Is Gabapentin Effective on Pain Management after Arthroscopic Anterior Cruciate Ligament Reconstruc tion? A Triple Blinded Randomized Controlled Trial

Document Type : RESEARCH PAPER

Authors

1 Department of Orthopedic Surgery Guilan Road Trauma Research Center, Guilan University of Medical, Sciences, Rasht, Iran.

2 Department of Orthopedic Surgery Kerman University of Medical Sciences, Kerman, Iran.

3 Orthopedic Research Center Guilan University of Medical Sciences, Rasht, Iran.

4 Orthopedic Research Center Guilan University of Medical Sciences, Rasht, Iran

Abstract

Background: Acute pain is common after arthroscopic surgeries and it is one of the most important causes of patient dissatisfaction, admission time and increased morbidity . Gabapentin with anti-hyperalgesic effects can play a critical role in pre-emptive analgesia methods. The aim of this study was to assess the efficacy of gabapentin in pain management after surgery and the rate of drug consumption in patients who are candidate for anterior cruciate ligament (ACL) reconstruction arthroscopic surgery.
Methods: In this randomized, triple blind clinical trial, 114 patients who were candidate for arthroscopic ACL reconstruction were divided into two groups of gabapentin (G) and placebo (p), with 57 patients in each group. The intervention group received gabapentin 600 mg and a placebo was administered in control group. Patients received on-demand pethedine for pain management. The primary outcome was pain intensity according to the visual analogue scale (VAS) and the secondary outcome was the amount of opioid consumption and incidence of side effects (including: dizziness, sedation, nausea and vomiting) at 6 and 24 h visits.
Results: The mean pain intensity in G group at both the 6 and 24 hour visits was significantly lower than the control group (Both p <0.0001). Also, patients in the gabapentin group consumed less opioid at both visits in comparison to the placebo group (p <0.001, p =0.032). The incidence rate of sedation, dizziness, nausea and vomiting was similar in both groups. Conclusion: In arthroscopic ACL reconstruction, administering a preoperative single dose of 600mg gabapentin may decrease both pain intensity and opioid consumption.

Keywords

References

  1. Spence D, Goff J, Mohan E, Bowen K, Osborne L, Maye J. Perioperative administration of gabapentin for shoulder arthroscopy: a prospective, randomized, double-blind, placebo-controlled study. AANA J. 2011;79(4):43-50.

  2. Alentorn-Geli E, Lajara F, Samitier G, Cugat R. The transtibial versus the anteromedial portal technique in the arthroscopic bone-patellar tendon-bone anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2010;18(8):1013-37.

  3. Dargel J, Schmidt-Wiethoff R, Fischer S, Mader K, Koebke J, Schneider T. Femoral bone tunnel placement using the transtibial tunnel or the anteromedial portal in ACL reconstruction: a radiographic evaluation. Knee Surg Sports Traumatol Arthrosc. 2009;17(3):220-7.

  4. Bang SR, Yu SK, Kim TH. Can gabapentin help reduce postoperative pain in arthroscopic rotator cuff repair? A prospective, randomized, double-blind study. Arthroscopy. 2010;26(9):106-11.

  5. Weinbroum AA. Non-opioid IV adjuvants in the perioperative period: pharmacological and clinical aspects of ketamine and gabapentinoids. Pharmacol Res. 2012;65(4):411-29.

  6. Buvanendran A, Kroin JS. Multimodal analgesia for controlling acute postoperative pain. Curr Opin Anaesthesiol. 2009;22(5):588-93.

  7. White PF. The role of non-opioid analgesic techniques in the management of pain after ambulatory surgery. Anesth Analg. 2002;94(3):577-85.

  8. Elvir-Lazo OL, White PF. The role of multimodal analgesia in pain management after ambulatory surgery. Curr Opin Anaesthesiol. 2010;23(6):697-703.

  9. Kehlet H, Dahl JB. The value of “multimodal” or “balanced analgesia” in postoperative pain treatment. Anesth Analg. 1993;77(5):1048-56.

  10. Al-Mujadi H, A-Refai AR, Katzarov MG, Dehrab NA, Batra YK, Al-Qattan AR. Preemptive gabapentin reduces postoperative pain and opioid demand following thyroid surgery. Can J Anaesth. 2006;53(3):268-73.

  11. Dahl JB, Mathiesen O, Moiniche S. ‘Protective premedication’: an option with gabapentin and related drugs? A review of gabapentin and pregabalin in in the treatment of post-operative pain. Acta Anaesthesiol Scand. 2004;48(9):1130-6.

  12. Dauri M, Faria S, Gatti A, Celidonio L, Carpenedo R, Sabato AF. Gabapentin and pregabalin for the acute post-operative pain management. A systematic-narrative review of the recent clinical evidences. Curr Drug Targets. 2009;10(8):716-33.

  13. Dirks J, Fredensborg BB, Christensen D, Fomsgaard JS, Flyger H, Dahl JB. A randomized study of the effects of single-dose gabapentin versus placebo on postoperative pain and morphine consumption after mastectomy. Anesthesiology. 2002;97(3):560-4.

  14. Hurley RW, Cohen SP, Williams KA, Rowlingson AJ, Wu CL. The analgesic effects of perioperative gabapentin on postoperative pain: a meta-analysis. Reg Anesth Pain Med. 2006;31(3):237-47.

  15. Pandey CK, Navkar DV, Giri PJ, Raza M, Behari S, Singh RB, et al. Evaluation of the optimal preemptive dose of gabapentin for postoperative pain relief after lumbar diskectomy: a randomized, double-blind, placebo-controlled study. J Neurosurg Anesthesiol. 2005;17(2):65-8.

  16. Radhakrishnan M, Bithal PK, Chaturvedi A. Effect of preemptive gabapentin on postoperative pain relief and morphine consumption following lumbar laminectomy and discectomy: a randomized, double-blinded, placebo-controlled study. J Neurosurg Anesthesiol. 2005;17(3):125-8.

  17. Short J, Downey K, Bernstein P, Shah V, Carvalho JC. A single preoperative dose of gabapentin does not improve postcesarean delivery pain management: a randomized, double-blind, placebo-controlled dose-finding trial. Anesth Analg. 2012;115(6):1336-42.

  18. Kinney MA, Mantilla CB, Carns PE, Passe MA, Brown MJ, Hooten WM, et al. Preoperative gabapentin for acute post-thoracotomy analgesia: a randomized, double-blinded, active placebo-controlled study. Pain Pract. 2012;12(3):175-83.

  19. Paul JE, Nantha-Aree M, Buckley N, Cheng J, Thabane L, Tidy A, et al. Gabapentin does not improve multimodal analgesia outcomes for total knee arthroplasty: a randomized controlled trial. Can J Anaesth. 2013;60(5):423-31.

  20. Adam F, Menigaux C, Sessler DI, Chauvin M. A single preoperative dose of gabapentin (800 milligrams) does not augment postoperative analgesia in patients given interscalene brachial plexus blocks for arthroscopic shoulder surgery. Anesth Analg. 2006;103(5):1278-82.

  21. Menigaux C, Adam F, Guignard B, Sessler DI, Chauvin M. Preoperative gabapentin decreases anxiety and improves early functional recovery from knee surgery. Anesth Analg. 2005;100(5):1394-9.

  22. Turan A, Karamanlioglu B, Memis D, Hamamcioglu MK, Tukenmez B, Pamukcu Z, et al. Analgesic effects of gabapentin after spinal surgery. Anesthesiology. 2004;100(4):935-8.

  23. Turan A, Kaya G, Karamanlioglu B, Pamukcu Z, Apfel CC. Effect of oral gabapentin on postoperative epidural analgesia. Br J Anaesth. 2006;96(2):242-6.

  24. Waikakul W. Combination of gabapentin and celecoxib for analgesia after major orthopedic surgery: a randomized, controlled trial. Asian Biomedicine. 2011;5(1):101-10.

  25. Gilron I. Gabapentin and pregabalin for chronic neuropathic and early postsurgical pain: current evidence and future directions. Curr Opin Anaesthesiol. 2007;20(5):456-72.

  26. Ho KY, Gan TJ, Habib AS. Gabapentin and postoperative pain--a systematic review of randomized controlled trials. Pain. 2006;126(1-3):91-101.

  27. Clarke H, Pereira S, Kennedy D, Gilron I, Katz J, Gollish J, et al. Gabapentin decreases morphine consumption and improves functional recovery following total knee arthroplasty. Pain Res Manag. 2009;14(3):217-22.

  28. Clarke H, Pereira S, Kennedy D, Andrion J, Mitsakakis N, Gollish J, et al. Adding gabapentin to a multimodal regimen does not reduce acute pain, opioid consumption or chronic pain after total hip arthroplasty. Acta Anaesthesiol Scand. 2009;53(8):1073-83.

  29. Brogly N, Wattier JM, Andrieu G, Peres D, Robin E, Kipnis E, et al. Gabapentin attenuates late but not early postoperative pain after thyroidectomy with superficial cervical plexus block. Anesth Analg. 2008;107(5):1720-5.

  30. Menda F, Köner Ö, Sayın M, Ergenoğlu M, Küçükaksu S, Aykaç B. Effects of Single-Dose Gabapentin on Postoperative Pain and Morphine Consumption After Cardiac Surgery. J Cardiothorac Vasc Anesth. 2010;24(5):808-13.

  31. Sen H, Sizlan A, Yanarates O, Emirkadi H, Ozkan S, Dagli G, et al. A comparison of gabapentin and ketamine in acute and chronic pain after hysterectomy. Anesth Analg. 2009;109(5):1645-50.

  32. Srivastava U, Kumar A, Saxena S, Mishra AR, Saraswat N, Mishra S. Effect of preoperative gabapentin on postoperative pain and tramadol consumption after minilap open cholecystectomy: a randomized double-blind, placebo-controlled trial. Eur J Anaesthesiol. 2010;27(4):331-5.

  33. Moore A, Costello J, Wieczorek P, Shah V, Taddio A, Carvalho JC. Gabapentin improves postcesarean delivery pain management: a randomized, placebo-controlled trial. Anesth Analg. 2011;112(1):167-73.

The Archives of Bone and Joint Surgery
Volume 1, Issue 1 - Serial Number 1
September 2013
Pages 18-22

Files

History

  • Receive Date: 21 July 2013
  • Revise Date: 22 July 2013
  • Accept Date: 21 August 2013

Share

How to cite

Statistics