Study To Check The Analgesic And Anti-Inflammatory Effects Of Atorvastatin In Patients Undergoing Abdominal Surgery (A4S)

• Pain as measured on Visual Analogue Scale [ Time Frame: 2, 4, 6, 12, 24 hour post-operative and twice daily till discharge ] [ Designated as safety issue: No ]
  

• Pain measured on Wong Pain Scale [ Time Frame: 2, 4, 6, 12, 24 hours post-operative and twice daily thereafter till discharge ] [ Designated as safety issue: No ]
  
• Pain measured by the McGill Pain Questionnaire [ Time Frame: Once daily till discharge ] [ Designated as safety issue: No ]
  
• TNF Alpha Levels [ Time Frame: baseline, on day of surgery, day 4 postoperative ] [ Designated as safety issue: Yes ]
  
• Serum Lipid Levels [ Time Frame: Before starting Atorvastatin and at end of study ] [ Designated as safety issue: Yes ]
  
• C Reactive Protein Levels [ Time Frame: baseline, on day of surgery, day 4 postoperative ] [ Designated as safety issue: Yes ]
  

Study type: Double Blind Placebo Controlled

Method of Randomization: Computer Generated Table

No. of patients to be recruited: 40

Accept Healthy Volunteers: No

Drugs to be administered: Atorvastatin to 20 patients and placebo to 20 patients

Mode of drug administration: Oral

Duration of Study: 3 weeks

Patients who attend the Surgical O.P.D and the Obstetrics and Gynaecology O.P.D and are diagnosed with any condition that requires elective abdominal surgery under spinal anaesthesia will be chosen for screening. Patients undergoing day care surgery with spinal anaesthesia and an abdominal incision will also be included for screening.

Two weeks before the decided date of surgery the patients will be called for screening. The patients will first be screened for obesity, risk factors for CVS diseases and blood will be withdrawn for estimation of serum lipid levels. Further risk assessment of these patients will be done according to the NCEP ATP III Guidelines (2004 Revision of NCEP Adult Treatment Panel III Guidelines). If the patient is under the moderate risk category and fits in the inclusion criteria he/she will be called the next week for starting atorvastatin/placebo.

Patients who are defined as dyslipidemic in the moderate risk category according to NCEP ATP III Guidelines i.e patients who would benefit from statin therapy will be given atorvastatin 10 mg or placebo started one week before their expected date of surgery. They will be explained the possible A.D.R of statin therapy. Informed consent form will be filled.

On the day of the surgery the patient will be explained the Visual Analouge Scale and the Wong Pain Scale. After the operation the patients will be started on S.O.S analgesic therapy. The protocol used will be the same as followed in the surgical wards. In case of severe pain opioids will be used. For other types of pain which can be tolerated by the patients Diclofenac Sodium will be used.

The patient will be monitored after the surgery for the total dose of analgesics required for the relief of pain. Further the time of first dose of analgesic required after operation will be noted. The patient will be monitored for pain at the incision site 2, 4, 6, 12, 24 hours after the operation using the visual analogue scale and the Wong Pain Scale. Later using the abovementioned scales the patient's pain will be monitored twice daily until the patient is discharged. The McGill Pain Questionnaire will be given to the patient on the first day and every day thereafter till the patient is discharged. After discharge the patient will followed up on the day of their suture removal and pain scores will be evaluated. The patient will be asked to come weekly till the end of the study period.

Blood will be withdrawn for the estimation of serum lipid levels, total leukocyte counts, C - reactive protein and TNF-α levels at baseline(i.e day of starting therapy), on the day of the surgery before the surgery and at the fourth postoperative day. All blood samples will be taken between 10A.M-12P.M Wound healing will be monitored on a daily basis until discharge and weekly thereafter. The attending surgeon will monitor the wound for discharge, swelling, etc. Additional signs of inflammation and infection like swelling, fever, erythema will also be monitored for.

The patients will be instructed to take atorvastatin or placebo once a day for three weeks (One week preoperative and two weeks postoperative). At the end of this period the patient will be asked to continue statins from outside. In the event that the patient is unable to afford the medication he will be weaned off the statin in a gradual manner.