Preoperative Gabapentin Research Articles

Preoperative adjuvant gabapentin with dexamethasone compared to dexamethasone alone for postoperative analgesia in cholecystectomy

Preoperative adjuvant gabapentin with dexamethasone compared to dexamethasone alone for postoperative analgesia in cholecystectomy

Preoperative Gabapentin Dosage Relationship to Length of Stay in Post-Anesthesia Care Unit in Patients Undergoing Pelvic and Breast Surgery

Background: Gabapentin is routinely prescribed preoperatively to decrease postoperative pain intensity. It is included in the enhanced recovery after surgery (ERAS) recommendations. Objective: To analyze correlation of gabapentin dosage and post anesthesia care unit (PACU) length of stay (LOS) and cost. Study Design: A retrospective chart review of patients who underwent general anesthesia and received preoperative oral gabapentin from June 2017 to August 2017 for pelvic and breast procedures. The main outcome was correlation between PACU LOS and gabapentin dosage in the outpatients. Financial analysis was performed to assess the cost to the hospital associated with increased LOS. Results: Of the 636 patients, 405 patients received 300 mg and 231 patients received 100 mg gabapentin. Mean dosage per kg (mg/kg ± SD) was 3.12 ± 1.51 (range: 0.86 to 6.12). PACU LOS was 96 ± 77 (minutes ± SD) in patients receiving 100 mg and 120 ± 96 in patients receiving 300 mg capsule (p = 0.001). Linear regression analysis, failed to show a statistically significant correlation between per kg dosage and PACU LOS (p = 0.13). Using multiple regression analysis, we calculated the correlation coefficient to be +1.71 minutes per 1mg/kg gabapentin (95% CI: -3.75 to +7.10, p = 0.54) after adjusting for confounders. Adding 3 mg/kg to pre-op gabapentin dosage of all outpatients cost on average, an extra $9794 per month in this cohort. Conclusion: Every 1mg/kg increase in gabapentin dosage adds an estimated 7.1 minutes to PACU LOS. A 3 mg/kg increase in gabapentin adds estimated 22 additional minutes in PACU LOS. Unfortunately, increase LOS is associated with increased hospital costs.

Optimal dosing of preoperative gabapentin for prevention of postoperative nausea and vomiting after abdominal laparoscopic surgery: A randomized prospective comparative study

ABSTRACT Background: Gabapentin has great efficacy in the treatment of neuropathic pain as a non-opioid alternative. It has been reported to prevent nausea and vomiting postoperatively. Our study compared different dosing regimens to evaluate their effectiveness and frequency of side effects in patients scheduled for laparoscopic abdominal surgery.Methods: 150 adult patients scheduled for elective abdominal laparoscopic surgery were randomly assigned to three equal groups. Group G300 received 300 mg gabapentin orally 1 h before surgery. Group G600 received 600 mg gabapentin orally 1 h before surgery. Group G900 received 900 mg gabapentin orally 1 h before surgery. Incidence and severity of PONV, need for rescue antiemetics, need for rescue analgesia, and incidence of side effects were assessed.Results: Incidence and severity of PONV were statistically higher in G300 versus G600, and G900 (8/50, 4/50, 3/50, respectively) and the total number of patients who received antiemetics, the overall dose of given granisetron, VAS scores for pain, and the total required rescue analgesia were higher in G300 versus G600, and G900. The time needed for first rescue analgesia was statistically longer in G600 and G900 versus G300. G900 was associated with a higher incidence of somnolence/sedation and dry mouth than G300 and G600.Conclusion: Gabapentin 600 mg administered 1 hr before laparoscopic abdominal surgery is as effective as gabapentin 900 mg for PONV control and VAS reduction of 24-hour postoperative pain scores with fewer side effects. On the other hand, gabapentin 300 mg did not demonstrate good control of PONV, or pain control compared to higher doses.

Preoperative Gabapentin Administration and Its Impact on Postoperative Opioid Requirement and Pain in Sinonasal Surgery.

To determine the efficacy of preoperative gabapentin on patient-reported pain levels and postoperative opioid requirements following sinonasal surgery. Retrospective review. Academic institution. Patients undergoing sinonasal surgery between July 2019 and January 2020 were followed. Groups were divided into those that received 600 mg of oral gabapentin 1 hour preoperatively (gabapentin) and those that did not (control). Postoperatively, each patient was counseled to use acetaminophen, ibuprofen, and oxycodone as needed for pain control. Patients completed a daily postoperative pain and medication log. Pain was measured by the visual analog scale (VAS) and opioid use by morphine equivalent dose (MED). Chi-square test and Wilcoxon test were used for data analysis. Fifty-seven patients were included (control, n = 28; gabapentin, n = 29). There was no significant difference in age, sex, or baseline Sinonasal Outcome Test-22 scores between the groups. The total MED, postoperative day (POD) 1-2 MED, POD 3-4 MED, and POD 5-6 MED did not differ significantly between the control (17.9, 12.2, 4.6, 1.5) and gabapentin (19.0, 8.9, 7.2, 3.5) groups (P = .98, .25, .16, .44). The mean daily VAS score did not differ significantly between the control (3.1) and gabapentin (2.8) groups (P = .81). The mean daily VAS score decreased significantly in both groups with each successive POD (P = .004). Preoperative gabapentin did not significantly reduce postoperative pain or opioid use. Postoperative discomfort following sinonasal surgery is mild, and opioid intake is minimal.

Opioid-Sparing Cardiac Anesthesia: Secondary Analysis of an Enhanced Recovery Program for Cardiac Surgery.

Cardiac anesthetics rely heavily on opioids, with the standard patient receiving between 70 and 105 morphine sulfate equivalents (MSE; 10-15 µg/kg of fentanyl). A central tenet of Enhanced Recovery Programs (ERP) is the use of multimodal analgesia. This study was performed to assess the association between nonopioid interventions employed as part of an ERP for cardiac surgery and intraoperative opioid administration. This study represents a post hoc secondary analysis of data obtained from an institutional ERP for cardiac surgery. Consecutive patients undergoing cardiac surgery received 5 nonopioid interventions, including preoperative gabapentin and acetaminophen, intraoperative dexmedetomidine and ketamine infusions, and regional analgesia via serratus anterior plane block. The primary objective, the association between intraoperative opioid administration and the number of interventions provided, was assessed via a linear mixed-effects regression model. To assess the association between intraoperative opioid administration and postoperative outcomes, patients were stratified into high (>50 MSE) and low (≤50 MSE) opioids, 1:1 propensity matched based on 15 patients and procedure covariables and assessed for associations with postoperative outcomes of interest. To investigate the impact of further opioid restriction, ultralow (≤25 MSE) opioid participants were then identified, 1:3 propensity matched to high opioid patients, and similarly compared. A total of 451 patients were included in the overall analysis. Analysis of the primary objective revealed that intraoperative opioid administration was inversely related to the number of interventions employed (estimated -7.96 MSE per intervention, 95% confidence interval [CI], -9.82 to -6.10, P < .001). No differences were detected between low (n = 136) and high (n = 136) opioid patients in postoperative complications, postoperative pain scores, time to extubation, or length of stay. No differences were found in outcomes between ultralow (n = 63) and high (n = 132) opioid participants. Nonopioid interventions employed as part of an ERP for cardiac surgery were associated with a reduction of intraoperative opioid administration. Low and ultralow opioid use was not associated with significant differences in postoperative outcomes. These findings are hypothesis-generating, and future prospective studies are necessary to establish the role of opioid-sparing strategies in the setting of cardiac surgery.

Administration of Preoperative Gabapentin to Patients Undergoing Laparoscopy: A Double-Blinded, Placebo-Controlled Randomized Trial

Objective: The aim of this study was to determine the influence of immediate preoperative gabapentin on postoperative pain in patients undergoing laparoscopy for benign gynecologic indications. Mat...

Gabapentin as an adjunct to paracervical block for perioperative pain management for first-trimester uterine aspiration: a randomized controlled trial

Pain management approaches during uterine aspiration vary, which include local anesthetic, oral analgesics, moderate sedation, deep sedation, or a combination of approaches. For local anesthetic approaches specifically, we continue to have suboptimal pain control. Gabapentin as an adjunct to pain management has proven to be beneficial in gynecologic surgery. We sought to evaluate the impact of gabapentin on perioperative pain during surgical management of first-trimester abortion or early pregnancy loss with uterine aspiration under local anesthesia. We hypothesized that adding gabapentin to local anesthesia will reduce perioperative and postoperative pain associated with uterine aspiration. Secondary outcomes included tolerability of gabapentin and postoperative pain, nausea, vomiting, and anxiety. We conducted a randomized double-blinded placebo-controlled trial of gabapentin 600 mg given 1 to 2 hours preoperatively among subjects receiving a first-trimester uterine aspiration under paracervical block in an outpatient ambulatory surgery center. There were 111 subjects randomized. The primary outcome was pain at time of uterine aspiration as measured on a 100-mm visual analog scale. Secondary outcomes included pain at other perioperative time points. To assess changes in pain measures, an intention to treat mixed effects model was fit with treatment groups (gabapentin vs control) as a between-subjects factor and time point as a within-subjects factor plus their interaction term. Because of a non-normal distribution of pain scores, the area under the curve was calculated for secondary outcomes with comparison of groups utilizing Mann-Whitney U tests. Among the 111 randomized, most subjects were Black or African American (69.4%), mean age was 26 years (±5.5), and mean gestational age was 61.3 days (standard deviation, 14.10). Mean pain scores at time of uterine aspiration were 66.77 (gabapentin) vs 71.06 (placebo), with a mean difference of-3.38 (P=.51). There were no significant changes in pain score preoperatively or intraoperatively. Subjects who received gabapentin had significantly lower levels of pain at 10 minutes after surgery (mean difference [standard error (SE)]=-13.0 [-5.0]; P=.01) and 30 minutes after surgery (mean difference [SE]=-10.8 [-5.1]; P=.03) compared with subjects who received placebo. Median nausea scores and incidence of emesis pre- and postoperatively did not differ between groups. Similarly, anxiety scores did not differ between groups, before or after the procedure. At 10 and 30 minutes after the procedure, most participants reported no side effects or mild side effects, and this did not differ between groups. Preoperative gabapentin did not reduce pain during uterine aspiration. However, it did reduce postoperative pain, which may prove to be a desired attribute of its use, particularly in cases where postoperative pain may be a greater challenge.

Effect of preoperative gabapentin after transurethral prostate resection under general anesthesia. A randomized double-blind, placebo-controlled trial.

Objectives:To investigate whether preoperative oral gabapentin could reduce postoperative pain, analgesic consumption and the occurrence of catheter-related bladder discomfort (CRBD).Methods:In this study, participants randomly received either 600 mg gabapentin or placebo orally 2 h prior to transurethral prostate resection. Visual analogue scale and Ramsay sedation scale was utilized to assess pain intensity and sedation status after surgery. Intravenous 1.5 mg.kg-1 tramadol was used for postoperative analgesia. Pain intensity, sedation status, CRBD, tramadol consumption, side effects and the overall satisfaction degree were assessed and recorded for 48 h after tracheal extubation.Results:Ninety participants given gabapentin and 91 participants given placebo completed the study. Lower visual analogue scale scores, less tramadol consumption, longer time to the first analgesic requirement, lower incidence of CRBD and nausea and higher satisfaction degree were detected in the patients receiving gabapentin compared with the patients receiving placebo.Conclusion:Preoperative oral gabapentin reduced postoperative visual analogue scale scores, tramadol consumption and the occurrence rate of CRBD and nausea, and consequently, increased the degree of patients’ satisfaction after transurethral prostate resection.

Preoperative Gabapentin for Minimally Invasive Hysterectomy: A Randomized Controlled Trial

To evaluate whether a single dose of gabapentin given preoperatively reduces narcotic use 24 hours after minimally invasive hysterectomy (MIH). Randomized controlled trial. Single academic-affiliated community hospital. Women undergoing MIH for benign indications between June 2016 and June 2017. Subjects were randomized to receive a preoperative regimen of acetaminophen, celecoxib, and gabapentin versus acetaminophen and celecoxib alone. The primary outcome assessed was the total amount of narcotics used at 24 hours after surgery. Secondary outcomes included adverse effects from gabapentin use, total narcotics used, and pain scores at 2 weeks after surgery. A total of 129 women were randomized and eligible for analysis in the gabapentin study arm (n = 68) or the control arm (n = 61). Demographic characteristics and surgical details were similar between groups. Narcotics used at 24 hours after surgery totaling 168 versus 161 oral morphine milligram equivalents in the gabapentin and control groups, respectively, did not significantly differ between groups (p = .60). Total narcotics used and pain scores at 2 weeks after surgery and the rates of adverse effects from gabapentin were also similar between study arms. Single-dose, preoperative gabapentin for women undergoing benign MIH does not reduce total opioid use 24 hours after surgery.

Implementation of new protocol for pain management following cardiac surgery

Aims: We assessed the implementation and effectiveness of an updated protocol designed to improve pain management in cardiac surgery patients. The new updated protocol was recommended systemic pain assessment every four hours unless patients were unstable, using the numerical rating score (NRS) after the endotracheal extubation. Our secondary aim was to analyze the factors predicting patients’ postoperative pain to guide development of future pain management protocols. Methods: Fifty patients undergoing cardiac surgery with median sternotomy were evaluated in this audit. Perioperative details and details regarding analgesic administration were collected. High-risk patients were classified as ones with a history of substance misuse, chronic pain, and preoperative opioid use. Pain was measured at rest, on coughing and on moving, for the first three postoperative days (POD), using 11-point NRS (0–10). Pain was considered “unacceptable” if it was NRS ≥4 at rest, and NRS ≥8 on activity. A univariate and multivariate mixed model linear regression was used to investigate factors that may contribute to pain following cardiac surgery. Results: On POD1 38% of patients reported unacceptable pain at rest, and 27% reported unacceptable pain on coughing or moving. There was limited implementation of the new protocol, thus we cannot comment on the effectiveness of the updated protocol. Multivariate analysis demonstrated an overall significant interaction effect between postoperative day and risk (p = 0.032). It was found that high-risk patients reported pain to be greater than pain reported by low-risk patients on POD3 (2.14, CI −0.32 to 4.26, p = 0.054). Use of preoperative gabapentin did not affect pain at rest nor pain on coughing or moving (p &gt; 0.5). Conclusion: The new pain protocol was not followed in the majority of patient cases. Preoperatively, only 25 (56%) patients received gabapentin. No patients received patient-controlled analgesia (PCA) postoperatively. Seven (15%) patients identified as high risk received no differential pharmacological management contrary to the updated protocol. It is believed that e-mail is not sufficient to implement a new protocol such as this, thus resulting in protocol implementation failure. However, it was found that postoperative pain differed between high-and low-risk patients, especially at rest. This indicates that risk assessment and individualized pain protocols are important to optimize postoperative pain management following cardiac surgery. We have discussed the efforts required to improve future protocol implementation and pain management across disciplines.

Risk factors and outcomes of postoperative emergency response team activation: a matched case–control study

To determine patient and perioperative characteristics associated with unexpected postoperative clinical deterioration as determined for the need of a postoperative emergency response team (ERT) activation. Retrospective case-control study. Tertiary academic hospital. Patients who underwent general anaesthesia discharged to regular wards between 1 January 2013 and 31 December 2015 and required ERT activation within 48 postoperative hours. Controls were matched based on age, sex and procedure. Baseline patient and perioperative characteristics were abstracted to develop a multiple logistic regression model to assess for potential associations for increased risk for postoperative ERT. Among 105 345 patients, 797 had ERT calls, with a rate of 7.6 (95% CI, 7.1-8.1) calls per 1000 anaesthetics (0.76%). Multiple logistic regression analysis showed the following risk factors for postoperative ERT: cardiovascular disease (odds ratio [OR], 1.61; 95% CI, 1.18-2.18), neurological disease (OR, 1.57; 95% CI, 1.11-2.22), preoperative gabapentin (OR, 1.60; 95% CI, 1.17-2.20), longer surgical duration (OR, 1.06; 95% CI, 1.02-1.11, per 30 min), emergency procedure (OR, 1.54; 95% CI, 1.09-2.18), and intraoperative use of colloids (OR, 1.50; 95% CI, 1.17-1.92). Compared with control participants, ERT patients had a longer hospital stay, a higher rate of admissions to critical care (55.5%), increased postoperative complications, and a higher 30-day mortality rate (OR, 3.36; 95% CI, 1.73-6.54). We identified several patient and procedural characteristics associated with increased likelihood of postoperative ERT activation. ERT intervention is a marker for increased rates of postoperative complications and death.

PROSPECT guideline for oncological breast surgery: asystematic review and procedure-specific postoperative pain management recommendations.

SummaryAnalgesic protocols used to treat pain after breast surgery vary significantly. The aim of this systematic review was to evaluate the available literature on this topic and develop recommendations for optimal pain management after oncological breast surgery. A systematic review using preferred reporting items for systematic reviews and meta‐analysis guidance with procedure‐specific postoperative pain management (PROSPECT) methodology was undertaken. Randomised controlled trials assessing postoperative pain using analgesic, anaesthetic or surgical interventions were identified. Seven hundred and forty‐nine studies were found, of which 53 randomised controlled trials and nine meta‐analyses met the inclusion criteria and were included in this review. Quantitative analysis suggests that dexamethasone and gabapentin reduced postoperative pain. The use of paravertebral blocks also reduced postoperative pain scores, analgesia consumption and the incidence of postoperative nausea and vomiting. Intra‐operative opioid requirements were documented to be lower when a pectoral nerves block was performed, which also reduced postoperative pain scores and opioid consumption. We recommend basic analgesics (i.e. paracetamol and non‐steroidal anti‐inflammatory drugs) administered pre‐operatively or intra‐operatively and continued postoperatively. In addition, pre‐operative gabapentin and dexamethasone are also recommended. In major breast surgery, a regional anaesthetic technique such as paravertebral block or pectoral nerves block and/or local anaesthetic wound infiltration may be considered for additional pain relief. Paravertebral block may be continued postoperatively using catheter techniques. Opioids should be reserved as rescue analgesics in the postoperative period. Research is needed to evaluate the role of novel regional analgesic techniques such as erector spinae plane or retrolaminar plane blocks combined with basic analgesics in an enhanced recovery setting.

A randomised controlled trial evaluating the effect of Pre-operative oral gabapentin on postoperative pain relief and opioid consumption in patients undergoing modified radical mastectomy

A randomised controlled trial evaluating the effect of Pre-operative oral gabapentin on postoperative pain relief and opioid consumption in patients undergoing modified radical mastectomy

Comparison of the effects of preoperative gabapentin and pregabalin on postoperative analgesic consumption, urinary retention and nausea-vomiting in patients undergoing anorectal surgery under spinal anesthesia

Comparison of the effects of preoperative gabapentin and pregabalin on postoperative analgesic consumption, urinary retention and nausea-vomiting in patients undergoing anorectal surgery under spinal anesthesia

Efficacy of preoperative gabapentin in producing post-operative analgesia in patients undergoing elective surgery under general Anaesthesia: A randomized double blinded trial

Background: Gabapentin is an adjuvant antiepileptic agent with analgesic properties used for the treatment of postoperative pain. The primary objective of this study is to assess and compare the analgesic effects of administering Gabapentin and Paracetamol pre-operatively, in patients undergoing elective surgery, under General Anesthesia. Methods: The study was a single-center, randomized and double-blind trial. A total of 60 patients of either sex, age > 18 yrs, with American Society of Anesthesiology (ASA) status I/II undergoing elective ENT surgery, under General Anaesthesia at a tertiary care hospital were included in this study. The patients were randomized into two groups. 30 patients were randomized to Group 1, who received oral Paracetamol, one hour prior to surgery. Group 2 had 30 patients who received oral Gabapentin, preoperatively. In this study, comparison of the duration of analgesia provided by a single dose of 600mg of Gabapentin over 650mg of Paracetamol, consumption of postoperative rescue analgesia and the incidence of side effects between both groups were assessed. Results: The mean duration of analgesia produced by Paracetamol was 83 minutes, whereas the mean duration of analgesia produced by Gabapentin was 74.48minutes(P=0.4413). The mean analgesic consumption of group 1 which received Paracetamol was 53.0 mg of Tramadol, whereas the mean analgesic consumption of group 2 which received Gabapentin was 51.66 mg of Tramadol (P=0.627). The incidence of adverse effects like nausea, vomiting, dizziness and headache were comparable but statistically not significant. Conclusions: Both Paracetamol and Gabapentin were comparable in terms of potency as pre-emptive analgesic. The mean duration of analgesia produced by paracetamol and gabapentin were found to be in same range. This study has shown that the time to first rescue analgesia, total amount of rescue analgesia between the two groups in the first 6 hours following surgery were not statistically significant.

Predicting prolonged opioid prescriptions in opioid-naïve lumbar spine surgery patients

IMPORTANCEPreoperative determination of the potential for postoperative opioid dependence in previously naïve patients undergoing elective spine surgery may facilitate targeted interventions. OBJECTIVEThe purpose of this study was to develop supervised machine learning algorithms for preoperative prediction of prolonged opioid prescription use in opioid-naïve patients following lumbar spine surgery. DESIGNRetrospective review of clinical registry data. Variables considered for prediction included demographics, insurance status, preoperative medications, surgical factors, laboratory values, comorbidities, and neighborhood characteristics. Five supervised machine learning algorithms were developed and assessed by discrimination, calibration, Brier score, and decision curve analysis. SETTINGOne healthcare entity (two academic medical centers, three community hospitals), 2000 to 2018. PARTICIPANTSOpioid-naïve patients undergoing decompression and/or fusion for lumbar disk herniation, stenosis, and spondylolisthesis. MAIN OUTCOMESustained prescription opioid use exceeding 90 days after surgery. RESULTSOverall, of 8,435 patients included, 359 (4.3%) were found to have prolonged postoperative opioid prescriptions. The elastic-net penalized logistic regression achieved the best performance in the independent testing set not used for algorithm development with c-statistic=0.70, calibration intercept=0.06, calibration slope=1.02, and Brier score=0.039. The five most important factors for prolonged opioid prescriptions were use of instrumented spinal fusion, preoperative benzodiazepine use, preoperative antidepressant use, preoperative gabapentin use, and uninsured status. Individual patient-level explanations were provided for the algorithm predictions and the algorithms were incorporated into an open access digital application available here: https://sorg-apps.shinyapps.io/lumbaropioidnaive/. CONCLUSION AND RELEVANCEThe clinician decision aid developed in this study may be helpful to preoperatively risk-stratify opioid-naïve patients undergoing lumbar spine surgery. The tool demonstrates moderate discriminative capacity for identifying those at greatest risk of prolonged prescription opioid use. External validation is required to further support the potential utility of this tool in practice.

Typical Opioid use After Minimally Invasive Hysterectomy

Study Objective To describe typical narcotic requirements after benign minimally invasive hysterectomy and evaluate patient risk factors for higher narcotic use. Design In a prospectively collected data set as part of a randomized controlled trial comparing single-dose preoperative gabapentin use to nonusers, women undergoing a benign minimally invasive hysterectomy were assessed for total narcotic use and subjective pain scores at 2 weeks postoperatively via phone. Results from this trial resulted in no difference between groups, therefore the data set was utilized to assess typical narcotic use at 2 weeks postoperative. Total narcotic use was then compared across surgical specialties (generalist, urogynecology, minimally invasive gynecology [MIGS]). Patient demographics and operative details were compared between top quartile users versus regular users. Setting Single academic affiliated community hospital. Patients or Participants From June 2016 to June 2017, women undergoing hysterectomy for benign indications via a minimally invasive approach were approached to participate. Inclusion was limited to patients of high volume surgeons (more than 20 hysterectomies annually) within the generalist, MIGS, and urogynecology divisions. Women were excluded if known to have a contraindication to gabapentin, acetaminophen, or celecoxib use, or if their procedure was converted to laparotomy for any indication. Interventions N/A Measurements and Main Results A total of 109 women had data at 2 weeks postoperative to be analyzed for cohort analysis. The median oral narcotic requirement was 40 morphine milligram equivalents [MME] (interquartile range 0 – 96). Patients undergoing surgery with MIGS providers required less postoperative narcotics than those with a generalist trained surgeon (15 MME versus 75 MME, p = 0.007). Younger age and prior laparoscopic surgery were also found to be associated with high narcotic utilization after benign hysterectomy. Conclusion Typical oral narcotic requirements after benign minimally invasive hysterectomy are minimal with median use equivalent to approximately five tablets of oxycodone (5 milligrams).

Preoperative Gabapentin Administration Improves Acute Postoperative Analgesia in Patients Undergoing Craniotomy: A Randomized Controlled Trial.

Gabapentin is an adjuvant antiepileptic agent and helps to reduce acute postoperative pain in several surgery settings. However, the effect of gabapentin on postoperative pain from suboccipital or subtemporal craniotomy is not clear. The study was a single-center, randomized, placebo-controlled, and double-blinded trial. A total of 122 patients undergoing elective craniotomy by a suboccipital or subtemporal approach were randomly allocated to a placebo group and gabapentin group. The patients received gabapentin (600 mg, orally) the night before surgery and 2 hours before anesthesia induction in the gabapentin group, and patients received vitamin B in the placebo group. The primary outcome was the postoperative pain score on movement at 24 hours. The secondary outcomes included the pain score at other time points, incidence of nausea and vomiting, sedation, and analgesic consumption. Gabapentin significantly decreased the postoperative acute pain scores at rest (P=0.001) and on movement (P=0.000) within 24 hours; however, it did not have an effect at 48 hours. Gabapentin decreased postoperative vomiting (P=0.047) and rescue antiemetic use (P=0.033), whereas it increased the postoperative sedation score at 2 hours (P<0.05). Moreover, gabapentin decreased the mean consumption of intraoperative propofol (0.7 mg/kg/h; P=0.021) and remifentanil (1.3 µg/kg/h; P=0.025); however, it did not influence postoperative opioid consumption. Preoperative gabapentin significantly alleviated acute postoperative pain and decreased the incidence of vomiting in patients undergoing suboccipital or subtemporal craniotomy. However, more attention should be paid to early postoperative sedation when multimodal analgesia with gabapentin is administered.

Optimizing Perioperative Pain Control After Ambulatory Urogynecologic Surgery.

The objective of this study was to determine the impact of a multimodal protocol on opiate use and postoperative pain after ambulatory urogynecologic surgery. This was a retrospective cohort study comparing ambulatory urogynecologic surgery patients treated under a standard perioperative pain protocol with those treated under a multimodal perioperative pain protocol. The multimodal protocol consisted of preoperative gabapentin and acetaminophen and postoperative scheduled doses of acetaminophen and nonsteroidal anti-inflammatory drugs. Pain scores were obtained from nursing records and assessed on the Numeric Rating Scale 11 per hospital protocol. All opioid dosages were converted into morphine milligram equivalents using standardized conversion tables. We treated 109 patients under the standard protocol and 112 under the multimodal protocol. Patients had similar baseline characteristics. Overall, a minority of patients (39%) used postoperative opioids; this was similar in the 2 groups (P=0.45). The 2 groups also were similar with regard to the total postoperative morphine milligram equivalents (P=0.35). Postoperatively, patients treated under the standard protocol had higher mean pain scores (2.2 vs 1.4, P=0.002). Patients treated under the standard protocol were also significantly more likely to report postoperative pain (69%) than those treated under the multimodal protocol (52%; P=0.01), and the multimodal protocol was associated with a 25% lower risk of postoperative pain (risk ratio, 0.75; 95% confidence interval, 0.60-0.94) than the standard protocol. Patients infrequently use opiates after ambulatory urogynecologic surgery. The use of a multimodal pain protocol was associated with lower pain scores, and patients in a multimodal pain protocol were more likely to report no pain.

(364) Administration of Pre-Operative Gabapentin to Patients Undergoing Laparoscopy: A Double-Blind, Placebo-Controlled Randomized Trial

The objective of this study was to determine the influence of immediate pre-operative gabapentin on postoperative pain in patients undergoing laparoscopy for benign gynecologic indications. We completed a double-blind, placebo controlled, randomized trial at an academic tertiary care hospital. One-hundred-nine gynecologic patients undergoing laparoscopy between June 2015 and January 2016 were included in our study. We randomized 109 patients to receive pre-operative gabapentin (300mg) or placebo. The patients were stratified based on a history of chronic pelvic pain. Pain scores were assessed at 2, 4, 6 and 8 hours post-operatively as well as post-operative days 1-7. We found no difference between the groups in terms of age, body mass index, gravidity, parity, or past surgical history. Post-operative pain was assessed using the numeric pain rating scale (NRS), rated as 0-10, and the visual analog scale (VAS), rated as 0-100. These values were adjusted for morphine dose received. Findings included, no significant difference in pain scores at any of the immediate post-operative hours. A secondary analysis stratified by procedure, hysterectomy or operative laparoscopy, showed no significant difference in pain scores. There was also no significant difference in pain scores on post-operative days one through seven. In this study, a single dose of pre-operative gabapentin did not significantly decrease post-operative pain in gynecologic patients undergoing laparoscopy for benign indications. The study was supported in part by an award from The Penn State Hershey Department of Obstetrics and Gynecology.