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Study record managers: refer to the Data Element Definitions if submitting registration or information. The purpose of this study is to determine the best strategy of administering gabapentin in connection with our current approach to perioperative pain management. We aim to evaluate two different adjunct gabapentin regimens given in the perioperative period, and to identify which manages patient pain more effectively and safely.


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The combined use of opioids and gabapentin multiple brands may raise the risk for opioid-related death, according to of a population-based nested case-control study from Ontario, Canada. Gabapentin is often used in conjunction with opioids to treat chronic pain. Both of these drugs suppress breathing, which can be fatal, the authors note. In addition, the use of gabapentin concomitantly with opioids can increase the amount of opioid absorbed by the body, potentially leading to higher risk.

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Postoperative pain is an important factor affecting anesthesia and surgery. The present study assessed the effects of mg gabapentin, an anticonvulsant drug that acts through voltage-dependent calcium channels, for the control of postoperative pain in patients undergoing abdominal hysterectomy.

Fifty patients undergoing hysterectomy were enrolled in the present study. Subjects received either mg gabapentin or placebo 2 h before surgery.

The amount of morphine consumption and level of postoperative pain at 2 h, 6 h, 12 h and 24 h after surgery were measured. There were no ificant differences in age, duration of surgery and anesthesia, or body mass index between the two groups. The mean intensity of pain in the gabapentin group was ificantly lower than in the placebo group. The mean amount of morphine used in the placebo group 5. The time interval for initial ambulation after surgery was ificantly shorter in the gabapentin group ificant side effects were not observed.

Postoperative pain affects recovery from surgery and anesthesia 1.

Opioids are commonly used for pain control, but are associated with complications that limit their use. Combination regimens of opioid and nonopioid drugs are used to increase the effects and decrease complications of opioids 2. Gabapentin is an anticonvulsant drug that acts through voltage-dependent calcium channels 3.

This drug causes the release of amino acids in the dorsal horn of the spinal cord and decreases response to neural inputs, thus reducing or stabilizing the activity of the damaged nerves 4. Gabapentin can, therefore, be used to control chronic pain, as in diabetic neuropathy 5herpetic neuralgia 6 and other neuropathic disorders 7. Recent studies examined the effectiveness and usefulness of gabapentin for postoperative pain and the inhibition of brain excitability 8. To date, no conclusive information is available 9 — In the present study, we assessed the effect of mg gabapentin on postoperative pain in patients undergoing abdominal hysterectomy.

Fifty patients undergoing hysterectomy class 1 or 2 of Gabapentin and opiates American Society of Anesthesiology admitted to the Shabihkhany Hospital of Kashan University of Medical Sciences Kashan, Iran in were enrolled in the present clinical trial. Patients with a history of use of alcohol, drugs, anticonvulsants, antidepressants, benzodiazepines or antihistamines, as well as patients with liver or kidney failure, were excluded. After approval by the ethics committee of the university, written informed consent was obtained from all subjects.

Using a random table, the patients were allocated to one of two study groups receiving either mg gabapentin or placebo 2 h before surgery. The surgeon and the staff assessing pain and complications postoperatively had no knowledge of the drug asment. Heart rate, blood pressure and arterial oxygen saturation were monitored. Atracurium 0. Surgery was performed while patients were supine.

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After extubation and ensuring adequate ventilation, patients were transferred to the recovery care unit for 2 h and then to the ward. All patients received mg suppository diclofenac every 6 h. Postoperative pain was measured using a visual analogue scale. The amount of morphine consumed and pain level at 2 h, 6 h, 12 h and 24 h after surgery were recorded. Postoperative complications, including vomiting and dizziness, were also recorded. The two groups showed no ificant difference in age, duration of surgery and anesthesia, or body mass index Table 1.

Mean age, duration of surgery and anesthesia, and body mass index of the gabapentin and placebo groups. The mean pain intensity at Gabapentin and opiates h, 6 h, 12 h and 24 h in the gabapentin group was ificantly lower than in the placebo group Table 2. Mean pain intensity, measured using a visual analogue scale, experienced by the gabapentin and placebo groups at 2 h, 6 h, 12 h and 24 h after surgery. In addition, nausea and vomiting were ificantly more common in the placebo group compared with the gabapentin group Table 3. of patients experiencing vomiting in the gabapentin and placebo groups at 2 h, 6 h, 12 h and 24 h after surgery.

Finally, the showed that patients in the gabapentin group recovered earlier, indicated by the time until first ambulation The present study showed that mg gabapentin administered 2 h before surgery reduced pain and opioid consumption and helped the patients to recover more quickly regain motion after surgery.

Pain after surgery is due to both surgical stimulation and neurogenic factors such as visceral tissue edema. Current pain treatment methods include several analgesic drugs with different mechanisms of treatment Gabapentin is primarily used Gabapentin and opiates an anticonvulsant drug, but recent studies have demonstrated that it also has antihyperalgesic effects Animal studies have demonstrated that presurgical treatment with gabapentin may prevent hyperalgesia and allodynia more effectively than when administered after surgery However, conflicting exist regarding the effects of gabapentin on pain and narcotic consumption.

Turan et al 1 evaluated the effect of mg gabapentin on pain and tramadol consumption after hysterectomy and found that both parameters were reduced in the gabapentin group. In a study by Durmus et al 8the effects of mg gabapentin and gabapentin with acetaminophen were compared with a placebo in hysterectomy patients.

Pain intensity and morphine requirement decreased in both groups compared with the placebo group, but differences between the gabapentin group and the gabapentin with acetaminophen group were observed only shortly after surgery.

Other studies on mastectomy 16 and thyroidectomy 14 revealed similar. In contrast to the studies showing a positive effect of gabapentin on pain and opioid consumption, some studies have reported no or low effects.

— small study shows no superiority over opioids alone

This may be due to confounding factors in experimental de. The placebo group had a mean morphine consumption of 63 mg. Similarly, in a study by Radhakrishnan et al 2pain level and opioid consumption were examined after lumbar laminectomy and discectomy in patients receiving either mg gabapentin or a placebo. No difference was observed between groups in terms of pain score or narcotic consumption.

However, the investigators Gabapentin and opiates a relatively low dose of gabapentin compared with other studies, which may have been insufficient to prevent sensitization to painful stimuli. Local anesthetic infiltration at the surgical site may also be an important factor. Neural sensitization and hyperalgesia induced by surgical stimulation are blocked using a local anesthetic, which blunts the antihyperalgesic effects of gabapentin.

In a study examining patients undergoing laparoscopic tubal ligation surgery, no ificant difference was observed between gabapentin and placebo groups in terms of pain or morphine consumption This lack of effect may have been due to either the administration of 80 mg of lornoxicam, which may have confounded theor the time frame in which the gabapentin effect was expected to have occurred. research has shown that gabapentin requires 1 h to 2 h to take effect; however, the patients examined by Bartholdy et al 18 received gabapentin only 30 min before surgery.

Because the duration of surgery was also quite short 30 minthere may have been insufficient time for the drug to take effect. Similarly, in a study by Adam et al 19administering mg of gabapentin to patients undergoing arthroscopic shoulder surgery had no effect on pain or opioid consumption after surgery. However, patients received gabapentin as well as bupivacaine, a drug used for interscalene block localized nerve blockingand surgery was performed under general anesthesia. Thus, the use of multiple methods of pain control may have confounded the study ; indeed, synergistic effects between specific drugs have been shown in Gabapentin and opiates and animals In addition, gabapentin is known to have an anxiolytic effect 21 This can reduce preoperative anxiety and result in reduced postoperative pain Based on these studies, we hypothesize that the effectiveness of gabapentin in postoperative pain management are determined by the following specific factors:.

Drug dosage according to type of surgery: In various studies, the dose of gabapentin has ranged between mg and mg.

What is gabapentin?

The optimal dose may vary according to the type of surgery, the severity of inflammation and tissue damage and the type of pain generated ie, somatic versus visceral. During surgical discectomy, for example, the optimal dose that reduces pain and opioid usage was reported to be mg before surgery On the other hand, increasing the dose to mg can lead to complications 2. According to various studies, a dose of mg before surgery, regardless of the type of action, is acceptable.

Further studies are required to determine the optimal dose of gabapentin in specific surgeries. Timing of administration: Gabapentin crosses the blood-brain barrier and has a therapeutic effect after 2 h to 3 h of administration Consequently, it should be administered 1 h to 2 h before anesthesia Gabapentin and opiates may not produce the desired result if administered later.

Postoperative nausea and vomiting are common complications of surgery. Gabapentin affects postoperative nausea and vomiting through two mechanisms. The central antiemetic effects are due to reduced consumption of opioids Similarly, in a study by Durmus et al 8the incidence of nausea and vomiting was lower in the gabapentin group. The of the present study are consistent with these studies in that nausea and vomiting were less common in the gabapentin group compared with the placebo group.

The present study shows that mg of gabapentin reduces postoperative pain and the need for opioids, and enables patients to move more quickly after surgery.

Essential things to know

The authors thank the personnel of Shabihkhany Hospital for their generous cooperation. National Center for Biotechnology InformationU. Journal List Pain Res Manag v. Pain Res Manag. Author information Copyright and information Disclaimer. Telephonefaxe-mail moc. All rights reserved. This article has been cited by other articles in PMC. TABLE 1 Mean age, duration of surgery and anesthesia, and body mass index of the gabapentin and placebo groups.