A single dose of preoperative gabapentin for pain reduction and requirement of morphine after total mastectomy and axillary dissection: Randomized placebo-controlled double-blind trial (original) (raw)
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Anesthesiology, 2002
Background: The anticonvulsant gabapentin has proven effective for neuropathic pain in three large placebo-controlled clinical trials. Experimental and clinical studies have demonstrated antihyperalgesic effects in models involving central neuronal sensitization. It has been suggested that central neuronal sensitization may play an important role in postoperative pain. The aim of the study was to investigate the effect of gabapentin on morphine consumption and postoperative pain in patients undergoing radical mastectomy. Methods: In a randomized, double-blind, placebo-controlled study, 70 patients received a single dose of oral gabapentin (1,200 mg) or placebo 1 h before surgery. Patients received patient-controlled analgesia with morphine at doses of 2.5 mg with a lock-out time of 10 min for 4 h postoperatively. Pain was assessed on a visual analog scale at rest and during movement, and side effects were assessed on a four-point verbal scale 2 and 4 h postoperatively.
2016
Introduction: Pre-emptive analgesia involves the introduction of an analgesic regimen before the onset of noxious stimuli, with the goal of preventing sensitization of the nervous system to subsequent stimuli that could amplify pain. We use Gabapentin as a preemptive analgesic and is more effective than conventional regimens in patients undergoing modified radical mastectomy. Materials& Method: 50 adult female patients of ASA grade I and II were divided randomly in to 2 groups(n=25). Conclusion: Preemptive Tab.Gabapentin 600mg. prolonges postoperative analgesia and reduces rescue analgesic requirement than control group but has more side effect like nausea and vomiting.
Egyptian Journal of Anaesthesia, 2010
Background/aim: Gabapentin is an anticonvulsant drug that is safe and effective for the treatment of neuropathic pain syndrome, as well as postoperative pain with good results. This prospective randomized study was done to evaluate the effects of preoperative administration of oral gabapentin (1200 mg) on the intraoperative fentanyl and isoflurane consumption, postoperative analgesic requirements and postoperative pain in patients undergoing radical mastectomy. Methods: Sixty ASA I and II patients were randomly allocated into two equal groups to receive oral gabapentin 1200 mg, 2 h before surgery (G group) or control (C group). General anesthesia was induced and maintained at bispectral index value between 40 and 60. During surgery the end-tidal isoflurane concentrations required to maintain adequate depth of anesthesia and the required incremental doses of intraoperative fentanyl were recorded. Postoperative pain was assessed using visual analogue scale (VAS) at rest for 24 h. Postoperatively, whenever visual analogue scale (VAS) was more than 5 or on patients' demand, analgesia in both groups was provided with diclofenac sodium (1 mg/kg IM) or tramadol hydrochloride (1 mg/kg IV) as needed. VAS, analgesics requirements, and side-effects were assessed for 24 h postoperatively. Results: Intraoperative fentanyl and postoperative analgesic consumption were significantly lower in G group than C group (P < 0.001). Patients in the G group had significantly lower end-tidal
The Analgesic Effect of Gabapentin and Mexiletine After Breast Surgery for Cancer
Anesthesia & Analgesia, 2002
We investigated the analgesic efficacy of mexiletine and gabapentin on acute and chronic pain associated with cancer breast surgery in 75 patients. They were randomized to receive, in a double-blinded manner, mexiletine 600 mg/d, gabapentin 1200 mg/d, or placebo for 10 days. Anesthesia was standardized, and all patients had access to routine postoperative analgesics on demand. The visual analog scale score assessed pain at rest and after movement. Three months later, all patients were interviewed to identify intensity of chronic pain and analgesic requirements. Mexiletine and gabapentin reduced codeine consumed from the second to tenth day by 50% (P ϭ 0.029; P ϭ 0.018 and P ϭ 0.035 for mexiletine versus control and gabapentin versus control comparisons, respectively). Total paracetamol consumption was also reduced during the same time (P ϭ 0.0085; P ϭ 0.007 and P ϭ 0.011 for the mexiletine and gabapentin groups when compared with the control, respectively). Pain at rest and after movement was reduced by both drugs on the third postoperative day. Pain after movement also was reduced by gabapentin between the second and fifth postoperative day. Three months later, the incidence of chronic pain, its intensity, and need for analgesics were not affected by either treatment. However, burning pain was more frequent in the control group (P ϭ 0.033).
International Journal of Basic & Clinical Pharmacology
Background: Conventional analgesics, used in peri-operative period cause numerous adverse effects and are not free from interactions with co-administered drugs. Gabapentin has been shown to be effective in various types of neuropathic pain. The primary aim of this study was to evaluate gabapentin as a post-operative analgesic. The study also evaluates the analgesic requirement and safety of gabapentin in post-operative period.Methods: Forty patients undergoing elective laparoscopic cholecystectomy were randomized to receive gabapentin or a matching placebo. The patients of group I received gabapentin 600mg orally 2 hrs before surgery and 12hrs after the first dose. The patients in group II received a matching placebo. Patients in both groups received diclofenac sodium 75mg i.m b.i.d for pain. Additional doses were given on demand and recorded.Results: The present study found that gabapentin significantly reduced pain score and analgesic consumption as compared to a placebo for a per...
Gabapentin for acute and chronic post-surgical pain
2007
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 anticonvulsant 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 synergy 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.
Comparing the Effect of Stellate Ganglion Block and Gabapentin on the Post Mastectomy Pain Syndrome
Shiraz E Medical Journal
Objective: To evaluate the effect of stellate ganglion block and gabapentin on post mastectomy pain. Methods: Sixty patients referred from departments of oncology and surgery to pain clinic were allocated to two groups. In group A, stellate ganglion block was performed with 8ml bupivacaine 0.25%. In group B, patients were treated with gabapentin 900mg per day in three divided doses. Drug dose was increased if necessary until eight weeks. Pain score and quality of life were determined. Data were collected before treatment, 48 hours and every 15 days after treatment until three months. Results: Pain scores at 48 hours after treating were higher in group B than group A and lower at one week, one month and three months after 1 treatment which were statically significant. (P<0.001, 0.024, 0.047 and <0.001 respectively) Conclusions: Gabapentin was found to be superior treatment for chronic pain following breast surgery.
Effectiveness and Safety of Gabapentin in the Management of Post-Operative Pain
Journal of Postgraduate Medical Institute, 2018
Objective: To determine the effectiveness and safety of preoperative gabapen- tin administration on post-operative pain after laparoscopic cholecystectomy. Methodology: Ninety patients undergoing laparoscopic cholecystectomy were divided into two groups. Group A received gabapentin in a dose of 300 mg two hours before surgery; and group B received placebo capsules in the same size and shape as gabapentin capsules. The pain scores, consumption of analgesics and adverse effects were compared between the two groups postoperatively at 2 hours, 6 hours, 12 hours and 24 hours after recovery. Results: Group A had statistically less pain scores as compared to group B at 2, 6, 12 and 24 hours after recovery (p values were 0.0001, <0.0001, 0.0004, <0.0001 respectively). The requirement of analgesics was statistically lower in group A in comparison to group B at all the time intervals (p <0.0001). Both groups had no difference in the frequency of adverse effects except for vomit- ing ...
PAIN Reports, 2017
Introduction: Chronic pain is a common and debilitating complication following breast surgery. One of the most challenging for treatment is the neuropathic pain condition, postmastectomy pain syndrome (PMPS). Gabapentin is a pharmacotherapy for neuropathic pain disorders; however, its once-daily, gastroretentive formulation, Gralise, has not been evaluated in PMPS. Objective: To evaluate the safety and effectiveness of Gralise in patients with moderate-to-severe PMPS. Methods: The primary effectiveness endpoint was a change in the worst pain intensity score from baseline to completion of 8 weeks of Gralise therapy. The secondary endpoints included the change in mood, coping behavior, sleep, and function. Sensitivity to experimental stimuli was tested before and after treatment via quantitative sensory testing. The incidence and type of adverse event were used to evaluate the safety and tolerability of Gralise. Results: Twenty-one patients with confirmed moderate-to-severe PMPS were ...