Abstract
Pain after surgery remains a significant clinical problem as it impairs recovery adversely and may lead to the transition to chronic pain. Opioid medications are far from ideal agents in suppressing postoperative pain. Gabapentin –an anticonvul-sant with antihyperalgesic properties- originally efficacious against neuropathic pain seems to be very promising for the management of pain after surgery as well. Gabapentin, by decreasing noxious stimulus-induced excitatory neurotransmitter release at the spinal cord, may attenuate central sensitization, and eventually decrease postoperative late pain. Furthermore, different sites of action may be pertinent to a synergistic effect with opioids. Both actions (antihyperalgesic effect and syn-ergy with opioid analgesia) may manifest as analgesia and/or opioid-sparing effect after surgery. This has been confirmed by a variety of clinical studies, in a variety of settings. Most of these studies have shown that either single preoperative or repeated doses of gabapentin, continued for up to a few days after surgery, decrease acute postoperative pain and/or need for postoperative opioids. This has been shown for procedures such as abdominal and vaginal hysterectomy, breast surgery for cancer (mastectomy or lumpectomy), lumbar discectomy and spinal fusion, laparoscopic cholecystectomy and other, such as ENT surgery. Finally, a few studies indicate that perioperative gabapentin may as well decrease chronic pain several weeks after surgery.
Highlights
Pain is a common postoperative symptom impairing the quality of postoperative recovery, delaying discharge from Post-anaesthesia care unit (PACU) or surgical centre, leading to post-discharge readmissions, and increasing overall morbidity and costs [1,2,3,4]
Mechanisms related to N-Methyl-DAspartate (NMDA) receptor activation and translocation of the protein kinase C (PKC) in dorsal horn neurons have been implicated in the development of persisting pain, hyperalgesia, and tolerance to opioid analgesia [16,17,18]
An enhancement of the calcium influx via voltage-gated calcium currents (VGCC) produced by gabapentin, in case of a possible enhancement of VGCC as a result of binding to the α2δ subunit might alternatively reduce the membrane excitability by facilitating K+ efflux via the calciumactivated potassium channels that have been identified on mammalian sensory nociceptive neurons and are altered by nerve injury [52]
Summary
The above findings indicate a potential role of gabapentin as a putative “broadspectrum” analgesic [76,77], with a selective antihyperalgesic and antiallodynic action, against pain induced intraoperatively by nerve or tissue injury [77]. The antinociceptive and antihyperalgesic and anti-inflammatory effects of gabapentin in states that emerge after acute nerve injury may have an impact on acute and chronic pain after surgery. Because of the synergism between gabapentin and opioids, the effects of gabapentin on acute postoperative pain and morphine consumption in patients undergoing different types of surgery have been investigated in randomized, controlled double-blind studies. The postoperative analgesic effect has been confirmed by systemic reviews that have analyzed series of clinical studies, evaluating gabapentin as a postoperative analgesic agent [78]. These studies have confirmed that perioperative gabapentin is an effective analgesic and has an opioid sparing effect. The specific effect after different types of surgery is reviewed
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
