Indian Journal of Anaesthesia  
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Year : 2019  |  Volume : 63  |  Issue : 11  |  Page : 895-899

Pre-emptive multimodal analgesic regimen reduces post-operative epidural demand boluses in traumatic shaft of femur fracture - A randomised controlled trial

1 Department of Anaesthesia and Intensive Care, Post Graduate Institute Medical Education and Research, Chandigarh, India
2 Department of Anesthesiology and Critical Care, Jawaharlal Institute of Post Graduate Medical Education and Research, Dhanvantari Nagar, Puducherry, India
3 Department of Anaesthesia and Intensive Care, All India Institute of Medical Sciences, New Delhi, India

Correspondence Address:
Dr. Aswini Kuberan
Department of Anesthesiology and Critical Care, Jawaharlal Institute of Post Graduate Medical Education and Research, Dhanvantari Nagar, Puducherry - 605 006
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ija.IJA_363_19

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Background and Aims: The efficacy of preemptive multimodal analgesia in post-traumatic patients has not been elucidated. Our aim was to evaluate the efficacy of preemptive MMA regimen in reducing the epidural demand boluses in the first 48 hours following the traumatic shaft of femur fractures. Methods: Patients scheduled for traumatic femur fracture surgery were randomised (n = 135) into two groups in this double blind, placebo controlled trial. Patients received either (Preemptive multimodal group) intravenous acetaminophen 1 gm, diclofenac 75 mg, morphine 3 mg, 75 mg Pregabalin (per oral) or a placebo 30 minutes pre-operatively. Intra-operatively, all patients were managed with spinal and epidural anaesthesia. Post-operatively, patients received patient-controlled epidural analgesia (PCEA) programmed to deliver a bolus of 5 ml of 0.2% Ropivacaine with 2 μg/ml of Fentanyl with lockout interval time of 15 min. Primary outcome was number of PCEA boluses received post-operatively over 48 h. Secondary outcomes measures were time to receive first epidural bolus, postoperative VAS scores and episodes of post-operative nausea, vomiting and sedation. Total number of PCEA bolus doses over 48 hours and VAS scores were analysed using Mann-Whitney test. Results: Significant reduction in median number of demand boluses were observed in preemptive multimodal group (3 [2-4]) compared to placebo group (5 [4-7]); P = 0.00. Time to first rescue epidural bolus was significantly greater in preemptive multimodal group than placebo group. Conclusion: The use of preemptive MMA regimen reduced the requirement of demand epidural bolus doses.

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