Perioperative gabapentin for the prevention of persistent pain after thoracotomy: a randomized controlled trial

Grosen, Kasper; Drewes, Asbjørn Mohr; Højsgaard, Anette; Pfeiffer-Jensen, Mogens; Hjortdal, Vibeke E.; Pilegaard, Hans K.

doi:10.1093/ejcts/ezu032

Cited by 53 publications

(63 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This may require days or even weeks of titration to target dosage with such medications as duloxetine, gabapentin, or pregabalin. Many prevention studies for CPSP have initiated gabapentin and other oral medications between 1 hour and 1 day prior to surgery [3,12,24,25,27,33,51,52,57,66,95,97,98,101,108,116,131,133,147,148,165]. One study initiated treatment with an antidepressant 2-3 weeks prior to coronary artery bypass surgery; however, chronic pain was only assessed as part of a composite quality of life measure [31].…”

Section: Design Considerations In the Context Of 4 Illustrative Prmentioning

confidence: 99%

“…We suggest that the time period in which post-surgical pain is considered acute should be based on natural history data specific to each surgery model or, in the absence of epidemiological data, the clinical expertise of the investigator. Several clinical trials have extended the investigational treatment between 5 and 14 days post-surgery [3,27,51,52,67,66,95,108,120,133]. …”

Section: Design Considerations In the Context Of 4 Illustrative Prmentioning

confidence: 99%

“…If the pain qualities are different before and after surgery, the pain can more confidently be attributed to the surgery. Multiple studies have included neuropathic pain measures as CPSP study outcomes [12,19,27,33,51,65,67,78,88,108]. …”

Section: Design Considerations In the Context Of 4 Illustrative Prmentioning

confidence: 99%

See 2 more Smart Citations

Research design considerations for chronic pain prevention clinical trials

Gewandter

Dworkin

Turk

et al. 2015

Pain

130

View full text Add to dashboard Cite

Although certain risk factors can identify individuals who are most likely to develop chronic pain, few interventions to prevent chronic pain have been identified. To facilitate the identification of preventive interventions, an IMMPACT meeting was convened to discuss research design considerations for clinical trials investigating the prevention of chronic pain. We present general design considerations for prevention trials in populations that are at relatively high risk for developing chronic pain. Specific design considerations included subject identification, timing and duration of treatment, outcomes, timing of assessment, and adjusting for risk factors in the analyses. We provide a detailed examination of 4 models of chronic pain prevention (i.e., chronic post-surgical pain, postherpetic neuralgia, chronic low back pain, and painful chemotherapy-induced peripheral neuropathy). The issues discussed can, in many instances, be extrapolated to other chronic pain conditions. These examples were selected because they are representative models of primary and secondary prevention, reflect persistent pain resulting from multiple insults (i.e., surgery, viral infection, injury, and toxic/noxious element exposure), and are chronically painful conditions that are treated with a range of interventions. Improvements in the design of chronic pain prevention trials could improve assay sensitivity and thus accelerate the identification of efficacious interventions. Such interventions would have the potential to reduce the prevalence of chronic pain in the population. Additionally, standardization of outcomes in prevention clinical trials will facilitate meta-analyses and systematic reviews and improve detection of preventive strategies emerging from clinical trials.

show abstract

Section: Design Considerations In the Context Of 4 Illustrative Prmentioning

confidence: 99%

Section: Design Considerations In the Context Of 4 Illustrative Prmentioning

confidence: 99%

See 1 more Smart Citation

Research design considerations for chronic pain prevention clinical trials

Gewandter

Dworkin

Turk

et al. 2015

Pain

130

View full text Add to dashboard Cite

show abstract

“…8,55 Interestingly, these trials provide the only evidence of the effects of gabapentin in high-risk patients. Within these postoperative pain trials, the results of studies with cardiothoracic surgery patients 8,[56][57][58] (which included high-risk cardiac patients) suggest a reduction in postoperative arrhythmia with the use of gabapentin (RR, 0.55; 95% CI, 0.28 to 1.08).…”

Section: Discussionmentioning

confidence: 99%

Gabapentin for the hemodynamic response to intubation: systematic review and meta-analysis

Doleman

Sherwin

Lund

et al. 2016

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

Purpose Endotracheal intubation is the gold standard for securing the airway before surgery. Nevertheless, this procedure can produce an activation of the sympathetic nervous system and result in a hemodynamic response which, in high-risk patients, may lead to cardiovascular instability and myocardial ischemia. The aim of this review was to evaluate whether gabapentin can attenuate this response and whether such an attenuation could translate into reduced myocardial ischemia and mortality. Source We searched MEDLINE Ò , EMBASE TM , CINAHL, AMED, and unpublished clinical trial databases for randomized-controlled trials that compared gabapentin with control, fentanyl, clonidine, or beta blockers for attenuating the hemodynamic response to intubation. Primary outcomes were mortality, myocardial infarction, and myocardial ischemia. Secondary outcomes were hemodynamic changes following intubation. Principal findings We included 29 randomized trials with only two studies at low risk of bias. No data were provided for the primary outcomes and no studies included high-risk patients. The use of gabapentin resulted in attenuation in the rise in mean arterial blood pressure [mean difference (MD), -12 mmHg; 95% confidence interval (CI), -17 to -8] and heart rate (MD, -8 beatsÁmin -1 ; 95% CI, -11 to -5) one minute after intubation. Gabapentin also reduced the risk of hypertension or tachycardia requiring treatment (risk ratio, 0.15; 95% CI, 0.05 to 0.48). Data were limited on adverse hemodynamic events such as bradycardia and hypotension. Conclusion It remains unknown whether gabapentin improves clinically relevant outcomes such as death and myocardial infarction since studies failed to report on these. Nevertheless, gabapentin attenuated increases in heart rate and blood pressure following intubation when compared with the control group. Even so, the studies included in this review were at potential risk of bias. Moreover, they did not include high-risk patients or report adverse hemodynamic outcomes. Future studies are required to address these limitations. RésuméObjectif L'intubation endotrachéale constitue l'étalon or de la prise en charge des voies aériennes avant une chirurgie. Toutefois, cette intervention peut entraîner une activation du système nerveux sympathique et provoquer une réponse hémodynamique qui, chez les patients courant un risque élevé, pourrait mener à une instabilité cardiovasculaire et une ischémie myocardique. L'objectif de ce compte rendu était d'examiner si la gabapentine pouvait atténuer cette réponse et si une telle atténuation pouvait se traduire en une réduction de l'ischémie myocardique et de la mortalité. Source Nous avons effectué des recherches dans les bases de données MEDLINE Ò , EMBASE TM , CINAHL, AMED, ainsi que dans les bases de données d'études cliniques non publiées afin d'en extraire les études randomisées contrô lées comparant la capacité de la gabapentine par rapport à un groupe témoin, au fentanyl, à la clonidine ou à des bêta-bloquants, à atténuer la réponse hémodynam...

show abstract

“…Other immediate goals are to (i) make access, searching and navigation within MMCTS' library of content easier for desktop/ laptop computers as well as for mobile devices, (ii) reorganize the Manual and gather more content ranging from basic techniques aimed at junior clinicians, to more challenging procedures and finally, (iii) position MMCTS as the site from which to launch new ideas in thoracic and cardiovascular surgery. Perioperative gabapentin for the prevention of persistent pain after thoracotomy: a randomized, controlled trial [9] Kasper Grosen, Asbjørn Mohr Drewes, Anette Højsgaard et al…”

Section: The Future: Three Journals One Familymentioning

confidence: 99%

TheEJCTSpublication family is growing: the appointment of new editors forICVTSandMMCTS

Beyersdorf

Lorusso

Prêtre

et al. 2016

Eur J Cardiothorac Surg

View full text Add to dashboard Cite

Perioperative gabapentin for the prevention of persistent pain after thoracotomy: a randomized controlled trial

Abstract: We found no evidence for the superiority of gabapentin over placebo for the treatment of acute pain following thoracotomy or for the prevention of persistent post-thoracotomy pain.

Cited by 53 publications

References 22 publications

Research design considerations for chronic pain prevention clinical trials

Research design considerations for chronic pain prevention clinical trials

Gabapentin for the hemodynamic response to intubation: systematic review and meta-analysis

TheEJCTSpublication family is growing: the appointment of new editors forICVTSandMMCTS

Contact Info

Product

Resources

About