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Journal of Postgraduate Medicine, Vol. 52, No. 3, July-September, 2006, pp. 230-231 Letters Authors' reply Pandey ChandrakantK, Priye S, Ambesh SP, Singh S, Singh U, Singh PK Departments of Anaesthesiology and Biostatistics,
Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow - 226014 Code Number: jp06074 Related Article: jp06031 Sir, We like to thank for the keen observations made by Ho regarding article "Prophylactic gabapentin for prevention of postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy: A randomized, double-blind, placebo-controlled study" published in J Postgrad Med 2006;52:97-100.[1] We would like to offer the following replies. 1. The effect of gabapentin in the prevention of emesis induced by cytotoxic drugs has been demonstrated.[2] However, the precise mechanism by which gabapentin prevents prevention of nausea and vomiting induced by cytotoxic drugs is not known but mitigation of tachykinin neurotransmitter activity is implicated in the treatment of hot flushes with gabapentin.[3] It is demonstrated that the activity of tachykinins is part of the pathogenesis of chemotherapy-induced emesis in animals and a selective tachykinins-receptor antagonist prevents emesis induced by chemotherapy.[4] 2. The etiology of PONV in patients undergoing laparoscopic cholecystectomy is not identical to that in patients receiving cytotoxic drugs and our study was not empowered to investigate the causative factors of emesis in laparoscopic cholecystectomy but we assume that mitigation of active tachykinins may also be one of the probable mechanisms for prevention of PONV. 3. We agree that the lower incidence of PONV in the gabapentin group was due to a decrease in opioids-related side effect. Fentanyl requirement was statistically significant lower in the gabapentin group. The use of postoperative opioids is one of the risk factor for PONV.[5] Thus decreased amount of opioids consumption might be the factor responsible for decreased PONV in gabapentin group in our study. 4. The question raised by the reader is the subject of further investigation that whether gabapentin reduces the incidence of PONV when compared with placebo in patients undergoing non-painful procedures under general anesthesia or when postoperative pain is being managed with other than opioids. References
Copyright 2006 - Journal of Postgraduate Medicine |
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