Effect of Gabapentin on Morphine Consumption and Pain after Surgical Debridement of Burn Wounds: A Double-Blind Randomized Clinical Trial Study

Abstract

Background:Burn pain is recognized as being maximal during therapeutic procedures, and wound debridement can be more painful than the burn injury itself. Uncontrolled acute burn pain increases the stress response and the incidence of chronic pain and associated depression. Although opiates are excellent analgesics, they do not effectively prevent central sensitization to pain. The anticonvulsant gabapentin has been proven effective for treating neuropathic pain in large placebo-controlled clinical trials. Experimental and clinical studies have demonstrated antihyperalgesic effects in models with central neuronal sensitization. It has been suggested that central neuronal sensitization may play an important role in postoperative pain.Objectives:The aim of this study was to investigate the effect of gabapentin on morphine consumption and postoperative pain in burn patients undergoing resection of burn wounds.Patients and Methods:In a randomized, double-blind, placebo-controlled study, 50 burn patients received a single oral dose of gabapentin (1200mg) or placebo 2h before surgery. Anesthesia was induced with propofol and fentanyl and maintained by infusingpropofol, remifentanil, and 50% N2O in O2. All patients received patient-controlled analgesia with morphine at doses of 2.5 mg bolus and a lock-out time of 10 min for 24h before the operation. Pain was assessed on a visual analog scale (VAS) at rest and during movement at 1,4,8,12,16,20, and 24 h before the operation. Heart rate, oxygen saturation, mean arterial blood pressure, respiratory rate, sedation score, and morphine consumption were studied.Results:All the enrolled patients were able to complete the study; therefore, data from 50 patients wereanalyzed. The VAS scores at rest andduring movement at 1,4,8,12,16,20, and 24 h after the operation were significantly lower in the gabapentin group than in the placebo group (P < 0.05). Morphine consumption was significantly lessr in the gabapentin group than in the placebo group (P < 0.05). Sedation scores were similar in the 2 groups at all measured times. There were no differences in adverse effects between the groups.Conclusions:A single oral dose of 1200mg gabapentin resulted in a substantial reduction in postoperative morphine consumption and pain scores after surgical debridement in burn patients.

A systematic review and meta‐regression analysis of prophylactic gabapentin for postoperative pain

“…Figure and Table detail the 133 trials we included in the review, with our categorisation of risks of bias in Fig. . We excluded one duplicate trial , three trials that were unavailable as full text , five trials that did not use a placebo , one trial that used combination therapy and two uncontrolled trials .…”

Exploring Opioid-Sparing Multimodal Analgesia Options in Trauma: A Nursing Perspective

“…Furthermore, in a pooled analysis of two double-blind trials, pregabalin was associated with superior pain reduction versus placebo in patients with chronic neuropathic pain related to spinal cord injury (Parsons, Sanin, Yang, Emir, & Juhn, 2013). Gabapentin and pregabalin led to decreased pain versus placebo in two double-blind studies of patients with burns (Gray et al, 2011; Rimaz et al, 2012). In addition to analgesic effects, data in the postoperative setting from reviews and a meta-analysis strongly demonstrate the opioid-sparing effects of gabapentin and pregabalin (Gilron, 2007; Melemeni et al, 2007; Zhang, Ho, & Wang, 2011).…”

Perioperative gabapentin as a component of multimodal analgesia for postoperative pain after total knee arthroplasty

“…Pre-procedural gabapentin treatment is also effective in treating pain during spinal, otolaryngological, gynecological, and endoscopic procedures, and burn wound debridement [9,15,16,[22][23][24][25]. Some studies suggest that it reduces the stress response that may occur during laryngoscopy and tracheal intubation [26].…”