Single Preoperative Dose Of Gabapentin Research Articles

A single preoperative dose of Gabapentin decreases postoperative pain in ambulatory anal surgeries

A single preoperative dose of Gabapentin decreases postoperative pain in ambulatory anal surgeries

A Perioperative Course of Gabapentin Does Not Produce a Clinically Meaningful Improvement in Analgesia after Cesarean Delivery: A Randomized Controlled Trial.

Studies examining the efficacy of a single preoperative dose of gabapentin for analgesia after cesarean delivery (CD) have been inconclusive. The authors hypothesized that a perioperative course of gabapentin would improve analgesia after CD. This single-center, randomized, double-blind, placebo-controlled, parallel-group, superiority trial was designed to determine the analgesic efficacy of a perioperative course of gabapentin when added to a multimodal analgesic regimen. Women scheduled for elective CD during spinal anesthesia were randomized to receive a perioperative oral course of either gabapentin (600 mg preoperatively followed by 200 mg every 8 h for 2 days) or placebo. Postoperative pain was measured at 24 and 48 h, at rest and on movement, on a visual analogue scale (VAS, 0 to 100 mm). The primary outcome was pain on movement at 24 h. Neonatal outcomes, opiate consumption, VAS satisfaction (0 to 100 mm), adverse effects, and persistent pain were also assessed. Baseline characteristics were similar between groups. There was a statistically significant but small reduction in VAS pain score (mean [95% CI]) on "movement" (40 mm [36 to 45] vs. 47 mm [42 to 51]; difference, -7 mm [-13 to 0]; P = 0.047) at 24 h in the gabapentin (n = 100) compared with control group (n = 97). There was more sedation in the gabapentin group at 24 h (55 vs. 39%, P = 0.026) but greater patient VAS satisfaction (87 vs. 77 mm, P = 0.003). A perioperative course of gabapentin produces a clinically insignificant improvement in analgesia after CD and is associated with a higher incidence of sedation.

Analgesic effects of gabapentin after scoliosis surgery in children: a randomized controlled trial

Postoperative pain remains an important challenge after scoliosis surgery in children. Opioids are the mainstay of treatment, and adult studies demonstrate gabapentin as a useful adjunct to opioids in the management of postoperative pain. Adolescent patients undergoing idiopathic scoliosis surgery were randomized to receive a single preoperative dose of gabapentin 600mg or placebo. The primary outcome measure was total morphine consumption in mg·kg(-1) between 0 and 24h postoperatively. Secondary outcome measures included time to first rescue analgesia, pain intensity scores at rest and with movement, incidence of nausea, vomiting, pruritus, sedation, dizziness, presence of persisting pain symptoms, and patient satisfaction. Cumulative opioid consumption was calculated at each time point: 1, 4, 8, 12, 24, 48, and 72h. The gabapentin group used 0.087±0.06mg·kg(-1) of morphine at 1h, 0.24±0.12mg·kg(-1) at 4h, 0.44±0.17mg·kg(-1) at 8h, and 1.29±0.44mg·kg(-1) at 24h. The placebo group used 0.121±0.06mg·kg(-1) of morphine at 1h, 0.35±0.16mg·kg(-1) at 4h, 0.56±0.27mg·kg(-1) at 8h, and 1.46±0.68mg·kg(-1) at 24h. There was no statistically significant reduction in opioid consumption in the patients receiving gabapentin. There were no significant differences in secondary outcomes. A single preoperative dose of gabapentin did not show a significant difference in opioid consumption or pain scores in adolescents undergoing idiopathic scoliosis surgery. This study is the first pediatric randomized controlled trial to assess the effectiveness of a single dose of gabapentin on morphine consumption and analgesia following major surgery.

A Single Preoperative Dose of Gabapentin Does not Improve Postcesarean Delivery Pain Management

Short, Jonathan*; Downey, Kristi*; Bernstein, Paul†; Shah, Vibhuti‡; Carvalho, Jose C. A.*† Author Information

PREOPERATIVE GABAPENTIN IN LAPAROSCOPIC CHOLECYSTECTOMY

Facts in gabapentin use are known about its effect on neuropathic pain management while its clinical significance as analgesic in laparoscopic cholecystectomy has not been studied much to clarify its importance and to know how and when it could be used or if this new analgesic strategy can be an alternative to others or be as a part of multimodal analgesic therapy in postoperative management. We conducted a prospective study to evaluate the significance of pre-emptive single dose gabapentin to reduce postoperative pain following laparoscopic cholecystectomy. Study group of hundred patients were analyzed in prospective study; Fifty of them were gabapentin group and another fifty were placebo group. Age, sex, body mass index, operation time and length of hospital stay were comparable in both groups. Analgesic requirements were recorded and pain assessment using 100 visual analogue scale in both groups were studied at three times intervals of 8,12 and 24 hours after surgery. In addition we studied the incidence of certain postoperative side effects in both groups as nausea, vomiting and drowsiness. Age, sex, body mass index, operation time and hospital stay were comparable in both groups. Opioid requirement two hours after surgery was significantly lower in gabapentin group than in placebo group (p 0.05). In conclusion, our work shows that a single preoperative dose of gabapentin has a significant effect on postoperative pain after a laparoscopic cholecystectomy.

A Single Preoperative Dose of Gabapentin Does Not Improve Postcesarean Delivery Pain Management

A single preoperative dose of 600 mg gabapentin, combined with multimodal analgesia, has previously been shown to reduce postcesarean pain and improve maternal satisfaction but was associated with increased maternal sedation. We hypothesized that a lower dose of gabapentin may be effective with less sedation. We conducted a doubleblind, randomized, placebo-controlled study. Women undergoing elective cesarean delivery were randomized into 3 groups to receive 300 or 600 mg oral gabapentin, or placebo, 1 hour before surgery. Temporal summation (TS) testing was performed at the time of study drug administration, and a visual analog scale (0 to 100 mm) difference ≥10 mm between the 1st and 10th stimuli was considered TS+. Spinal anesthesia and postoperative analgesia were instituted, including intrathecal fentanyl and morphine, oral diclofenac and acetaminophen, and systemic morphine as required. Pain assessments at rest and on movement (visual analog scale 0 to 100 mm) were conducted at 6, 12, 24, and 48 hours after surgical incision. The primary outcome was pain on movement at 24 hours. Secondary outcomes included satisfaction with analgesia, supplemental opioid consumption, lactation difficulties, neonatal outcomes, maternal sedation, and other adverse effects. Three months after delivery, patients were contacted for assessment of chronic pain. One hundred thirty-two women were randomized and 6 were excluded. The difference in mean pain scores at 24 hours (95% confidence intervals [CI]) were as follows: 600 mg versus 300 mg mean difference: 5 mm (95% adjusted CI, -7 to 17); 600 mg versus placebo: 3 mm (-9 to 15); 300 mg versus placebo: -2 mm [-14 to 10]; overall P value = 0.61. There was no apparent benefit of gabapentin in TS+ women, although overall pain scores were significantly higher in these women irrespective of the study group. Given the wide confidence intervals of the differences in mean pain scores, the current study did not allow us to determine whether a single preoperative dose of gabapentin (300 mg and 600 mg) improved postcesarean analgesia compared to placebo in the context of a multimodal analgesic regimen. A larger study is required.

The Concurrent Use of Gabapentin and Opioid Analgesia in Burns Patients

Dear Editor, I read with interest the study by Rimaz et al. (1) which showed a statistically significant reduction in visual analogue pain scores and morphine consumption in a double blind randomised setting with 25 patients in each wing. This is not the first study to suggest that in tackling the complex mechanism of post-burn hypersensitivity, as yet not fully understood but thought to be similar to post-operative pain hypersensitivity; analgesics with different but synergistic effects may prove superior to opioid analgesia alone (2, 3). Although in common use for neuropathic pain worldwide gabapentin has only relatively recently been taken up by plastic surgeons for use in acute burn pain both pre and post-surgical debridement. Although the study undoubtedly shows promising results in terms of a significant decrease in both pain scores and morphine consumption, there are some difficulties which must be addressed prior to gabapentin potentially becoming an accepted adjunct to opioid analgesia in the treatment of acute burns pain. As is often the case with the introduction of adjuvant drug treatment studies are difficult to compare due to the inherent variability of drug dosage, regimen, and use of adjuvant drugs and length of treatment. A similar study looking at the effects of gabapentin on morphine consumption in burns patients by Cuignet et al. (2), although reaching the same overall conclusions as Rimaz et al. (1) used a very different dosing regimen; a single dose of 1200mg gabapentin pre-operatively (1) and 2400mg daily from burn day 3-24 and results recorded for 21 days pre and post-surgical debridement (2) respectively. Additionally, in a further case series using gabapentin for acute burn pain Gray et al. (3) used regimens as varied as 1000mg four times per day with concurrent oxycodone and 300mg three times per day are described. Therefore although several studies have now shown gabapentin to be a beneficial addition to an opioid analgesia regimen in burns patients (1-3) what is required is collaborative research effort in order to determine the lowest possible dose of gabapentin to achieve maximal pain relief but with minimal side effects. This will allow a future systematic review with significant power to change recommended practice should future research continue to produce positive results. Although Rimaz et al. (1) found no side effects with the 1200mg single pre-operative dose of gabapentin, it must not be forgotten that gabapentin is a drug which can cause significant side effects even if only used for a short period of time, especially at the relatively high doses recommended by Cuignet et al. (2) Multicentre studies of gabapentin in post-herpetic neuralgia and painful diabetic neuropathy have shown significant side effects reporting day-time somnolence of up to 27% (4) and dizziness at 24% (5) which must be balanced with the potential analgesic benefit of gabapentin in burns patients. In the interests of burns patients world-wide is it hoped that further collaborative research will follow promptly to advance a treatment which, although currently in its infancy, has the potential to alleviate the significant pain that many such patients currently suffer.

P-38: Effect of a single preoperative dose of gabapentin on ponv in patients after laparoscopic gastric bypass

Postoperative nausea and vomiting (PONV) is the most common adverse event requiring extended hospital stay in patients undergoing laparoscopic gastric bypass (LRYGB). This study was performed to examine the effect of gabapentin on PONV in patients undergoing LGB for morbid obesity.

Gabapentin and postoperative pain—a systematic review of randomized controlled trials

Abstract The objective of this systematic review was to evaluate the efficacy and tolerability of perioperative gabapentin administration for the control of acute postoperative pain. We searched Medline (1966–2006), the Cochrane Library (2006), Scopus, CINAHL and bibliographies from clinical trials and review articles. We included randomized controlled trials (RCTs) comparing gabapentin with inactive controls in surgical patients. Sixteen valid RCTs were included. Weighted mean difference (WMD) for postoperative pain intensity (0–100 mm visual analogue scale) was −16.55 mm at 6 h and −10.87 mm at 24 h for treatment with a single preoperative dose of gabapentin 1200 mg. Cumulative opioid consumption at 24 h was also significantly decreased with gabapentin (WMD, −27.90 mg). When gabapentin was administered at doses less than 1200 mg, pain intensity was also lower at 6 h (WMD, −22.43 mm) and 24 h (WMD, −13.18 mm). Cumulative 24 h opioid consumption was also lower (WMD, −7.25 mg). Gabapentin was associated with an increased risk of sedation (Peto OR 3.86; 95% CI 2.50–5.94) but less opioid-related side effects such as vomiting (Peto OR 0.58; 95% CI 0.39–0.86) and pruritus (Peto OR 0.27; 95% CI 0.10–0.74). In conclusion, gabapentin has an analgesic and opioid-sparing effect in acute postoperative pain management when used in conjunction with opioids.

A single preoperative dose of gabapentin reduces tourniquet pain during IV regional anaesthesia,

A single preoperative dose of gabapentin reduces tourniquet pain during IV regional anaesthesia,

A Single Preoperative Dose of Gabapentin (800 Milligrams) Does Not Augment Postoperative Analgesia in Patients Given Interscalene Brachial Plexus Blocks for Arthroscopic Shoulder Surgery

Inadequate analgesia is common after shoulder arthroscopy. Both interscalene blocks and gabapentin are effective methods of pain management under various circumstances. We tested the hypothesis that gabapentin augments postoperative analgesia provided by interscalene brachial plexus block in patients having ambulatory arthroscopic shoulder surgery. Sixty patients were randomly assigned to receive oral gabapentin, 800 mg, or placebo 2 h before surgery. An interscalene brachial plexus block with 0.3 mL/kg of 0.5% ropivacaine was performed. General anesthesia was maintained with sevoflurane and included a single 1-microg/kg dose of remifentanil. Postoperative analgesia was initially provided with morphine and subsequently with ketoprofene (150 mg orally twice daily) and a combination of 400 mg acetaminophen and 30 mg dextropropoxyphene as needed. Pain scores, analgesic requirements, and side effects were assessed in the ambulatory unit and at home for 48 h. Emergence from general anesthesia was similar in both groups. There were no significant differences in pain scores, first postoperative request for analgesia, or oral analgesic consumption. The incidence of side effects was comparable in both groups, except that headaches were less frequent in the gabapentin group. A single preoperative dose of gabapentin (800 mg) does not augment postoperative analgesia in patients given interscalene brachial plexus blocks for arthroscopic shoulder surgery.

Gabapentin and postoperative pain – a systematic review of randomized controlled trials

The objective of this systematic review was to evaluate the efficacy and tolerability of perioperative gabapentin administration for the control of acute postoperative pain. We searched Medline (1966–2006), the Cochrane Library (2006), Scopus, CINAHL and bibliographies from clinical trials and review articles. We included randomized controlled trials (RCTs) comparing gabapentin with inactive controls in surgical patients. Sixteen valid RCTs were included. Weighted mean difference (WMD) for postoperative pain intensity (0–100 mm visual analogue scale) was −16.55 mm at 6 h and −10.87 mm at 24 h for treatment with a single preoperative dose of gabapentin 1200 mg. Cumulative opioid consumption at 24 h was also significantly decreased with gabapentin (WMD, −27.90 mg). When gabapentin was administered at doses less than 1200 mg, pain intensity was also lower at 6 h (WMD, −22.43 mm) and 24 h (WMD, −13.18 mm). Cumulative 24 h opioid consumption was also lower (WMD, −7.25 mg). Gabapentin was associated with an increased risk of sedation (Peto OR 3.86; 95% CI 2.50–5.94) but less opioid-related side effects such as vomiting (Peto OR 0.58; 95% CI 0.39–0.86) and pruritus (Peto OR 0.27; 95% CI 0.10–0.74). In conclusion, gabapentin has an analgesic and opioid-sparing effect in acute postoperative pain management when used in conjunction with opioids.