Comparison of Analgesic Effects of B Vitamins and Diclofenac plus B Vitamins During General Anesthesia and PACU
AbstractBackground: B Vitamins deficiencies in humans and animals have been known for some time to induce pain and inflammation. These symptoms can be readily alleviated by appropriate administration of Vitamins B. The aim of this study was to evaluate opioids requirements and hemodynamic variables and analgesic effect of B Vitamins and B Vitamins-diclofenac in general anesthesia and Post-anesthesia care unit (PACU).Methods: In this randomized prospective and double-blinded clinical trial study 105 patients undergoing orthopedic surgery were assessed. Patients were then randomized to receive placebo, B vitamin and diclofenac plus B Vitamins. Preinduction and postinduction hemodynamic parameters and opioid requirement were measured.Results: Sufentanil requirement postoperatively was significantly lower in the DB group (0.12 µg/kg) and B group (0.17 µg/kg) compared with the Placebo group (0.2 µg/kg) (P=0.001). Maximum mean systolic blood pressure related to basal heart rate were increased in DB group 20±6%, B group 30± 17% and P group 35± 9% with significant difference in three groups (P= 0.0001).Discussion: Analgesic effect of diclofenac plus B Vitamins was better than B Vitamins and required less opioid agents.
Chavarria‐Bolaños D, Perez‐Urizar J, Grandfils C, Pozos‐Guillén A. Peripheral Synergism between Tramadol and Ibuprofen in the Formalin Test. Drug Dev Res. 2014; 75(4):224-30.
Ostadalipour A, Jamshidi M, Zamani A, Tavasoli A. Analgesic and antisympathetic effects of clonidine in burn patients, a randomized, double-blind, placebo-controlled clinical trial. Indian J of Plastic Surgery. 2007; 40(1):29-33.
Ivani G, Tonetti F. Postoperative analgesia in infants and children: new developments. Minerva Anestesiol. 2004; 70(5):399-403.
Beck A, Salem K, Krischak G, Kinzl L, Bischoff M, Schmelz A. Nonsteroidal anti-inflammatory drugs (NSAIDs) in the perioperative phase in traumatology and orthopedics effects on bone healing. Oper Orthop Traumatol. 2005; 17(6):569-78.
Levin OS, Moseikin IA. [Vitamin B complex (milgamma) in the treatment of vertebrogenic lumbosacral radiculopathy]. Zh Nevrol Psikhiatr Im S S Korsakova. 2009; 109(10):30-5.
Kuhlwein A, Meyer H, Koehler C. Reduced diclofenac administration by B vitamins: results of a randomized double-blind study with reduced daily doses of diclofenac (75 mg diclofenac versus 75 mg diclofenac plus B vitamins) in acute lumbar vertebral syndromes]. Klin Wochenschr. 1990; 68(2):107-15.
Brüggemann G, Koehler C, Koch E. [Results of a double-blind study of diclofenac+ vitamin B1, B6, B12 versus diclofenac in patients with acute pain of the lumbar vertebrae. A multicenter study]. Klin Wochenschr. 1990; 68(2):116-20.
Pérez-Flores E, Medina-Santillán R, Reyes-García G, Mateos-García E. Combination of diclofenac plus B vitamins in acute pain after tonsillectomy: a pilot study. Proc West Pharmacol Soc. 2003; 46:88-90.
Mibielli MA, Geller M, Cohen JC, Goldberg SG, Cohen MT, Nunes CP, et al. Diclofenac plus B vitamins versus diclofenac monotherapy in lumbago: the DOLOR study. Curr Med Res Opin. 2009; 25(11):2589-99.
Yu CZ, Liu YP, Liu S, Yan M, Hu SJ, Song XJ. Systematic administration of B vitamins attenuates neuropathic hyperalgesia and reduces spinal neuron injury following temporary spinal cord ischaemia in rats. Eur J Pain. 2014; 18(1):76-85.
Fu QG, Carstens E, Stelzer B, Zimmermann M. B vitamins suppress spinal dorsal horn nociceptive neurons in the cat. Neurosci Lett. 1988; 95(1-3):192-7.
Takeshige C, Ando Y, Ando M. Effects of vitamin B12 and aldosterone on the conduction of sensory and motor nerve impulse. Vitamins (Jpn). 1971; 44:272-82.
Ponce-Monter HA, Ortiz MI, Garza-Hernández AF, Monroy-Maya R, Soto-Ríos M, Carrillo-Alarcón L, et al. Effect of diclofenac with B vitamins on the treatment of acute pain originated by lower-limb fracture and surgery. Pain Res Treat. 2012; 2012:104782.
Nooruzzaman M, Pervez MM, Akan MAB, Anisuzzaman M, Islam MN, Shahinoor A. Assesment of The Effect of Multimodal Preemptive Analgesia in Children. J Pediatric Surgeons Bangladesh 2014; 2(2):56-62.
Tripathi S, Shah R, Sharma D. Analgesic activity of fixed dose combinations of paracetamol with diclofenac sodium and paracetamol with tramadol on different pain models in healthy volunteers-A randomized double blind crossover study. J Anaesthesiol Clin Pharmacol. 2012; 28(4):465.
Torres-López JE, Carmona-Díaz E, Cortés-Peñaloza JL, Guzmán-Priego CG, Rocha-González HI. Antinociceptive synergy between diclofenac and morphine after local injection into the inflamed site. Pharmacol Rep. 2013; 65(2):358-67.
Curatolo M, Sveticic G. Drug combinations in pain treatment: a review of the published evidence and a method for finding the optimal combination. Best Pract Res Clin Anaesthesiol. 2002; 16(4):507-19.