Invited Comment on “Comparison of Analgesic Effect Between Gabapentin and Diclofenac on Post-Operative Pain in Patients Undergoing Tonsillectomy”

Abstract

We read with interest the research article by Mogadam AY, Fazel MR and Parviz S entitled “Comparison of analgesic effect between gabapentin and diclofenac on postoperative pain in patients undergoing tonsillectomy” (1). The results suggested that diclofenac and gabapentin reduce both post-operative pain and opiod consumption without any obvious side effects. The authors have been very methodical and have presented a very detailed account of the research process. However, some studies have stated that oral tramadol can deliver the similar analgesic effects as oral diclofenac for pain relief after tonsillectomy and thereby, avoiding the adverse effects of nonsteroidal anti-inflammatory drugs (2). A study has also suggested that preoperative tramadol in lower doses could be used not only at induction of anesthesia in tonsillectomy of children as an alternative to propofol anesthesia but also postoperative analgesia in only early period (3). Although studies have stated the premedication with gabapentin decreased post-tonsillectomy pain, it did not show any significant reduction in post-operative nausea and vomiting (PONV) (4, 5). A recent systematic review on gabapentin revealed that it effectively reduces post-operative pain, opioid consumption, and opioid-related adverse effects after surgery (6). A study has stated that preoperative 600 mg of gabapentin did not cause any reduction in post-operative pain after hip arthroplasty whereas another study conducted with the same dose of gabapentin showed significant reduction of postoperative pain after total mastectomy and axillary dissection (7, 8). Although there have been numerous conflicting outcomes in the recent studies regarding the preemptive use of diclofenac and gabapentin in reduction of postoperative pain and side effects such as nausea and vomiting, the researchers have made a very systematic effort to study these drugs.