Pre-emptive multimodal analgesic regimen reduces post-operative epidural demand boluses in traumatic shaft of femur fracture - A randomised controlled trial

Jeetinder K. Makkar; Kajal Jain; Aswini Kuberan; Mukilan Balasubramanian; Nidhi Bhatia; Preet M. Singh

doi:10.4103/ija.IJA_363_19

$Pre-emptive multimodal analgesic regimen reduces post-operative epidural demand boluses in traumatic shaft of femur fracture - A randomised controlled trial$

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Pre-emptive multimodal analgesic regimen reduces post-operative epidural demand boluses in traumatic shaft of femur fracture - A randomised controlled trial

Jeetinder K. Makkar, Kajal Jain, Aswini Kuberan, Mukilan Balasubramanian, Nidhi Bhatia and Preet M. Singh

Indian journal of anaesthesia, Vol.63(11), pp.895-899

11/01/2019

DOI: 10.4103/ija.IJA_363_19

PMCID: PMC6868665

PMID: 31772397

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Abstract

Background and Aims: The efficacy of preemptive multimodal analgesia in post-traumatic patients has not been elucidated. Our aim was to evaluate the efficacy of preemptive MMA regimen in reducing the epidural demand boluses in the first 48 hours following the traumatic shaft of femur fractures. Methods: Patients scheduled for traumatic femur fracture surgery were randomised (n = 135) into two groups in this double blind, placebo controlled trial. Patients received either (Preemptive multimodal group) intravenous acetaminophen 1 gm, diclofenac 75 mg, morphine 3 mg, 75 mg Pregabalin (per oral) or a placebo 30 minutes pre-operatively. lntra-operatively, all patients were managed with spinal and epidural anaesthesia. Post-operatively, patients received patient-controlled epidural analgesia (PCEA) programmed to deliver a bolus of 5 ml of 0.2% Ropivacaine with 2 mu g/ml of Fentanyl with lockout interval time of 15 min. Primary outcome was number of PCEA boluses received post-operatively over 48 h. Secondary outcomes measures were time to receive first epidural bolus, postoperative VAS scores and episodes of post-operative nausea, vomiting and sedation. Total number of PCEA bolus doses over 48 hours and VAS scores were analysed using Mann-Whitney test. Results: Significant reduction in median number of demand boluses were observed in preemptive multimodal group (3 [2-4]) compared to placebo group (5 [4-7]); P= 0.00. Time to first rescue epidural bolus was significantly greater in preemptive multimodal group than placebo group. Conclusion: The use of preemptive MMA regimen reduced the requirement of demand epidural bolus doses.

Anesthesiology

Life Sciences & Biomedicine

Science & Technology

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Title: Subtitle: Pre-emptive multimodal analgesic regimen reduces post-operative epidural demand boluses in traumatic shaft of femur fracture - A randomised controlled trial
Creators: Jeetinder K. Makkar - Jawaharlal Institute of Post Graduate Medical Education and Research
Kajal Jain - Post Graduate Institute of Medical Education and Research
Aswini Kuberan - Jawaharlal Institute of Post Graduate Medical Education and Research
Mukilan Balasubramanian - Jawaharlal Institute of Post Graduate Medical Education and Research
Nidhi Bhatia - Post Graduate Institute of Medical Education and Research
Preet M. Singh - All India Inst Med Sci, Dept Anaesthesia & Intens Care, New Delhi, India
Resource Type: Journal article
Publication Details: Indian journal of anaesthesia, Vol.63(11), pp.895-899
DOI: 10.4103/ija.IJA_363_19
PMID: 31772397
PMCID: PMC6868665
NLM abbreviation: Indian J Anaesth
ISSN: 0019-5049
eISSN: 0976-2817
Publisher: Wolters Kluwer Medknow Publications
Number of pages: 5
Language: English
Date published: 11/01/2019
Academic Unit: Anesthesia
Record Identifier: 9984845395602771

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