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Pain management plays a very important role in recovery after ambulatory surgery and any delay in the time to discharge may lead to logistic problems associated with increased hospital stay for a day care procedure. A higher dose of opioid may be needed for better analgesia which may lead to complications such as respiratory depression, nausea, vomiting. Newer drugs and agents are being used to prevent such complications and decrease hospital stay post procedure. We present a study where preemptive use of two doses of Pregabalin, 75mg and 150mg was evaluated not only for its analgesic efficacy but also to ascertain comparative effects on the time to discharge in patients undergoing laparoscopic sterilisation. Observations and Results: Hundred patients included in the study, were comparable with respect to age, ASA physical status, educational status and body mass index. The VAS score at rest at 2,3 and 4hours post-surgery was significantly less in the P150 group as analyzed by the Mann Whitney test (p value of 0.001 for each recording). We found that 150 mg pregabalin delays the need for first rescue analgesic administration even though clinically both doses were comparable. The time to discharge between the two groups as per the Post Anaesthesia discharge scoring system (PADSS) was comparable. Conclusion: The multimodal approach to analgesia especially in day care surgeries have not only reduced the time to discharge but also improved patient outcome. This has become possible by using certain adjuvant drugs with analgesic effects that have proven to be beneficial in preventing central sensitisation. We report that Preemptive Pregabalin 150mg has a better VAS scores for pain at rest and mobilisation after laparoscopic sterilisation and also did not delay the time to discharge. Introduction Provision of effective analgesia for the surgical patient is one of the most important aspects of anaesthesiology practice. An increasing percentage of surgical procedures are being performed on an outpatient basis, as ambulatory surgery can offer a number of advantages for patients, health care providers, third party payers and even hospitals. Laparoscopy, being minimally invasive involves insufflation of the abdomen by gas, so that an endoscope is introduced through one or more ports to view the intraabdominal contents without being in direct contact with the viscera or tissues. Laparoscopic tubal ligation is one of the most common gynaecologic operative procedure performed on an outpatient basis. Pain which occurs after this procedure is significantly less and of shorter duration than that caused by laparotomy. Nevertheless, pain intensity may be significant and is multifactorial. The three methods used for laparoscopic sterilization are tubal diathermy, ring or loop occlusion and clips. All the three methods have been associated with considerable postoperative pain especially due to pelvic spasm that mimics the colicky pain of dysmenorrhoea. Multimodal analgesia is now recommended to prevent and treat post laparoscopy pain. Many clinical studies suggest that the intensity of acute postoperative pain is a significant predictor of chronic postoperative pain. Thus, control of perioperative pain and the fashion in which it is implemented (e.g. multimodal) may be important in facilitating short and long-term patient convalescence after surgery. We need to balance between an early discharge and effective pain relief; wherein multimodal analgesia is becoming increasingly popular for postoperative pain relief. Noxious stimuli release inflammatory mediators from peripheral nociceptors and are transmitted by A delta and C fibers. After complex modulating influences in the spinal cord, some impulses pass to the ventral and ventrolateral horns. This will initiate segmental (spinal) reflex responses, while others are transmitted to higher centers where they induce suprasegmental and cortical responses (central sensitization) to ultimately produce the perception of pain. Pre-emptive analgesia includes medication (oral, parenteral, epidural, peripheral nerve block etc.) that is administered before the surgical incision is given. This prevents the establishment of central sensitization resulting Article Info Received: 5th August, 2019 Accepted: 8th August, 2019 Published Online: 22nd August, 2019

indian journal of clinical anaesthesia

Comparative evaluation of two doses of pregabalin as oral premedication for laparoscopic sterilisation with respect to analgesic efficacy and time to discharge