Preoperative Gabapentin to Prevent Postoperative Shoulder Pain After Laparoscopic Ovarian Cystectomy: A Randomized Clinical Trial

Abstract

Background:Patients undergoing gynecology laparoscopy frequently experience shoulder pain as a common postoperative complication. Considering diaphragm stimulation in its pathophysiology, there are some advice to prevent or control this special form of referral pain.Objectives:The current study aimed to assess the prophylactic effect of preoperative administration of oral gabapentin to prevent Post Laparoscopic Shoulder Pain (PLSP) after laparoscopic ovarian cystectomy.Patients and Methods:In a randomized, double blind, placebo controlled trial 40 female patients who were candidates to have elective laparoscopic ovarian cystectomy, received uniformed capsules containing gabapentin 600 mg or placebo 30 minutes before anesthesia induction. All patients had the American Society of Anesthesiologists (ASA) Physical Status of I-II and none had pervious abdominal surgery. Thereafter, the presence of side effects and PLSP and its severity was assessed by Visual Analog Scale (VAS) in the beginning of surgery and 2, 6, 12 hours after the surgery.Results:Comparing the gabapentin (n = 20) and placebo (n = 20) groups, basic characteristics including age (P = 0.446), Body Mass Index (BMI) (P = 0.876), pregnancy history (P = 0.660), and surgery time (P = 0.232) were statistically similar. PLSP occurrence was less frequent in the gabapentin group (45%) compared with the placebo group (75%) (P = 0.053), while In gabapentin group the VAS scores were lower in 2(P = 0.004), 6 (P = 0.132), and 12 (P = 0.036) hours, post operatively.Conclusions:Prophylactic gabapentin administration could be considered as an effective and safe intervention to reduce occurrence and severity of PLSP after gynecologic laparoscopic cystectomy.

Gabapentin for pain management after osmotic dilator insertion and prior to dilation and evacuation: A randomized controlled trial

“…The lack of a clear benefit with gabapentin use correlates with a recently reported double-blind randomized trial demonstrating that gabapentin did not reduce postoperative pain with first trimester surgical abortion [22]. When considering these findings together with the benefit of pre-emptive gabapentin for pain reduction with abdominal hysterectomy [8][9][10][11][12][13][14], and the slight and variable pain reduction benefit with cesarean delivery [15][16][17][18][19][20], perhaps gabapentin is more beneficial for incision-related (sensory) pain and less for uterine cramping related (visceral) pain.…”

“…A systematic review demonstrated a significant benefit of pre-operative gabapentin for preemptive analgesia for abdominal hysterectomy [14]. Data regarding preoperative gabapentin use in other contexts, such as Cesarean delivery and laparoscopic ovarian cystectomy, are less consistent [15][16][17][18][19][20]. The heterogeneity of gabapentin dosing and overall pain regimen along with study design limitations make these data challenging to generalize to abortion procedures.…”

Analysis of risk factors of postlaparoscopic shoulder pain

“…Valadan et al . revealed preoperative administration of gabapentin reduced the occurrence and severity of SP after laparoscopic ovarian cystectomy . Thus the other drugs than opioids were indicated to be useful for relief from SP, which might help to decrease the opioids use.…”

Perioperative pain management strategies among women having reproductive surgeries

“…A meta-analysis among women undergoing total abdominal hysterectomy has demonstrated decreased opioid consumption and decreased pain scores for the first 24 hours after surgery with preoperative gabapentin (30). Preoperative gabapentin or pregabalin has also been shown to significantly decrease post-laparoscopy shoulder pain in women undergoing laparoscopic gynecologic surgery (31,32). The use of gabapentinoids should be considered in patients undergoing major reproductive/gynecological surgeries, particularly patients at high risk for difficult to control postoperative pain.…”