A Randomized Study of the Effects of Single-dose Gabapentin versus  Placebo on Postoperative Pain and Morphine Consumption after Mastectomy

Dirks, Jesper; Fredensborg, B. B.; Christensen, Dennis; Fomsgaard, Jonna Storm; Flyger, Henrik; Dahl, Jørgen B.

doi:10.1097/00000542-200209000-00007

Cited by 328 publications

(223 citation statements)

References 28 publications

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“…It has been shown that a reduction in morphine requirements of approximately 30% would be clinically significant. [12][13][14] Based upon results of previous studies with comparable designs, a standard deviation of 20 mg in the placebo group was predicted. 14 A mean cumulative morphine requirement of 60 mg in the placebo group, and 42 mg in the active treatment group was assumed.…”

Section: Discussionmentioning

confidence: 99%

Effects of nabilone, a synthetic cannabinoid, on postoperative pain

Beaulieu

2006

Can J Anesth/J Can Anesth

146

118

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Purpose:Cannabinoids have been shown to have analgesic properties in animal studies, but a potential role for these drugs in acute pain management has not been established. It was hypothesized that nabilone, an oral cannabinoid synthetic tetrahydrocannabinol analogue, decreases morphine consumption, pain scores, nausea and vomiting following major surgery. Methods:A double-blind, randomized, placebo-controlled, parallel-group pilot trial compared the effects of two different doses, 1 mg (n = 11) and 2 mg (n = 9) of nabilone, ketoprofen 50 mg (n = 11) or placebo (n = 10), given at eight-hour intervals for 24 hr. Outcomes included morphine consumption, pain scores and emesis after major surgery. Secondary outcomes included patient tolerability of the study medication.Results: Forty-one patients (mean age 52 ± 2 yr) undergoing gynecologic (46%), orthopedic (44%), or other (10%) surgery were recruited. Cumulative 24-hr morphine consumption was not different between the four groups, but pain scores at rest and on movement were significantly higher in the 2 mg nabilone group compared to the other groups. There were no significant differences between groups with respect to episodes of nausea and vomiting, quality of sleep, sedation, euphoria, pruritus, or the number and severity of adverse events. No serious adverse event was recorded.Conclusions: Contrary to the main hypothesis, high dose nabilone in the presence of morphine patient controlled analgesia is associated with an increase in pain scores in patients undergoing major surgery.

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Section: Discussionmentioning

confidence: 99%

Effects of nabilone, a synthetic cannabinoid, on postoperative pain

Beaulieu

2006

Can J Anesth/J Can Anesth

146

118

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“…During the postoperative period, no significant difference was seen between the two groups with respect to pain levels or morphine administration. 96 …”

Section: Gabapentinmentioning

confidence: 99%

Use of Antiepileptic Drugs for Nonepileptic Conditions: Psychiatric Disorders and Chronic Pain

2007

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Summary: Antiepileptic drugs (AEDs) are commonly utilized for nonepileptic conditions, including various psychiatric disorders and pain syndromes. Evidence for their benefit in these nonepileptic conditions varies widely among different drugs, but there is, in general, a paucity of published multicenter randomized double-blind trials. Variable levels of evidence suggest that lamotrigine and the vagal nerve stimulator have antidepressant properties. Carbamazepine, valproate, lamotrigine, and oxcarbazepine appear to have mood stabilizing properties while gabapentin, pregabalin, and tiagabine have anxiolytic benefits. Barbiturates, topiramate, and possibly phenytoin may precipitate or exacerbate depression. Underlying depression and anxiety symptoms may be exacerbated by levetiracetam, while psychotic symptoms have rarely been reported with topiramate, levetiracetam, and zonisamide. Pregabalin, gabapentin, carbamazepine, and oxcarbazepine have been used to treat neuropathic pain such as postherpetic neuralgia, and diabetic polyneuropathy. Topiramate and divalproex sodium have utility in the prophylaxis or acute treatment of migraine. Further rigorous studies are needed to clarify the utility of AEDs in nonepileptic conditions.

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“…Both drugs, in earlier clinical trials, have been used as a preemptive analgesic and found to be safe and effective. [3][4][5]12,13 The preemptive administration of gabapentin and tramadol approximately two hours before surgery appears rational in order to attain maximal plasma concentrations at the time of surgical stimuli. It has also been demonstrated that a single dose of 600 mg of gabapentin added to 60 mg slow release morphine increases pain tolerance to the cold pressure test in humans.…”

Section: Méthodementioning

confidence: 99%

L’usage préventif de gabapentine diminue significativement la douleur postopératoire et les besoins d’analgésique de secours lors d’une cholécystectomie laparoscopique

Pandey

Priye

Singh

et al. 2004

Can J Anesth/J Can Anesth

195

150

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P Pu ur rp po os se e: : To evaluate the comparative preemptive effects of gabapentin and tramadol on postoperative pain and fentanyl requirement in laparoscopic cholecystectomy.M Me et th ho od ds s: : Four hundred fifty-nine ASA I and II patients were randomly assigned to receive 300 mg gabapentin, 100 mg tramadol or placebo in a double-blind manner two hours before laparoscopic cholecystectomy under general anesthesia. Postoperatively, patients' pain scores were recorded on a visual analogue scale every two hours for the initial 12 hr and thereafter every three hours for the next 12 hr. Patients received fentanyl 2 µg·kg -1 intravenously on demand. The total fentanyl consumption for each patient was recorded.R Re es su ul lt ts s: : Patients in the gabapentin group had significantly lower pain scores at all time intervals (2.65 ± 3.00, 1.99 ± 1.48, 1.40 ± 0.95, 0.65 ± 0.61) in comparison to tramadol (2.97 ± 2.35, 2.37 ± 1.45, 1.89 ± 1.16, 0.87 ± 0.50) and placebo (5.53 ± 2.22, 3.33 ± 1.37, 2.41 ± 1.19, 1.19 ± 0.56). Significantly less fentanyl was consumed in the gabapentin group (221.16 ± 52.39 µg) than in the tramadol (269.60 ± 44.17 µg) and placebo groups (355.86 ± 42.04 µg; P < 0.05). Sedation (33.98%), nausea/retching/vomiting (24.8%) were the commonest side effects in the gabapentin group whereas respiratory depression (3.9%) was the commonest in the tramadol group and vertigo (7.8%) in the placebo group. C Co on nc cl lu us si io on n: : Preemptive use of gabapentin significantly decreases postoperative pain and rescue analgesic requirement in laparoscopic cholecystectomy. (2,65 ± 3,00; 1,99 ± 1,48; 1,40 ± 0,95; 0,65 ± 0,61) que ceux du groupe tramadol (2,97 ± 2,35; 2,37 ± 1,45; 1,89 ± 1,16; 0,87 ± 0,50) ou placebo (5,53 ± 2,22; 3,33 ± 1,37; 2,41 ± 1,19; 1,19 ± 0,56). La demande de fentanyl a été significativement plus basse avec la gabapentine (221,16 ± 52,39 µg) qu'avec le tramadol (269,60 ± 44,17 µg) ou le placebo (355,86 ± 42,04 µg; P < 0,05). La sédation (33,98 %), les nausées/haut-lecoeur/vomissements (24,8 %) ERIPHERAL tissue injury provokes peripheral sensitization (a reduction in the threshold of nociceptor afferent peripheral terminals) and central sensitization (an activity dependent increase in the excitability of spinal neurons). 1,2 These changes contribute to the postinjury pain hypersensitivity state which manifests as an increase in the responsiveness to noxious stimuli and a decrease in the pain threshold, both at the site of injury and in the surrounding uninjured tissue. 1,2 The optimal form of treatment is that applied pre, intra and postoperatively to preempt the establishment of pain hypersensitivity during and after surgery. The preemptive treatment could be directed at the periphery, at inputs along sensory axons, and at central neurons. Different treatment regimens could be used at different times relative to surgery to maximize the prevention of pain in response to different levels of sensory inputs. 1,2 Gabapentin and tramadol both have demonstrated analgesic effect...

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A Randomized Study of the Effects of Single-dose Gabapentin versus Placebo on Postoperative Pain and Morphine Consumption after Mastectomy

Cited by 328 publications

References 28 publications

Effects of nabilone, a synthetic cannabinoid, on postoperative pain

Effects of nabilone, a synthetic cannabinoid, on postoperative pain

Use of Antiepileptic Drugs for Nonepileptic Conditions: Psychiatric Disorders and Chronic Pain

L’usage préventif de gabapentine diminue significativement la douleur postopératoire et les besoins d’analgésique de secours lors d’une cholécystectomie laparoscopique

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