Effects of Gabapentinoids Premedication on Shoulder Pain and Rehabilitation Quality after Laparoscopic Cholecystectomy: Pregabalin versus Gabapentin

Abstract

Introduction Gabapentinoids are increasingly used in preoperative premedication despite controversial results. The aim of our study was to evaluate the effects of preemptive use of gabapentin or pregabalin on postoperative shoulder pain and rehabilitation quality after laparoscopic cholecystectomy. Methods This is a clinical trial comparing the effects of a preoperative premedication with 600 mg of gabapentin or 150 mg of pregabalin versus placebo on postoperative pain and recovery quality after laparoscopic cholecystectomy. Premedication was taken 2 hours before the surgery beginning. Ninety patients were included and randomized into 3 groups (gabapentin, pregabalin, and placebo). The anesthetic protocol was the same for all patients. Primary endpoint was the shoulder pain intensity at the 48th postoperative hour. Secondary endpoints were postoperative nausea and vomiting (PONV), sleep quality during the first night, and the onset time for the first standing position. Results During the first 48 postoperative hours, the gabapentin and pregabalin groups had significantly lower shoulder pain than the placebo group (p < 0.05). In gabapentinoids groups, the incidence of PONV was lower and the sleep quality during the first postoperative night was better with significant results. Mean Spiegel scores were 22.43 ± 1.45, 22.30 ± 1.44, and 17.17 ± 1.66, respectively, in pregabalin, gabapentin, and placebo groups (p < 0.05). The delay for the first standing position was 14.9 ± 4.9 hours in the pregabalin group, 9.7 ± 3.6 hours in the gabapentin group, and 21.6 ± 2.1 hours in the placebo group. No superiority was found between gabapentin and pregabalin. Conclusion Preemptive premedication with gabapentinoids can enhance postoperative rehabilitation quality after laparoscopic cholecystectomy by reducing postoperative shoulder pain, decreasing PONV incidence, and improving sleep quality during the first postoperative night. This trial is registered with ClinicalTrial.gov (NCT03241875).

Application of anesthetic premedication in palliative medicine

“…Zaliczanymi do tej grupy substancjami są gabapentyna i pregabalina. Gabapentyna podawana w dawce 1200 mg przed zabiegiem operacyjnym zmniejsza natężenie bólu odczuwane przez pacjenta [40,41] oraz obniża zapotrzebowanie na opioidy w okresie pooperacyjnym. Gabapentyna stosowana z morfiną zmniejsza efekty uboczne związane z przyjmowaniem opioidów, tj.…”

“…Gabapentyna stosowana z morfiną zmniejsza efekty uboczne związane z przyjmowaniem opioidów, tj. nudności, wymioty [41][42][43][44], oraz zmniejsza incydenty zatrzymania moczu [45]. Aplikowana w dawce 600 mg według danych eksperymentalnych niestety nie wpływa na zmniejszenie zapotrzebowania na leki przeciwbólowe [44,46].…”

State of the art opioid-sparing strategies for post-operative pain in adult surgical patients

“…In a more recent meta-analysis that included 43 studies, they also reported reduction in analgesic usage associated with perioperative pregabalin usage [13]. One placebo-controlled RCT demonstrated no analgesic superiority between gabapentin (600 mg) and pregabalin (150 mg) during the first 48 postoperative hours following laparoscopic cholecystectomy in terms of postoperative shoulder pain, although it failed to evaluate opioid consumption [14]. In contrast, another RCT involving lumbar spine surgery showed improved postoperative opioid consumption for preoperative pregabalin in comparison to gabapentin [15].…”

Effects of Gabapentin on Postoperative Pain after Laparoscopic Cholecystectomy

“…There are few studies on effect of Gabapentin on acute post-operative pain control in laparoscopic cholecystectomy. 9,10 Aim of present study was to evaluate efficacy of oral Gabapentin in relief of acute post-operative pain in laparoscopic cholecystectomy and also compare the efficacy of oral Gabapentin with that of oral Tramadol. This study was conducted in the Department of anesthesiology and intensive care unit of the hospital.…”