The effect of pre-emptive gabapentin on anaesthetic and analgesic requirements in patients undergoing rhinoplasty: A prospective randomised study

Abstract

Background and Aims:Hypotensive anaesthesia is necessary in rhinoplasty for better visualisation of surgical field and reduction of surgery time. Gabapentin is a new generation anticonvulsant with anti-hyperalgesic and anti-nociceptive properties. We aimed to investigate the effect of pre-operative administration of oral gabapentin (1200 mg) on anaesthetic requirements and post-operative analgesic consumption and its role in hypotensive anaesthesia for rhinoplasty.Methods:Seventy adult patients undergoing rhinoplasty, were randomly allocated to two groups. Group I (G I) (n = 35) received gabapentin 1.2 g and Group II (G II) (n = 35) received oral placebo capsules 2 h before surgery. General anaesthesia was maintained with sevoflurane in oxygen-nitrous oxide to maintain bispectral index value between 40 and 60, and remifentanil infusion to keep mean arterial pressure (MAP) at 55–60 mmHg. End-tidal sevoflurane concentration, intra-operative remifentanil consumption and time to intended MAP were recorded. Visual analogue scale (VAS) scores, post-operative analgesic requirements and side effects for the first 24 h were recorded.Results:G I required significantly lower intra-operative remifentanil (G I = 0.8 ± 0.26 mg and G II = 1.7 ± 0.42 mg; P = 0.001) and end-tidal sevoflurane concentration, with reduced doses of post-operative tramadol and diclofenac sodium. Time to the intended MAP was significantly less in G I than G II (59.1 ± 12.3 vs. 73.6 ± 16.4, respectively, with P = 0.001).Conclusion:Pre-operative oral gabapentin significantly reduced intra-operative remifentanil and sevoflurane requirements during hypotensive anaesthesia along with decreased post-operative analgesic requirement.

Preoperative gabapentin versus bisoprolol for haemodynamic and surgical field optimisation during endoscopic sinus surgery

“…Jacob and associates reported a reduction of both inhaled isoflurane and IV fentanyl requirements during ESS without any increase in the incidence of awareness on pre-treating patients with bisoprolol 2.5 mg.[ 8 ] Salama and Amer have also revealed a reduction in both intraoperative remifentanil and sevoflurane administration on pre-treating patients with gabapentin 1200 mg.[ 22 ] The difference between our study results which showed no difference in inhaled isoflurane concentration, and those of Jacob et al . study and Salama and Amer study may be attributed to the use of bispectral index (BIS) to guide anaesthetic administration in both studies.…”

International consensus statement on allergy and rhinology: rhinosinusitis 2021

“…Although these medications are US FDA approved for the treatment of seizures and neuropathic pain, they are frequently used off‐label for the treatment of other types of acute and chronic pain, including in peri‐operative pain management. The use of pre‐emptive gabapentinoids in nasal surgery has been well documented in several RCTs, with the majority reporting significantly lower VAS pain scores compared to placebo 1876–1881 …”

Perioperative Analgesia for Patients Undergoing Septoplasty and Rhinoplasty: An Evidence‐Based Review

“…In comparison, Farzi et al demonstrated no significant difference in the average VAS values for gabapentin versus placebo ( P = .55) . When considering rescue analgesic consumption, Turan et al, Salama et al, and Kazak et al showed significantly lower intravenous (IV) fentanyl (122 mg ± 40 mg vs. 148 mg ± 42 mg, P < .05), patient‐controlled analgesia (PCA) tramadol (81.9 mg ± 25.3 mg vs. 134.6 mg ± 32.7 mg, P < .01), and remifentanil (171.42 μg ± 68 μg vs. 219.17 μg ± 95 μg, P = .033) consumption, respectively . Time to first rescue analgesic requirement was prolonged in all studies reporting on this variable; Farzi et al did not measure time to first analgesic.…”

“…Kim et al dosed pregabalin at 150 mg, whereas Demirhan used doses of 300 mg . Gabapentinoid doses varied and were 300 mg in the study by Farzi et al, 600 mg in Kazak et al’s study, compared to 1,200 mg for Turan et al and Salama and Amer . Six of the seven studies reported significantly lower VAS/NRS perioperative pain scores as compared to placebo.…”