Abstract Background: Acute postoperative pain after breast surgery is one of the major factors contributing to prolonged hospital stay. In addition persistent post mastectomy pain (PPMP) is rated as the most important cause of suffering in those patients. Objectives: The objectives of this study are to investigate the efficacy and safety of ketamine infusion on the incidence of acute postoperative and chronic post-mastectomy pain in female patients undergoing modified radical mastectomy. Patients and methods: 40 Patients were included in this study, divided into 2 groups (20 patients for each): Group 1 (G1): Control group in which patients received I.V. saline infusion before skin incision and for 24 hours after surgery. Group 2 (G2): In which patients received pre-emptive I.V bolus 0.5 mg / kg ketamine before skin incision followed by a continuous infusion of 0.25 mg / kg per hour for 24 hours post-operative. We measured hemodynamic variables, Visual Analogue Score at rest and movement of the limb or cough (VAS-R and VAS-M respectively) at zero line, 2, 4, 8, 12, 16, 24 hours postoperatively, time to the first request of analgesia, total morphine consumption, sedation score and development of side effects. LANSS (Leeds Assessment of Neuropathic Symptoms and Signs) score was assessed at 1, 2, 3, 6 months postoperatively. Results: There was a significant reduction in VAS-R and VAS-M (p0.05), total morphine consumption (p0.01) with significant delay in the 1st analgesic request (p0.001) at all time points in ketamine group. LANSS score was significant reduced (p0.05) in ketamine group compared to control group at all time points. Conclusion: Perioperative use of ketamine in patients undergoing modified radical mastectomy, reduced acute postoperative pain, morphine consumption and the development of chronic post mastectomy pain with no serious side effects

Abstract Background: Acute postoperative pain after breast surgery is one of the major factors contributing to prolonged hospital stay. In addition persistent post mastectomy pain (PPMP) is rated as the most important cause of suffering in those patients. Objectives: The objectives of this study are to investigate the efficacy and safety of ketamine infusion on the incidence of acute postoperative and chronic post-mastectomy pain in female patients undergoing modified radical mastectomy. Patients and methods: 40 Patients were included in this study, divided into 2 groups (20 patients for each): Group 1 (G1): Control group in which patients received I.V. saline infusion before skin incision and for 24 hours after surgery. Group 2 (G2): In which patients received pre-emptive I.V bolus 0.5 mg / kg ketamine before skin incision followed by a continuous infusion of 0.25 mg / kg per hour for 24 hours post-operative. We measured hemodynamic variables, Visual Analogue Score at rest and movement of the limb or cough (VAS-R and VAS-M respectively) at zero line, 2, 4, 8, 12, 16, 24 hours postoperatively, time to the first request of analgesia, total morphine consumption, sedation score and development of side effects. LANSS (Leeds Assessment of Neuropathic Symptoms and Signs) score was assessed at 1, 2, 3, 6 months postoperatively. Results: There was a significant reduction in VAS-R and VAS-M (p0.05), total morphine consumption (p0.01) with significant delay in the 1st analgesic request (p0.001) at all time points in ketamine group. LANSS score was significant reduced (p0.05) in ketamine group compared to control group at all time points. Conclusion: Perioperative use of ketamine in patients undergoing modified radical mastectomy, reduced acute postoperative pain, morphine consumption and the development of chronic post mastectomy pain with no serious side effects

ABSTRACT Unfortunately spinal morphine is associated with high incidence of pruritus and emetic symptoms which can limit its use. The aim of this study was to compare the efficacy of preoperative oral Gabapentin versus tropisetron on postoperative nausea and vomiting after major abdominal surgery under combined spinal and general anesthesia. Ninety patients randomly assigned into three groups 30 patients each; group Control received placebo, group Gabapentin received 600 mg of gabapentin and group Tropisetron received 5 mg tropisetron orally 2 hours before surgery. Frequency and severity of PONV, pruritus, pain severity, time to first request of rescue analgesic and incidence of side effects were recorded in the 1st 24 hours postoperative. Incidence of PONV in Gabapentin and Tropisetron group decreased compared to Control group (p0.05). Incidence of pruritus deceased in Gabapentin group compared to Control group (p = 0.03). Pain score in Gabapentin group was reduced at 2, 6, 12, 18 and 24 hours postoperative compared to Control group (P 0.05). The time to 1st request of rescue analgesia was prolonged in Gabapentin group compared to Control and Tropisetron group (P 0.05). There was no difference in the incidence of adverse effect in the three groups. Prophylactic use of 600 mg of gabapentin or 5 mg tropisetron orally reduce the incidence of post operative nausea and vomiting induced by intrathecal morphine. Also gabapentin reduce the incidence of post operative itching and led to a decrease in postoperative analgesic requirement and pain scores

ABSTRACT Unfortunately spinal morphine is associated with high incidence of pruritus and emetic symptoms which can limit its use. The aim of this study was to compare the efficacy of preoperative oral Gabapentin versus tropisetron on postoperative nausea and vomiting after major abdominal surgery under combined spinal and general anesthesia. Ninety patients randomly assigned into three groups 30 patients each; group Control received placebo, group Gabapentin received 600 mg of gabapentin and group Tropisetron received 5 mg tropisetron orally 2 hours before surgery. Frequency and severity of PONV, pruritus, pain severity, time to first request of rescue analgesic and incidence of side effects were recorded in the 1st 24 hours postoperative. Incidence of PONV in Gabapentin and Tropisetron group decreased compared to Control group (p0.05). Incidence of pruritus deceased in Gabapentin group compared to Control group (p = 0.03). Pain score in Gabapentin group was reduced at 2, 6, 12, 18 and 24 hours postoperative compared to Control group (P 0.05). The time to 1st request of rescue analgesia was prolonged in Gabapentin group compared to Control and Tropisetron group (P 0.05). There was no difference in the incidence of adverse effect in the three groups. Prophylactic use of 600 mg of gabapentin or 5 mg tropisetron orally reduce the incidence of post operative nausea and vomiting induced by intrathecal morphine. Also gabapentin reduce the incidence of post operative itching and led to a decrease in postoperative analgesic requirement and pain scores

Abstract Background: Patients beginning cancer treatment consistently list chemotherapy- induced nausea and vomiting as one of their greatest fears. Inadequately controlled emesis impairs functional activity and quality of life for patients, increases the use of health care resources and may occasionally compromises adherence to treatment. The goal of this study was to evaluate the effectiveness of gabapentin, in prevention of delayed chemotherapy induced nausea, vomiting and neuropathic pain in cancer patients receiving highly and moderatly emetogenic chemotherapy. Patients and methods: 125 chemotherapy-naive cancer patients, who were scheduled to receive moderately and highly emetogenic chemotherapy were enrolled in the study. Patients were stratified according to gender, age and they were allocated to one of three groups: Group І: received 20mg oral dexamethasone with 5HT3 receptor antagonist ondansetron (Zofran) 24 mg on day1 and oral gabapentin300mg once daily on day2 through 6 of chemotherapy. Group п: received 20mg oral dexamethasone with 5HT3 receptor antagonist ondansetron (Zofran) 24mg on day1, and oral prochlorperazine (Emedrotec) 3mg twice daily on day 2 through 6 of chemotherapy. Group ш: received 20 mg oral dexamethasone with 5HT3 receptor antagonist ondansetron (Zofran) 24mg on day1 and oral ondansetron (Zofran) 8mg daily on day2 through 6. The average severity of nausea and vomiting during days 2 to 6 after chemotherapy was assessed for every patient, using National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) and this assessment was repeated for every chemotherapy cycle for 6 cycles. Results: The reported average severity of nausea during cycle 1, 2, 3, 6 was lower in patients receiving ondansetron and gabapentin compared to emedrotec (p0.05). As regard average severity of vomiting scores there was significant decrease in vomiting scores in patients received either gabapentin or ondansetrone in cycles 2,3,4,5,6 compared to patients received emedrotec (p0.05). A percentage of patients required rescue medication to alleviate CINV during the study period, 8(19.5%) patients taking ondansetrone compared with 10 (24.3%) patients in the gabapentin group and 17(39.5%) patients in the Emedrotec group. Rescue medication used was ondansetron (zofran) 24 mg IV. Inter groups comparison for the DN4 during the 6 cycles showed significant reduction in the gabapentin group compared to both emedrotec and ondansetrone groups (p0.05). The incidence of neuropathic pain (DN4 ≥ 4) was significantly reduced in gabapantin group in the 3rd cycle compared to emedrotec and ondansetrone groups (p =0.048). Conclusion: Gabapentin is a useful drug for the management of delayed chemotherapy- induced nausea and vomiting and it also reduced incidence of chemotherapy-induced neuropathic pain.

Abstract Background: Patients beginning cancer treatment consistently list chemotherapy- induced nausea and vomiting as one of their greatest fears. Inadequately controlled emesis impairs functional activity and quality of life for patients, increases the use of health care resources and may occasionally compromises adherence to treatment. The goal of this study was to evaluate the effectiveness of gabapentin, in prevention of delayed chemotherapy induced nausea, vomiting and neuropathic pain in cancer patients receiving highly and moderatly emetogenic chemotherapy. Patients and methods: 125 chemotherapy-naive cancer patients, who were scheduled to receive moderately and highly emetogenic chemotherapy were enrolled in the study. Patients were stratified according to gender, age and they were allocated to one of three groups: Group І: received 20mg oral dexamethasone with 5HT3 receptor antagonist ondansetron (Zofran) 24 mg on day1 and oral gabapentin300mg once daily on day2 through 6 of chemotherapy. Group п: received 20mg oral dexamethasone with 5HT3 receptor antagonist ondansetron (Zofran) 24mg on day1, and oral prochlorperazine (Emedrotec) 3mg twice daily on day 2 through 6 of chemotherapy. Group ш: received 20 mg oral dexamethasone with 5HT3 receptor antagonist ondansetron (Zofran) 24mg on day1 and oral ondansetron (Zofran) 8mg daily on day2 through 6. The average severity of nausea and vomiting during days 2 to 6 after chemotherapy was assessed for every patient, using National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) and this assessment was repeated for every chemotherapy cycle for 6 cycles. Results: The reported average severity of nausea during cycle 1, 2, 3, 6 was lower in patients receiving ondansetron and gabapentin compared to emedrotec (p0.05). As regard average severity of vomiting scores there was significant decrease in vomiting scores in patients received either gabapentin or ondansetrone in cycles 2,3,4,5,6 compared to patients received emedrotec (p0.05). A percentage of patients required rescue medication to alleviate CINV during the study period, 8(19.5%) patients taking ondansetrone compared with 10 (24.3%) patients in the gabapentin group and 17(39.5%) patients in the Emedrotec group. Rescue medication used was ondansetron (zofran) 24 mg IV. Inter groups comparison for the DN4 during the 6 cycles showed significant reduction in the gabapentin group compared to both emedrotec and ondansetrone groups (p0.05). The incidence of neuropathic pain (DN4 ≥ 4) was significantly reduced in gabapantin group in the 3rd cycle compared to emedrotec and ondansetrone groups (p =0.048). Conclusion: Gabapentin is a useful drug for the management of delayed chemotherapy- induced nausea and vomiting and it also reduced incidence of chemotherapy-induced neuropathic pain.

Abstract Background: Patients beginning cancer treatment consistently list chemotherapy- induced nausea and vomiting as one of their greatest fears. Inadequately controlled emesis impairs functional activity and quality of life for patients, increases the use of health care resources and may occasionally compromises adherence to treatment. The goal of this study was to evaluate the effectiveness of gabapentin, in prevention of delayed chemotherapy induced nausea, vomiting and neuropathic pain in cancer patients receiving highly and moderatly emetogenic chemotherapy. Patients and methods: 125 chemotherapy-naive cancer patients, who were scheduled to receive moderately and highly emetogenic chemotherapy were enrolled in the study. Patients were stratified according to gender, age and they were allocated to one of three groups: Group І: received 20mg oral dexamethasone with 5HT3 receptor antagonist ondansetron (Zofran) 24 mg on day1 and oral gabapentin300mg once daily on day2 through 6 of chemotherapy. Group п: received 20mg oral dexamethasone with 5HT3 receptor antagonist ondansetron (Zofran) 24mg on day1, and oral prochlorperazine (Emedrotec) 3mg twice daily on day 2 through 6 of chemotherapy. Group ш: received 20 mg oral dexamethasone with 5HT3 receptor antagonist ondansetron (Zofran) 24mg on day1 and oral ondansetron (Zofran) 8mg daily on day2 through 6. The average severity of nausea and vomiting during days 2 to 6 after chemotherapy was assessed for every patient, using National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) and this assessment was repeated for every chemotherapy cycle for 6 cycles. Results: The reported average severity of nausea during cycle 1, 2, 3, 6 was lower in patients receiving ondansetron and gabapentin compared to emedrotec (p0.05). As regard average severity of vomiting scores there was significant decrease in vomiting scores in patients received either gabapentin or ondansetrone in cycles 2,3,4,5,6 compared to patients received emedrotec (p0.05). A percentage of patients required rescue medication to alleviate CINV during the study period, 8(19.5%) patients taking ondansetrone compared with 10 (24.3%) patients in the gabapentin group and 17(39.5%) patients in the Emedrotec group. Rescue medication used was ondansetron (zofran) 24 mg IV. Inter groups comparison for the DN4 during the 6 cycles showed significant reduction in the gabapentin group compared to both emedrotec and ondansetrone groups (p0.05). The incidence of neuropathic pain (DN4 ≥ 4) was significantly reduced in gabapantin group in the 3rd cycle compared to emedrotec and ondansetrone groups (p =0.048). Conclusion: Gabapentin is a useful drug for the management of delayed chemotherapy- induced nausea and vomiting and it also reduced incidence of chemotherapy-induced neuropathic pain.

Abstract Background: Patients beginning cancer treatment consistently list chemotherapy- induced nausea and vomiting as one of their greatest fears. Inadequately controlled emesis impairs functional activity and quality of life for patients, increases the use of health care resources and may occasionally compromises adherence to treatment. The goal of this study was to evaluate the effectiveness of gabapentin, in prevention of delayed chemotherapy induced nausea, vomiting and neuropathic pain in cancer patients receiving highly and moderatly emetogenic chemotherapy. Patients and methods: 125 chemotherapy-naive cancer patients, who were scheduled to receive moderately and highly emetogenic chemotherapy were enrolled in the study. Patients were stratified according to gender, age and they were allocated to one of three groups: Group І: received 20mg oral dexamethasone with 5HT3 receptor antagonist ondansetron (Zofran) 24 mg on day1 and oral gabapentin300mg once daily on day2 through 6 of chemotherapy. Group п: received 20mg oral dexamethasone with 5HT3 receptor antagonist ondansetron (Zofran) 24mg on day1, and oral prochlorperazine (Emedrotec) 3mg twice daily on day 2 through 6 of chemotherapy. Group ш: received 20 mg oral dexamethasone with 5HT3 receptor antagonist ondansetron (Zofran) 24mg on day1 and oral ondansetron (Zofran) 8mg daily on day2 through 6. The average severity of nausea and vomiting during days 2 to 6 after chemotherapy was assessed for every patient, using National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) and this assessment was repeated for every chemotherapy cycle for 6 cycles. Results: The reported average severity of nausea during cycle 1, 2, 3, 6 was lower in patients receiving ondansetron and gabapentin compared to emedrotec (p0.05). As regard average severity of vomiting scores there was significant decrease in vomiting scores in patients received either gabapentin or ondansetrone in cycles 2,3,4,5,6 compared to patients received emedrotec (p0.05). A percentage of patients required rescue medication to alleviate CINV during the study period, 8(19.5%) patients taking ondansetrone compared with 10 (24.3%) patients in the gabapentin group and 17(39.5%) patients in the Emedrotec group. Rescue medication used was ondansetron (zofran) 24 mg IV. Inter groups comparison for the DN4 during the 6 cycles showed significant reduction in the gabapentin group compared to both emedrotec and ondansetrone groups (p0.05). The incidence of neuropathic pain (DN4 ≥ 4) was significantly reduced in gabapantin group in the 3rd cycle compared to emedrotec and ondansetrone groups (p =0.048). Conclusion: Gabapentin is a useful drug for the management of delayed chemotherapy- induced nausea and vomiting and it also reduced incidence of chemotherapy-induced neuropathic pain.

ABSTRACT Inappropriate acute postoperative pain management after breast cancer surgery has been associated with the development of chronic postmastectomy pain syndrome 'PMPS'. The aim of this study was to investigate the analgesic effect of tramadol versus tramadol and bupivacaine locally administered postoperatively before skin closure in patients undergoing surgery for cancer breast. Ninety female patients randomly assigned into three groups (30 patients each); group Control received 20 ml 0.9% saline, group Tramadol received 100 mg tramadol in 20 ml 0.9% saline and group Tramadol+ received 100 mg tramadol in 20 ml plain bupivacaine 0.25%.The study drugs were irrigated by a 20-ml syringe locally postoperatively before skin closure. Pain severity, time to first request of rescue analgesic, analgesic consumption and incidence of side effects were recorded in the 1st 48 hours postoperative. The incidence of neuropathic pain was assessed using DN4 Questionnaire scores in the 1st,2nd,and 3rd months postoperative. Pain score in Tramadol and Tramadol+ group was reduced at 4,6,12,24,36,and 48 hours postoperative compared to the Control group (p0.001). The time to 1st request of rescue analgesia was prolonged in Tramadol and Tramadol+ groups compared to Control group (p0.001). The total consumption of rescue analgesia was reduced in Tramadol and Tramadol+ groups compared to Control group (p0.01).There was no difference in the incidence of side effects in the three groups .The incidence of neuropathic pain (NP) was significantly reduced in Tramadol and Tramadol+ groups compared to Control group. Study parameters showed no difference between Tramadol and Tramadol+ groups. Postoperative local administration of tramadol significantly reduces early acute postoperative pain and the incidence of development of chronic neuropathic pain after cancer breast surgery, to a level comparable to the combined use of tramadol and bupivacaine

ABSTRACT Inappropriate acute postoperative pain management after breast cancer surgery has been associated with the development of chronic postmastectomy pain syndrome 'PMPS'. The aim of this study was to investigate the analgesic effect of tramadol versus tramadol and bupivacaine locally administered postoperatively before skin closure in patients undergoing surgery for cancer breast. Ninety female patients randomly assigned into three groups (30 patients each); group Control received 20 ml 0.9% saline, group Tramadol received 100 mg tramadol in 20 ml 0.9% saline and group Tramadol+ received 100 mg tramadol in 20 ml plain bupivacaine 0.25%.The study drugs were irrigated by a 20-ml syringe locally postoperatively before skin closure. Pain severity, time to first request of rescue analgesic, analgesic consumption and incidence of side effects were recorded in the 1st 48 hours postoperative. The incidence of neuropathic pain was assessed using DN4 Questionnaire scores in the 1st,2nd,and 3rd months postoperative. Pain score in Tramadol and Tramadol+ group was reduced at 4,6,12,24,36,and 48 hours postoperative compared to the Control group (p0.001). The time to 1st request of rescue analgesia was prolonged in Tramadol and Tramadol+ groups compared to Control group (p0.001). The total consumption of rescue analgesia was reduced in Tramadol and Tramadol+ groups compared to Control group (p0.01).There was no difference in the incidence of side effects in the three groups .The incidence of neuropathic pain (NP) was significantly reduced in Tramadol and Tramadol+ groups compared to Control group. Study parameters showed no difference between Tramadol and Tramadol+ groups. Postoperative local administration of tramadol significantly reduces early acute postoperative pain and the incidence of development of chronic neuropathic pain after cancer breast surgery, to a level comparable to the combined use of tramadol and bupivacaine