'Protective premedication': an option with gabapentin and related drugs? A review of gabapentin and pregabalin in the treatment of post-operative pain

Department of Anaesthesiology, Glostrup University Hospital, Glostrup, Denmark.
Acta Anaesthesiologica Scandinavica (Impact Factor: 2.31). 11/2004; 48(9):1130-6. DOI: 10.1111/j.1399-6576.2004.00484.x
Source: PubMed

ABSTRACT Substantial progress has been made during the last decades in our understanding of acute pain mechanisms, and this knowledge has encouraged the search for novel treatments. Of particular interest has been the observation that tissue injury initiates a number of modulations of both the peripheral and the central pain pathways, which convert the system from a 'physiological' to a 'pathological' mode of processing afferent information. Gabapentin, which binds to the alpha(2)delta subunit of the voltage-dependent calcium channel, is active in animal models of 'pathological' but not in models of 'physiological' pain. Consequently, attention has so far been focused on neuropathic pain as a target for the clinical use of gabapentin and analogues. Recently, several reports have indicated that gabapentin may have a place in the treatment of post-operative pain. This article presents a brief summary of the potential mechanisms of post-operative pain, and a systematic review of the available data of gabapentin and pregabalin for post-operative analgesia. It is concluded that the results with gabapentin and pregabalin in post-operative pain treatment published so far are promising. It is suggested that future studies should explore the effects of 'protective premedication' with combinations of various antihyperanalgesic and analgesic drugs for post-operative analgesia.

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    ABSTRACT: 43 INTRODUCTION "Excessive tearing due to obstruction of the nasolacrimal duct is a common ophthalmic problem. External dacryocystorhinostomy(E-DCR) is the procedure of choice designed to treat primary or secondary adult anatomical obstruction. Surgery produces injury with consequent release of histamine and inflammatory mediators. Noxious stimuli are transduced by peripheral nociceptors and transmitted by A and C fibers from peripheral visceral and somatic sites to the dorsal horn of the spinal cord and higher centers through the spinothalamic and spinoreticular tract, where they ultimately produce the perception of and affective component of pain" (Julius and Basbaum, 2001). "Central sensitization and hyperexcitability develop after the surgical incision and result in amplification of postoperative pain. Uncontrolled postoperative pain may produce a range of detrimental acute and chronic effects. These effects include sympathoadrenal hyperactivity, increased heart rate and blood pressure, increase ABSTRACT Preoperative administration of gabapentin and pregabalin is proposed as a promising way of enhancing postoperative pain control. However there is a few studies about comparison of gabapentin with pregabalin. This study was designed to compare efficacy of pre-emptive gabapentin with pregabalin respecting to increase in duration of analgesia, reduction in total post-operative analgesic requirement and study side effects after external dacryocystorhinostomy (E-DCR). In a double blind randomized study, ninety patients undergoing E-DCR under regional anesthesia were randomly assigned in three groups to receive single dose oral 900mg gapapentin,300mg pregabalin or placebo 2 hours before the operation in the morning of the surgery. Pain was assessed by visual analog scale (VAS) until 24 hours after the operation time. Duration from the end of the surgery until analgesic (pethidine) administration and total pethidine requirement in the first 24 hours and side effects were recorded and the result of the three groups were compared. Patients in gabapentin and pregabalin groups had similar mean pain scores but lower than the placebo group during 24 hours after surgery (P=0/000).The total postoperative analgesic duration was 380±249.5 min in gabapentin group, 380±275.1 min in pregabalin group, whereas 208±91.7 min in placebo group (P=0.003).Total dose of analgesics in first 24 h was 21.66±12.27 mg in gabapentin group, 19.16±13.58 mg in pregabalin group and 48.5±17.07 mg in placebo group (P=0.000). Dizziness and somnolence were the only prominent side effects noticed in gabapentin and pregabalin groups, nousea frequency was higher in the placebo group than gabapentin and pregabalin groups(P<0.05). The study has shown that pre-emptive gabapentin and pregabalin 2h before E-DCR, both better than placebo, have been effective in reducing postoperative pain score, analgesic consumption and nausea/vomiting. Pergabalin and gabapentin and either can be used as a part of multimodal analgesia if not as sole analgesic.
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    ABSTRACT: Background Postoperative pain is difficult to be managed with the use of opioids analgesia alone, so multimodal pain management is a method to improve postoperative analgesia with minimal side effects. Pregabalin has an analgesic and opioid sparing effects in postoperative analgesia. The objective of the present study was to evaluate the effect of premedication with pregabalin on postoperative analgesia in patients undergoing shoulder arthroscopy. Methods Eighty patients ASA I-II and aged 18–60 years undergoing elective shoulder arthroscopy were randomized to receive two doses of either placebo or pregabalin 300 mg 12 h and 1 h before surgery. Anesthesia was induced with thiopental (3–5 mg/kg) and atracurium (0.5 mg/kg) and maintained with isoflurane with O2. Patients were studied at 1, 4, 8, 12 and 24 h postoperatively for Visual Analogue Scale (VAS), nalbuphine consumption (was given when VAS > 4), satisfaction score and side effects of pregabalin. Results The VAS scores of the pregabalin group were significantly lower than the control group at 1, 4 and 8 h after surgery. The total nalbuphine consumption at 24 h postoperatively of pregabalin group (33.8 + 6.89) was highly significant lower than the control group (46.4 + 5.72) (p < 0.001). There were no significant differences between groups in somnolence-dizziness and nausea-vomiting. The satisfaction score was higher in the pregabalin group. Conclusion A 300 mg pregabalin administered 12 h and 1 h preoperatively is a safe and effective method in management of pain after shoulder arthroscopy.
    10/2013; 29(4):363–367. DOI:10.1016/j.egja.2013.07.001
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    ABSTRACT: Background Functional Endoscopic sinus surgery (FESS) is a delicate and time consuming procedure; it is performed routinely under general anesthesia. Hypotensive techniques should be employed for best visualization of operative field. Gabapentin is a structural analog of gamma amino butyric acid. The aim of this study was to determine the analgesic efficacy of gabapentin and its role in deliberate hypotension during and after FESS.Methods Eighty patients ASA physical status I–II patients were scheduled to undergo elective FESS under general anesthesia. Patients were randomly assigned to one of two groups using a computer-generated table. Patients in the control group (40 patients) received oral placebo capsules and the study group (40 patients) patients received oral gabapentin (Conventin 400 mg; Evapharma Egypt) 1.2 g 1 h before surgery. Intraoperative, mean arterial blood pressure, infusion rates of the hypotensive agent (sodium nitroprusside) were recorded at 15 min interval. Assessments of pain, opioid usage, and side effects were performed at 1 h interval after arrival in the PACU.ResultsGabapentin group patients required significantly lower (p value <0.05) infusion rates and total doses of hypotensive agent (sodium nitroprusside) than the placebo group patients at all measured intervals. Postoperative assessment of pain scores revealed that gabapentin group recorded significantly lower mean values of VAS than the control group (p value <0.05).Conclusion Oral gabapentin, 1200 mg decreased dose requirements of intraoperative hypotensive agent (sodium nitroprusside) and postoperative morphine. In addition, patients receiving gabapentin had suffered less from opioid side effects (nausea, vomiting and urinary retention) than those receiving placebo.
    07/2012; 28(3):189–192. DOI:10.1016/j.egja.2012.02.008