Effect of Gabapentin on Morphine Consumption and Pain after Surgical Debridement of Burn Wounds: A Double-Blind Randomized Clinical Trial Study

Abstract

Background: Burn pain is recognized as being maximal during therapeutic procedures, and wound debridement can be more painful than the burn injury itself. Uncontrolled acute burn pain increases the stress response and the incidence of chronic pain and associated depression. Although opiates are excellent analgesics, they do not effectively prevent central sensitization to pain. The anticonvulsant gabapentin has been proven effective for treating neuropathic pain in large placebo-controlled clinical trials. Experimental and clinical studies have demonstrated antihyperalgesic effects in models with central neuronal sensitization. It has been suggested that central neuronal sensitization may play an important role in postoperative pain. Objectives: The aim of this study was to investigate the effect of gabapentin on morphine consumption and postoperative pain in burn patients undergoing resection of burn wounds. Patients and Methods: In a randomized, double-blind, placebo-controlled study, 50 burn patients received a single oral dose of gabapentin (1200mg) or placebo 2h before surgery. Anesthesia was induced with propofol and fentanyl and maintained by infusingpropofol, remifentanil, and 50% N2O in O2. All patients received patient-controlled analgesia with morphine at doses of 2.5 mg bolus and a lock-out time of 10 min for 24h before the operation. Pain was assessed on a visual analog scale (VAS) at rest and during movement at 1,4,8,12,16,20, and 24 h before the operation. Heart rate, oxygen saturation, mean arterial blood pressure, respiratory rate, sedation score, and morphine consumption were studied. Results: All the enrolled patients were able to complete the study; therefore, data from 50 patients wereanalyzed. The VAS scores at rest andduring movement at 1,4,8,12,16,20, and 24 h after the operation were significantly lower in the gabapentin group than in the placebo group (P < 0.05). Morphine consumption was significantly lessr in the gabapentin group than in the placebo group (P < 0.05). Sedation scores were similar in the 2 groups at all measured times. There were no differences in adverse effects between the groups. Conclusions: A single oral dose of 1200mg gabapentin resulted in a substantial reduction in postoperative morphine consumption and pain scores after surgical debridement in burn patients.

The Concurrent Use of Gabapentin and Opioid Analgesia in Burns Patients

“…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.…”

“…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).…”

The Use of Gabapentin to Decrease Morphine Consumption After Surgical Debridement for Burns

“…I read with great interest the recent manuscript by Siamak Rimaz on “ Effect of Gabapentin on Morphine Consumption and Pain after Surgical Debridement of Burn Wounds: A Double-Blind Randomized Clinical Trial Study” published in Archives of Trauma Research (1). In this article they recruited 50 patients and through a randomized, double-blind, placebo-controlled study demonstrated a significant improvement in pain scores and clinical parameters after administration of a single oral dose of 1200mg gabapentin.…”

Gabapentin for Pain Control After Surgical Debridement of Burn Wounds

“…I read with great interest the contribution “Effect of Gabapentin on Morphine Consumption and Pain after Surgical Debridement of Burn Wounds: A Double-Blind Randomized Clinical Trial Study” by Raziet al (1). Carrying out a Randomized Controlled Trial without funding and especially in our region is an uphill task indeed.…”