الفهرس 
ANATOMY AND PHYSIOLOGY OF PAINOnly 14 pages are availabe for public view
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Abstract
Abdominal surgeries are considered one of the most painful among all types of surgeries. About 70% of patients who had done abdominal surgeries suffered from severe pain in the postoperative period especially the gynaecological one (Sommer et al., 2008). This pain and fatigue are the two key causes of prolonged convalescence following abdominal surgery (Bekker et al., 2013).
In order to relieve these pain and fatigue, a current predominant approach of multimodal postoperative analgesia is used, mostly based on a combination of opioids, non-steroidal anti-inflammatory drugs (NSAIDs), paracetamol, and perioperative administration of local anesthetics. Each of these different approaches has its own set of complications (Cashman and Dolin, 2004).
It was found that Non-steroidal anti-inflammatory drugs (NSAIDS) either those acting by inhibiting cyclooxygenase-1 (COX-1) like diclofenac sodium or by inhibiting COX-2 enzymes like meloxicam and lornoxicam have a relative equipotency (Gan, 2010).
That is why diclofenac sodium is the widely used post-operative analgesic (Chelly et al., 2013; Hospira, 2016).
An emerging concepts of pre-emptive analgesia has been applied in the management of post-operative pain especially after abdominal operations. It consists of a drug having analgesic properties as well as opioid sparing effects. This regimen can possibly reduce the opioid tolerance and relieves anxiety. It is not also associated with the typical adverse effects for the traditional analgesic (Kelhet and Dahl 2003).
This pre-emptive analgesia depend on the use of drug that act on neuropathic neurons like pregabalin (Imani and Rahimzadeh, 2012).
Many studies had found that the administration of preoperatively oral pregabalin reduce the acute postoperative pain and prolong the anaesthesia duration as well as reduces the pain scores in the postsurgical setting (Clarke et al., 2015; Mishriky et al., 2015; Cegin et al., 2016).
The current study aimed to assess the efficacy of oral pregabalin 150 mg as adjuvant analgesic to i.v diclofenac sodium 75 mg since up to our knowledge no similar study had been done in Egypt.
A randomized controlled trial was done on female patients that done laparotomy for benign gynaecological diseases in Ain Shams University Maternity Hospital during a duration of nine month.
The trial included one hundred and sixteen patients, divided into two equal groups. The first group (group A) received oral pregabalin 150 mg one hour before operation and 12 hour after operation and repeated every 12 hour for the first 24hour and/or in demand. The second group (group B) received intravenous Diclofenac Sodium 75 mg 12 hour after operation and repeated every 12 hour for the first 24 hour and/or in demand to assess postoperative by using VAS-100 score, also early patient ambulation and audible intestinal sounds.
Pain perception was significantly lower among (group A) than the (group B). As on VAS study group record of 20-10, control group record 45-30.
Analgesia-free time was significantly lower among study than among control by 2 hours.
Side effects were more frequent among study than among control group, but the differences were significant only in somolence.
This study had showed also a significant early post-operative mobilisation in those who took oral pregabalin 150mg in comparison to those who took i.v diclofenac sodium 75mg which is attributed to decrease pain perception. It revealed also no significant difference between both groups regarding the intestinal activity.