title: Comparative Pre-Emptive Analgesic Efficacy Study of Novel Antiepileptic Agents Lamotrigine and Topiramate in Patients Undergoing Major Surgeries at a Tertiary Care Hospital: A Randomized Double Blind Clinical Trial.
abstract: BACKGROUND
  Central nervous sensitization, following surgical injury, leads to postoperative pain hypersensitivity due to lowered pain threshold in peripheral nociceptors and increased excitability of spinal neurons. Pre-emptive analgesia is intended to decrease pain perception and overall analgesic need by use of drug regimen, seizing CNS sensitization before exposure to painful stimuli. Few studies support pre-emptive analgesic efficacy of novel antiepileptic agent Gabapentin. Though Topiramate and Lamotrigine have been proven analgesic in animal models of chronic pain and clinical studies of Gabapentin-resistant neuropathic pain, literature search revealed scarce data on its pre-emptive analgesic efficacy.
  
  
  OBJECTIVE
  This study is designed to study and compare the pre-emptive analgesic efficacy of Lamotrigine, Topiramate, and Diclofenac sodium in postoperative pain control.
  
  
  METHODS
  This randomized clinical trial included 90 patients of either sex, between 18 and 70 years undergoing major surgeries. Patients were randomly allocated to control and test groups and received respective treatment 30 min before induction of anesthesia. Aldrete's and pain scores were recorded using the Visual Analog Scale, Facial and Behavioral Rating Scale at awakening and at 1, 2, 4, 6, and 24 h. Postoperative rescue analgesic consumption for 24 h was recorded.
  
  
  RESULTS
  Significantly higher pain scores were observed in the Topiramate group postoperatively for 2 h on all pain scales (p < 0.05), whereas in the control group it was significantly higher at 1 h (p < 0.05). Lamotrigine-treated patients were more comfortable throughout the study with significantly less (p < 0.05) postoperative analgesic requirement.
  
  
  CONCLUSIONS
  Study results strongly suggest the pre-emptive analgesic efficacy of a single oral dose of Lamotrigine over Diclofenac and Topiramate in postoperative pain control.
authors.affiliation: Department of Pharmacology, Smt. Kashibai Navale Medical College and General Hospital, Narhe (Ambegaon), Pune, India.
authors.forename: Ankush
authors.initials: A
authors.lastname: Gupta
authors.affiliation: Department of Pharmacology, Smt. Kashibai Navale Medical College and General Hospital, Narhe (Ambegaon), Pune, India.
authors.forename: Uma A
authors.initials: UA
authors.lastname: Bhosale
authors.affiliation: Department of Pharmacology, Smt. Kashibai Navale Medical College and General Hospital, Narhe (Ambegaon), Pune, India.
authors.forename: Priyank
authors.initials: P
authors.lastname: Shah
authors.affiliation: Department of Pharmacology, Smt. Kashibai Navale Medical College and General Hospital, Narhe (Ambegaon), Pune, India.
authors.forename: Radha
authors.initials: R
authors.lastname: Yegnanarayan
authors.affiliation: Department of Anesthesia, Smt. Kashibai Navale Medical College and General Hospital, Narhe (Ambegaon), Pune, India.
authors.forename: Shalini
authors.initials: S
authors.lastname: Sardesai
keywords: Aldrete's score; Behavioral Rating Scale; Facial Rating Scale; Pre-emptive analgesia; Visual Analog Scale