Analgesic efficacy of pre-emptive oral flupirtine maleate for post-operative analgesia after total abdominal hysterectomy under general anaesthesia

Abstract

Background: Total abdominal hysterectomy is a major gynaecological procedure involving significant postoperative pain and morbidity. It demands a multimodal approach for postoperative pain relief and deserves prevention and rapid control. Pre-emptive analgesia with N-methyl D-aspartate receptor antagonist flupirtine maleate has been tried to overcome this problem.

OBJECTIVE: To study the analgesic efficacy of pre-emptive oral flupirtine maleate for postoperative analgesia after total abdominal hysterectomy under general anesthesia.

Study Design: A Prospective Observational study.

Participants: Female patients with ASA I and II in the age group 30-60 years.

Methods: 50 female patients were enrolled and divided into two groups of 25 each.90 minutes before induction of anesthesia, patients in group A received oral flupirtine 100mg and patients in group B received multivitamin tablet. Patients were assessed at 0, 1, 2, 4, 8, 6, 12, 24 and 36 hrs after recovery from anaesthesia for pain by Visual Analogue Scale. The time to the request for first rescue analgesic and total analgesic consumption were recorded in both the groups.

Results: Patients in group A and group B were comparable with respect to age, ASA status, duration of surgery, preoperative hemodynamic variables and oxygen saturation of haemoglobin. The mean Visual Analogue Score for pain in patients in group A was significantly lower than that in group B (p<0.05) . The time to the request for first analgesic, frequency of rescue analgesic doses given and total analgesic consumption also demonstrated a significantly better pain control in the flupirtine group (p<0.05) . The mean postoperative hemodynamics were also significantly lower in the flupirtine group (P<0.05) .

Conclusion: Pre-emptive administration of oral flupirtine 100mg ninety mins before induction of anesthesia provides effective analgesia in first 2-3 hrs of postoperative period with reduced amount and frequency of rescue analgesics, without significant adverse effects.

Implications: Flupirtine can be used safely and effectively as a single dose pre-emptive analgesic for providing postoperative analgesia in total abdominal hysterectomy patients under general anesthesia without any significant side effects.