporting instrument like a belt that constitutes a plug that covers the hernia externally. Utilizing Truss to treat hernia can be beneficial in some circumstances but t is typically discouraged due to a lack of data to support its effectiveness. In addition, using a truss incorrectly might damage the contents of a hernia sac and make surgical repair more difficult. Patients with substantial symptoms caused by inguinal hernia must have the hernia repaired surgically [38]. For symptomless patients of hernia, it’s recommended to have either elective repair or vigilant observation by informing the patient about the red flag signs for those who want to postpone surgery. The patient who chooses watchful waiting as way of treatment must be free of the hernia pain or the discomfort that is restricting their normal activities, as well as recent difficulty in decreasing the hernia. In the past, inguinal hernias were treated as soon as they were discovered, based on the idea that unrepaired hernias were frequent and might increase operational morbidity [39-41]. However, three randomised trials have evaluated careful waiting vs surgical repair of the inguinal hernias and found that postponing surgical repair in asymptomatic individuals was safe, with only 1.8 emergency procedures per 1000 patient-years. However, for 38 percent of patients at three years, and about 70 percent of patients at 7 to 10 years, surgical repair needed when pain increased. This information is particularly important when counseling young patients. Surgical outcomes of delayed repairs were not compromised compared with immediate surgery. Patients with inguinal hernias treated with alert waiting must be advised on modifiable risk factors such as quitting smoking, medical optimization (e.g., diabetes), and weight loss. They should be advised that no evidence that the physical activity causes a hernia to incarcerate or a hernia to deteriorate clinically. As a result, there is no convincing reason for patients to refrain from engaging in beneficial physical activities (e.g., cardiovascular or aerobic workouts) for fear of aggravating their hernia [41]. If patients opting for careful waiting get new-onset pain or discomfort with specific physical activities, they should seek immediate surgical assessment. Two methods that are used to repair hernial defects through anterior approach include mesh repair and non-mesh repair. Mesh repair is preferable to non-mesh repair unless mesh placement is contraindicated. Patients with a current groin infection or contamination may require non-mesh repair methods. A tension-free closure is required for successful hernia repair, which is usually accomplished with the use of a mesh. Tension-free mesh repair of the inguinal hernias has been shown in several trials to minimize postoperative groin discomfort, speed healing, and lower the risk of recurrence [42]. McVay, Bassini and Shouldice repairs are open methods that do not employ mesh to accomplish main tissue approximation. While the Shouldice repair does not use mesh, it is considered a tension-free method by some. When mesh placement is contraindicated, like when there is local infection the groin, or when the use of a mesh is too costly for the patient, non-mesh restoration procedures are utilized [43]. The hernia defect is approached from the back using laparoscopic procedures. TEP (totally extraperitoneal) and TAPP (transabdominal preperitoneal patch) are the two primary methods, both of which need mesh and considered tension-free repairs. To avoid recurrences, the mesh used for these repairs should be large enough to cover the whole pre-peritoneal groin area [44]. General, neuraxial (epidural or spinal), or the regional anaesthesia can be used to treat inguinal or femoral hernias (peripheral nerve block, local). The kind and hernia size, surgical technique, and patient/surgeon preferences all influence the anaesthetic used [45]. The rate of mortality within thirty days after elective surgery is one in ten and three percent after emergency surgery for both femoral and inguinal hernia repair. When intestinal resection is combined with hernia repair, mortality rate is greater [46]. Other variables that have been linked to a higher death rate include: Older age– After an emergency hernia repair, older individuals had a greater death risk. In one research, individuals in their seventies, the eighties, and the nineties had death rates of 1, 5, and 16 percent, respectively [47]. Women – After groin hernia repair, women had a greater death rate than males. Women who require groin hernia procedures are older, have further femoral hernias, thus it is not obvious if females have escalated risk of developing these hernias. Minor problems like wound infection or hematoma formation occur often after hernia repair and can be easily managed. Hernia post-herniorrhaphy neuralgia and recurrence are also serious consequences. Less than four percent of operated cases of hernia develop complain of recurrence. However, ten percent of operated cases develop long-term pain which can be sometimes severe in intensity. Complications after femoral or inguinal hernia repair are very common. Complications occur more often after urgent or recurrent hernia surgery than elective repairs. Hernia recurrence has decreased as a result of the shift to tension-free repair, but other problems, like post-herniorrhaphy neuralgia, have increased. Blood collection at surgical site, urinary retention, damage to urinary bladder, and wound infection can occur during the perioperative period, while late developing complications include consistent groin ache, mesh displacement, recurrence of hernia, and infection of implanted mesh, local neurological pain, and testicular complications. Rate of occurrence of complications after hernia repair depend upon whether the case was emergent or elective, and site of hernia. When compared to elective cases, emergency hernia repair has higher rate of developing complication [48]. In a study of one thousand and thirty-four groin hernia repair, it was observed that rate of complication after urgent hernia repair was about twenty-seven percent but only fifteen percent for elective hernia repair procedures. Operating of recurred hernia had higher rate of complication than first time hernia repair. Rate of occurrence of complications is similar in both open and laparoscopic procedure but the variety of problems differed among the two procedures [49]. Recurred hernia in inguinal region shared same presenting complaints as the primary hernia in inguinal region. The surgical technique used for primary hernia repair must be identified to plan recurrent hernia repair. Clinical examination by an experienced surgeon is usually sufficient for detecting recurrent inguinal hernia; however, imaging may be needed for patients with symptoms consistent with a recurrent inguinal hernia but for whom the physical examination does not clearly demonstrate a recurrent hernia. On physical examination, systemic symptoms such as fevers, chills, malaise, local findings of pain on palpation, erythema, warmth, swelling, or drainage raise suspicion for mesh infection and alter the course of treatment in the patient with recurrent hernia. Hernia recurrence can happen right after hernia repair, or it might happen later in the healing process. Although a particular time interval has not been defined, several experts use a gap of five years to differentiate early from late recurrence [50]. Tramadol was discovered in 1962 but FDA approval came in 1995. Pain alleviation is achieved by activating opioid receptors and inhibiting noradrenaline reuptake and serotonin. Naloxone only partially blocks tramadol’s analgesic action. Tramadol is an unusual opioid due to its dual mechanism of action. Tramadol & antidepressant impact has been verified in preclinical research. Tramadol is a modest agonist of the -opioid receptor compared to other opioids. For a long period, it was thought to be less harmful and less addictive than other opioids. But now we know that tramadol use is linked to misuse and significant adverse consequences. Tramadol and its end product ODT have been abused as recreational drugs in Sweden between December 2007 and May 2011. TRAMADOL: “Trans -2- (dimethylaminomethyl)-1-(m.methoxy phenyl) Cyclohexanol hydrochloride” [51]. Trends in tramadol use Some call this well-known situation an opioid pandemic. The usage of oxycodone, fentanyl and tramadol likely explain the rise in Europe [52]. Tramadol sales in France climbed by 62% between 2006 and 2015. Overall, weak opioid intake fell by 53% due to less dextropropoxyphene use. Between 2000 and 2010, tramadol sales to community pharmacies increased by 269% in Italy. During this time span, hospital sales grew by only 3.6% [52]. Between 1995 and 2010, number of the community-dispensed analgesic prescriptions in Scotland increased modestly. However, the prescription of powerful opioids increased significantly. It is commonly considered a mild opioid, but it was classed as strong opioid in this study, and it had the greatest prescription rise among strong opioids. In 1995, dextropropoxyphene was most regularly prescribed mild opioid, but not in 2010. The medicine was pulled from sale in Scotland in 2007 due to overdose deaths. Between 2002 &amp; 2006, all five Nordic nations except Sweden saw an increase in tramadol consumption [53]. Norway saw the biggest rise at 98%. While dextropropoxyphene was not prescribed in Iceland, it was reduced in use in all other nations, including Sweden by 53%. Dextropropxyphene use and prescription reduced, as expected. Tramadol prescriptions and patients have decreased since 2011. However, autopsy findings did not show the same decreased trend. This discrepancy may represent tramadol abuse and a black market. A similar pattern emerged with fentanyl, with an increase in postmortem results but a somewhat consistent prescription rate. Although the National Department of Forensic Medicine upgraded to a more elaborate and thorough screening approach in 2011, an escalation in surveillance rate may also be the cause of an enhanced drug detection rate [54]. The most common side effects of tramadol include but not limited to excessive drowsiness, nausea, vomiting, ddiaphoresi and diaphoresis. Serious complications include convulsions and serotonin syndrome. There appear to be linked to tramadol overdoses and other medicines, particularly antidepressants. They can also arise after only tramadol use. Serotonin syndrome occurs when the central and peripheral neural systems get too much of the neurotransmitter. Symptoms include tremor, hyperreflexia, rigidity, fever, tachycardia, and altered mentation e. g, confusion, delirium, or agitation [55]. Eight unconscious patients (7.0%) need admission to intensive care unit and invasive ventilatory support. Two of the suicidal individuals who had overdosed with intention to suicide expired due to cardiopulmonary arrest. The doses consumed were five thousand mg and eight thousand two hundred mg [56]. In the United States, addiction centres assessed incidence of opioid overdose by utilization of prescription. prescription. Expiry, hospital admission, or serious medical outcomes were classified as serious adverse events (SAEs). Symptoms were classified as life-threatening or substantial residual impairment. Despite being the least strong opioid analgesic studied, tramadol was the third most commonly reported substance to addiction centers. Tramadol’s inhibitory effect on serotonin and noradrenaline reuptake may explain the convulsions, hyperactivity and serotonin syndrome. In six years starting two thousand ten, seven deaths were attributed to tramadol overdose; 526 significant medical side effects and 3070 hospital admissions were also reported [57]. The term FTI indicates relative toxicity. Number of the fatal adverse reactions by a certain drug is divided by the number of administrations of that drug during the same time period and territorial space. The highest rate of opioid relative toxicity in Finland over 2005, 2009, and 2013 were morphine, tramadol, oxycodone, dextropropoxyphene and methadone. In 2013, fentanyl (4.61), tramadol (6.77) and oxycodone (7.18) had the greatest FTIs (deaths per million defined daily doses). FTIs above 1.0 indicate high toxicity. However, the results should have vigilant interpretation as fatal overdose can be caused by many drugs but in this study, only forensic pathologists most significant drug finding was considered the culprit. Pregabalin oral capsule is marketed as Lyrica. It can be used in combination with other drugs. It may be necessary to take it alongside other drugs. For partial seizures in infants and older patients, Pregabalin is an anticonvulsant of choice. A class of pharmaceuticals is a collection of comparable drugs. Drugs like this are frequently prescribed. How pregabalin works is unknown. It may operate by relaxing injured or hyperactive nerves that produce pain or seizures. Prescribing Pregabalin oral pill can cause dizziness, drowsiness, and Brain, vision, and movement may be harmed. Notify your doctor if you plan to drive or operate machinery until you know how this drug affects you. Pregabalin has additional adverse effects. A similar study in animal studies illustrates that gabapentin in subarachnoid space does not cause sympathectomy. Both tramadol and pregabalin patients had lower systolic and diastolic blood pressures five minutes after passage of ETT as compared to placebo, but the difference was not statistically significant. Tramadol blunts the stress response after endotracheal intubation. Spinal anaesthesia is a regional anaesthesia technique in which local aesthetic is injected in the subarachnoid space. The intrathecal space has cerebrospinal fluid (CSF). It’s the clear fluid that surrounds the central nervous system. The amount of CSF surrounding the CNS is about 150ml in adults. Daily production of CSF is 500mls. A prominent limitation of spinal anaesthesia is a relatively short duration of the sensory and motor block with a single shot of local aesthetic. With utilization of adjuvant, the analgesic action can be prolonged in patients with long procedures. Spinal anaesthesia is used for surgical procedures involving lower limbs, lower abdomen and pelvis [58].

  1. CONCLUSION

It has been reviewed that both Tramadol and Pregabalin are equally effective in prolonging the duration of spinal anesthesia as compared to placebo. Both Tramadol and pregabalin have analgesic effect significantly better than placebo and both drugs have comparable analgesic effect. Both Tramadol and Pregabalin increase the time for first analgesic request as compared to placebo and both have comparable effect in this regards. Both Tramadol and Pregabalin decrease the requirement of rescue analgesia as compared to placebo and both drugs have comparable opioid-sparing effects. The frequency of side effect of dry mouth is highest in Tramadol group but the frequency of nausea, vomiting is highest in placebo group. Pregabalin has least frequency of side effects in all groups. In a nutshell, Pregebalin and Tramadol are equally effective in prolonging the duration of spinal anesthesia but Pregabalin is preferable to Tramadol as it has lesser side effects.

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Publication History

Submitted: December 05, 2022
Accepted: December 20, 2022
Published: January 01, 2023

Identification

D-0094

Citation

Nimra Naseem, Rubab Zahra, Umm-e-Aimen & Tahir Rana (2023). Literature Review on Comparison of the effect of Single Oral Dose 150 Mg Pregabalin Premedication to Single Oral Dose 100mg Tramadol in Elective Inguinal Hernia Surgery. Dinkum Journal of Medical Innovations, 2(01):01-11.

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