Carbamezapine for pain management in Guillain-Barré syndrome patients in the intensive care unit

Crit Care Med. 2000 Mar;28(3):655-8. doi: 10.1097/00003246-200003000-00009.

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 cross-over 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 x 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).

Conclusion: The pain in GBS has a dual origin, and we recommend CBZ as an adjuvant to treat pain in GBS patients, during the recovery phase in the ICU, to reduce the narcotic requirement.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Analgesics, Non-Narcotic / therapeutic use*
  • Analgesics, Opioid / administration & dosage
  • Analysis of Variance
  • Carbamazepine / therapeutic use*
  • Causalgia / drug therapy
  • Critical Care / methods*
  • Cross-Over Studies
  • Double-Blind Method
  • Female
  • Guillain-Barre Syndrome / complications
  • Guillain-Barre Syndrome / drug therapy*
  • Humans
  • Male
  • Meperidine / administration & dosage
  • Neuralgia / drug therapy*
  • Neuralgia / etiology
  • Paresthesia / drug therapy
  • Prospective Studies
  • Sciatica / drug therapy

Substances

  • Analgesics, Non-Narcotic
  • Analgesics, Opioid
  • Carbamazepine
  • Meperidine