title: Multimodal preincisional premedication to prevent acute pain after cholecystectomy.
abstract: BACKGROUND
  Postoperative pain as an important medical concern is usually treated by opioids which also are of various inevitable side effects. The aim of this study was to assess the efficacy of multimodal preincisional premedication on preventing post-cholecystectomy acute pain.
  
  
  METHODS
  In a randomized clinical trial, sixty patients undergoing open cholecystectomy were randomized into two groups. Before anesthesia induction, Diclofenac suppository (100 mg) and oral Clonidine (0.2 mg) were administered in the first group. Immediately before operation, patients received Ketamine (1 mg/kg IV) while the control group received placebo. The site of incision was infiltrated by the surgeon with 20 mL Bupivacaine 0.25% in both groups. Anesthesia induction and maintenance were similar in both groups. The severity of pain was recorded 2, 4, 6, 12, 24 and 48 hours after operation according to Visual Analogue Scale.
  
  
  RESULTS
  The severity of pain at two defined stages (6 and 12 hours later) was significantly less in the intervention group than the control group (P<0.005). The average pain severity score was less than the control group (P<0.005).
  
  
  CONCLUSIONS
  In our study, the administration of Clonidine, Diclofenac and Ketamine and bupivacaine infiltration to the site of incision, altogether was associated with a significant decrease in pain score and opioid requirement after cholecystectomy in comparison to bupivacaine infiltration to the site of incision.
authors.affiliation: Department of Anesthesiology, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Dawood
authors.initials: D
authors.lastname: Aghamohammadi
authors.forename: Hamzeh
authors.initials: H
authors.lastname: Hosseinzadeh
authors.forename: Mahmood
authors.initials: M
authors.lastname: Eidy
authors.forename: Zahra
authors.initials: Z
authors.lastname: Mohammadzadeh Vizhe
authors.forename: Mohammad Bassir
authors.initials: MB
authors.lastname: Abolghasemi Fakhri
authors.forename: Reza
authors.initials: R
authors.lastname: Movassaghi
authors.forename: Kamyar
authors.initials: K
authors.lastname: Ghabili
authors.forename: Samad Ej
authors.initials: SE
authors.lastname: Golzari
keywords: Multimodal Analgesia; Postoperative Opioid; Postoperative Pain