Carbamezapine for pain management in Guillain-Barré syndrome patients in the intensive care unit [Clinical Investigations] Tripathi, Mukesh MD; Kaushik, Soma MS, MNAMS, DA From the Department of Anaesthesiology and Critical Care Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India. Presented, in part, at the 7th World Congress of Intensive and Critical Care Medicine, Ottawa, Ontario, Canada, June 29 to July 3, 1997. Address requests for reprints to: Mukesh Tripathi, MD, Type IV/50, Campus, SGPGIMS, Lucknow-226 014, India. E-mail: mukesh_tripathi@hotmail.com Abstract Objective: To evaluate carbamezapine (CBZ) for neuritic pain relief in Guillain-Barré syndrome (GBS) patients in the intensive care unit (ICU). Design: Prospective, double-blind, randomly allocated crossover study days. Setting: ICU in a tertiary care university hospital. Participants: Twelve consecutive, conscious adult (22-54 yrs) patients with GBS during recovery from the muscular weakness and receiving pressure-support ventilation in the ICU. All patients complained of severe backache and/or leg cramps and tenderness in muscles, and they required opioids for pain relief. Interventions: CBZ (100 mg every 8 hrs) or equivalent placebo was given to nursing staff in coded powder form. Medication was given to patients through a nasogastric feeding tube. The same coded medicine was given for 3 days, and after a 1-day omission, a second set of coded powder was given for the next 3 days in a randomized, double-blind, crossover fashion. Pethidine (1 mg·kg -1 ) was given intravenously in between, if the pain score was >2. Group 1 (n = 6) patients were given a placebo on the first 3 days, followed by CBZ. Group 2 (n = 6) patients were given CBZ on the first 3 days, followed by a placebo. Measurements and Main Results: In these two study periods of different medications, we observed and scored pain (1, no pain; 5, severe pain), sedation (1, alert; 6, asleep, does not respond to verbal command), and total pethidine requirement per day. In group 1 patients, a significant (p < .001) improvement in the sedation score and a low requirement for pethidine was observed 3 days later, when CBZ was started. However, in group 2 patients, a gradual increase in the pethidine requirement and a high sedation score were noteworthy in the later days of placebo medication. Observations were also analyzed for CBZ days vs. placebo days. Overall, the pain score (1.7 ± 0.8) during the CBZ period of both regimens was significantly (p < .001) lower than during the placebo days (3.1 ± 0.9). Significantly higher doses of pethidine (3.7 ± 0.9 mg/kg/day) were used on the placebo days than on the CBZ days (1.7 ± 1.0 mg/kg/day). © 2000 Lippincott Williams & Wilkins, Inc. Volume 28(3), March 2000, pp 655-658 Page 1 of 9 Ovid: Tripathi: Crit Care Med, Volume 28(3).March 2000.655-658 7/19/2006 http://gateway.ut.ovid.com/gw2/ovidweb.cgi