Carbamezapine for pain management in Guillain-Barré syndrome patients in the intensive care unit.
OBJECTIVE
To evaluate carbamezapine (CBZ) for neuritic pain relief in Guillain-Barré syndrome (GBS) patients in the intensive care unit (ICU).


METHODS
Prospective, double-blind, randomly allocated cross-over study days.


METHODS
ICU in a tertiary care university hospital.


METHODS
Twelve consecutive, conscious adult (22-54 yrs) patients with GBS during recovery from the muscular weakness and receiving pressure-support ventilation in the ICU. All patients complained of severe backache and/or leg cramps and tenderness in muscles, and they required opioids for pain relief.


METHODS
CBZ (100 mg every 8 hrs) or equivalent placebo was given to nursing staff in coded powder form. Medication was given to patients through a nasogastric feeding tube. The same coded medicine was given for 3 days, and after a 1-day omission, a second set of coded powder was given for the next 3 days in a randomized, double-blind, crossover fashion. Pethidine (1 mg x kg(-1)) was given intravenously in between, if the pain score was >2. Group 1 (n = 6) patients were given a placebo on the first 3 days, followed by CBZ. Group 2 (n = 6) patients were given CBZ on the first 3 days, followed by a placebo.


RESULTS
In these two study periods of different medications, we observed and scored pain (1, no pain; 5, severe pain), sedation (1, alert; 6, asleep, does not respond to verbal command), and total pethidine requirement per day. In group 1 patients, a significant (p < .001) improvement in the sedation score and a low requirement for pethidine was observed 3 days later, when CBZ was started. However, in group 2 patients, a gradual increase in the pethidine requirement and a high sedation score were noteworthy in the later days of placebo medication. Observations were also analyzed for CBZ days vs. placebo days. Overall, the pain score (1.7 +/- 0.8) during the CBZ period of both regimens was significantly (p < .001) lower than during the placebo days (3.1 +/- 0.9). Significantly higher doses of pethidine (3.7 +/- 0.9 mg/kg/day) were used on the placebo days than on the CBZ days (1.7 +/- 1.0 mg/kg/day).


CONCLUSIONS
The pain in GBS has a dual origin, and we recommend CBZ as an adjuvant to treat pain in GBS patients, during the recovery phase in the ICU, to reduce the narcotic requirement.
Tripathi
M
M
Department of Anaesthesiology and Critical Care Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India. mukesh_tripathi@hotmail.com
Kaushik
S
S
D000328:Adult; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000704:Analysis of Variance; D002220:Carbamazepine / Q000627:therapeutic use*; D002422:Causalgia / Q000188:drug therapy; D003422:Critical Care / Q000379:methods*; D018592:Cross-Over Studies; D004311:Double-Blind Method; D005260:Female; D020275:Guillain-Barre Syndrome / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008614:Meperidine / Q000008:administration & dosage; D009437:Neuralgia / Q000188:drug therapy* / Q000209:etiology; D010292:Paresthesia / Q000188:drug therapy; D011446:Prospective Studies; D012585:Sciatica / Q000188:drug therapy
D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D002220:Carbamazepine; D008614:Meperidine