Review article: The role of anticonvulsant drugs in postoperative pain management: a bench-to-bedside perspective

Abstract

Purpose: Anticonvulsant drugs are effective in the treatment of chronic neuropathic pain but were not, until recently, thought to be useful in more acute conditions such as postoperative pain. However, similar to nerve injury, surgical tissue injury is known to produce neuroplastic changes leading to spinal sensitization and the expression of stimulus-evoked hyperalgesia and allodynia. Pharmacological effects of anticonvulsant drugs which may be important in the modulation of these postoperative neural changes include suppression of sodium channel, calcium channel and glutamate receptor activity at peripheral, spinal and supraspinal sites. The purpose of this article is to review preclinical evidence and clinical trial data describing the efficacy and safety of anticonvulsant drugs in the setting of postoperative pain management. Source: A Medline search was performed to retrieve available literature on the basic and clinical pharmacology of anticonvulsant drugs as they pertain to postoperative pain management. Principal findings: Numerous laboratory studies have described analgesic effects of different anticonvulsant drugs in experimental pain models. Furthermore, several recent clinical trials have shown that anticonvulsants may reduce spontaneous and movement-evoked pain, as well as decrease opioid requirements postoperatively. Some early findings suggest further that anticonvulsant drugs may alleviate postoperative anxiety, accelerate postoperative functional recovery and reduce chronic postsurgical pain. Conclusion: Given the incomplete efficacy of currently available non-opioid analgesics, and the identified benefits of opioid sparing, anticonvulsant medications may be useful adjuncts for postoperative analgesia. Further research in this field is warranted. Objectif

Gabapentin and Pregabalin for the Acute Post-operative Pain Management. A Systematic-narrative Review of the Recent Clinical Evidences

“…Generally our data on PONV incidence are in accordance with those of Seib et al [83] and Hurley et al [81] meta-analysis and in discordance with the other authors who described a significant reduction of nausea and vomiting [79,80,82,84,85]. Meanwhile, the information reported from the other systematic-narrative reviews regarding PONV are inconclusive [11,28,77,78] Furthermore, it would be considered that RCTs included in the previous reviews and those included in the present one are partially different.…”

“…The first studies of PGL use after major surgery pain management were published in 2006 and furthermore previous systematic narrative [11,28,77,78] or meta-analytic [79][80][81][82][83][84][85] reviews reported data from GBP clinical trials until 2006 (included). A total of three trials on PGL use for post-operative pain management [30,69,71] have been included in only one review [11] and the other three [77][78][79] included only one trial on postoperative dental pain published in 2001 [30]. Thus, we decided to take in consideration only recent (from 2006-2009) RCTs which investigated the analgesic effects of GBP or PGL in adult patients (age range 18 years and above) underwent to surgical procedures.…”

Non-opioid strategies for acute pain management

“…Other trials also suggest the potential analgesic efficacy of other anticonvulsant drugs including pregabalin, lamotrigine and possibly oxcarbazepine. 20 This was also confirmed in a recent meta-analysis by Seib and Paul 23 showing that gabapentin given preoperatively decreased pain scores and analgesic consumption in the first 24 hr after surgery. However, the clinical significance of this finding has yet to be determined.…”

Cardiopulmonary bypass does not affect plasma concentration of preoperatively administered gabapentin

“…22 Gabapentin is a 3-alkylated analogue of gamma-amino butyric acid (GABA) that has been shown to be effective in reducing pain scores and opioid consumption in a number of surgical settings. [23][24][25][26] Also, when used in combination with a COX-2 inhibitor, gabapentin has been shown to have specific efficacy in reducing pain evoked by movement and respiration after surgery. 9 Furthermore, gabapentin, both alone and in combination with a COX-2 inhibitor, led to improvement in indices of pulmonary function during the recovery period after abdominal surgery.…”