Gabapentin in Improvement of Procedural Sedation and Analgesia in Oncologic Pediatric Patients: A Clinical Trial

Filho, Washington Aspilicueta Pinto; Silveira, Lara de Holanda Jucá; Vale, Mariana Lima; Fernandes, Cláudia Regina; Gomes, Josenilia Alves

doi:10.5812/aapm.91197

Cited by 10 publications

(5 citation statements)

References 20 publications

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“…Some patients required many sedative medications and multiple doses due to chronic underlying medical/surgical conditions and anxiety to achieve the level of comfort. In addition, some children experienced medical procedures and went through the traumatic stress related to their age and environment ( 18 ). The choice of medication for PSA depended on not only intensivists to maintain hemodynamic stability but also their need based on the duration of the procedure and drug sensitization in the children.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Pediatric Procedural Sedation Outside the Operating Room

2020

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Background: The volume of pediatric Procedural Sedation and Analgesia (PSA) outside the operating room has been increasing. This high clinical demand leads non-anesthesiologists, especially pediatric intensivists, pediatricians, and emergency physicians, to take a role in performing procedural sedation. Our department has established the PSA service by pediatric intensivists since 2015. Objectives: We aimed to assess the efficacy and safety of PSA outside the operating room conducted by pediatric intensivists and identify risk factors for severe adverse events. Methods: This was a retrospective descriptive study conducted from January 2015 to July 2019. Children aged less than 20 years who underwent procedural sedation were included. We collected demographic data, sedative and analgesic medications, American Society of Anesthesiologists (ASA) Physical Status Classification, indications for sedation, the success of procedural sedation, and any adverse events. Results: Altogether, 395 patients with 561 procedural sedation cases were included. The median age was 55 months (range: 15 to 119 months), and 58.5% (231/395) were male. The rate of successful procedures under PSA was 99.3%. Serious Adverse Events (SAE) occurred in 2.7%. Patients who received more than three sedative medications had higher SAE than patients who received fewer medications (adjusted for age, location of sedation, type of procedure, and ASA classification) (odds ratio: 8.043; 95% CI: 2.472 - 26.173, P = 0.001). Conclusions: Our data suggest that children who undergo procedural sedation outside the operating room conducted by pediatric intensivists are safe and effectively treated. Receiving more than three sedative medications is the independent risk factor associated with serious adverse events.

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Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Pediatric Procedural Sedation Outside the Operating Room

2020

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“…They exert their analgesic effects by binding to the α-2-δ subunit of voltage-dependent calcium channels. Gabapentinoids may cause sedation, respiratory depression, and altered cognition, and they possess the potential for abuse (30)(31)(32)(33)(34)(35).…”

Section: Anticonvulsantsmentioning

confidence: 99%

Conolidine: A Novel Plant Extract for Chronic Pain

et al. 2021

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: Pain, the most common symptom reported among patients in the primary care setting, is complex to manage. Opioids are among the most potent analgesics agents for managing pain. Since the mid-1990s, the number of opioid prescriptions for the management of chronic non-cancer pain (CNCP) has increased by more than 400%, and this increased availability has significantly contributed to opioid diversion, overdose, tolerance, dependence, and addiction. Despite the questionable effectiveness of opioids in managing CNCP and their high rates of side effects, the absence of available alternative medications and their clinical limitations and slower onset of action has led to an overreliance on opioids. Conolidine is an indole alkaloid derived from the bark of the tropical flowering shrub Tabernaemontana divaricate used in traditional Chinese, Ayurvedic, and Thai medicine. Conolidine could represent the beginning of a new era of chronic pain management. It is now being investigated for its effects on the atypical chemokine receptor (ACK3). In a rat model, it was found that a competitor molecule binding to ACKR3 resulted in inhibition of ACKR3’s inhibitory activity, causing an overall increase in opiate receptor activity. Although the identification of conolidine as a potential novel analgesic agent provides an additional avenue to address the opioid crisis and manage CNCP, further studies are necessary to understand its mechanism of action and utility and efficacy in managing CNCP.

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“…Protective analgesia is administered before surgery to reduce the pain experienced and opioid consumption afterward (4). Adjuvant drugs, such as gabapentin or its congener pregabalin, have been tried and tested as protective analgesics (5,6). Other studies have used different medications, such as melatonin and acetaminophen, for controlling pain during the regional block (7).…”

Section: Introductionmentioning

confidence: 99%

Perioperative Anxiolytic and Analgesic Effects of Pregabalin in Vitreo-Retinal Surgery: A Randomized, Double-blind Study

et al. 2021

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Objectives: This study was done to examine the effect of a single, one-time pregabalin dose on postoperative pain, anxiety, and analgesic consumption after vitrectomy performed under the peribulbar block and to assess the satisfaction of the patients as well as the surgeons. Methods: This randomized, double-blinded, placebo-controlled trial was conducted at Magrabi Eye, ENT and Dental Center, Doha, Qatar on 58 adult patients aged 37 - 75 years, who met status I and II of the American Society of Anesthesiologists (ASA) and scheduled for elective vitrectomy, under the peribulbar block (PB). Of the total participants, 30 cases were randomized to receive pregabalin, while the remaining received placebo 90 minutes before surgery. Pain was assessed using a Verbal Analog Scale (VAS) score, and the levels of anxiety were gauged by verbal anxiety score. Results: Patients who received pregabalin had a significantly higher sedation score (3 ± 0 vs. & 2 ± 0.65; P < 0.05), and a significantly less anxiety score (3 ± 1.3 vs. 5 ± 1.6; P < 0.001) compared to the control group. During needle insertion for PB, patients in the pregabalin group experienced less pain compared to the control group (32 ± 15 vs. 44 ± 15; P < 0.05). Pregabalin group showed a significantly higher cooperation rate and patient satisfaction scores (3.2 ± 0.7 and 3.8 ± 0.4, respectively), compared to the placebo group (2.8 ± 0.7 and 3.4 ± 0.5, respectively). The placebo group required intraoperative midazolam more in comparison to the pregabalin group (19 vs. 5; P < 0.001). Moreover, the need for postoperative analgesia was more in the placebo group two hours postoperatively. Conclusions: Pregabalin is a potent premedication in controlling post-surgical pain and anxiety in patients undergoing vitrectomy under the PB.

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Gabapentin in Improvement of Procedural Sedation and Analgesia in Oncologic Pediatric Patients: A Clinical Trial

Cited by 10 publications

References 20 publications

Efficacy and Safety of Pediatric Procedural Sedation Outside the Operating Room

Efficacy and Safety of Pediatric Procedural Sedation Outside the Operating Room

Conolidine: A Novel Plant Extract for Chronic Pain

Perioperative Anxiolytic and Analgesic Effects of Pregabalin in Vitreo-Retinal Surgery: A Randomized, Double-blind Study

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