Effect of Preoperative Gabapentin With a Concomitant Adductor Canal Block on Pain and Opioid Usage After Anterior Cruciate Ligament Reconstruction

Abstract

Background: An adductor canal block (ACB) and preoperative oral gabapentin have each been shown to decrease postoperative pain scores and opioid usage in patients undergoing anterior cruciate ligament (ACL) reconstruction. Purpose/Hypothesis: This study evaluated the efficacy of preoperative gabapentin on postoperative analgesia in patients who received an ACB. We hypothesized that patients undergoing ACL reconstruction with an ACB who utilized a single dose of preoperative oral gabapentin would have decreased pain and opioid consumption in the 24 to 72 hours after surgery compared with patients who did not utilize gabapentin. Study Design: Cohort study; Level of evidence, 3. Methods: Between January and October 2016, patients at a single institution who underwent ACL reconstruction and received an ACB were identified. Patients who underwent surgery before May 2016 were placed in the control group, and patients seen after May 2016 received a preoperative dose of gabapentin and were placed in the gabapentin group. All patients completed a pain log via a smartphone application to record pain scores and opioid usage after surgery. Results: A total of 74 patients were identified: 41 in the gabapentin group and 33 in the control group. There were no significant differences between groups in demographics and operative characteristics. There were no differences in pain scores on postoperative day 1 (gabapentin vs control: 5.53 vs 5.56; P = .95), day 2 (4.58 vs 4.83; P = .59), or day 3 (4.15 vs 3.87; P = .59). The mean opioid consumption in oral morphine equivalents was not different on postoperative day 1 (gabapentin vs control: 47.2 vs 48.1; P = .90), day 2 (29.9 vs 33.5; P = .60), or day 3 (17.4 vs 18.7; P = .80). Conclusion: Preoperative gabapentin did not reduce pain scores or opioid usage in patients who received an ACB and underwent ACL reconstruction in this retrospective cohort study.

Effect of preoperative gabapentin after transurethral prostate resection under general anesthesia

“…Contrary to our results, there are studies which are unable to display a decrease in pain scores and analgesic requirement following surgery in patients administrated preoperative gabapentin. 13 The different findings may result from the different types of surgeries or smaller dose of gabapentin administrated.…”

Preoperative Gabapentin Administration and Its Impact on Postoperative Opioid Requirement and Pain in Sinonasal Surgery

“…5 In addition, patients with a history of chronic pain or chronic analgesic use are often excluded. 7,11,12,15 Concomitant chronic comorbidities, including mood or migraine disorder (which can affect baseline pain perception), are often not reported. 5,8,10,23,24…”

“…Thoracic, obstetrics, and some orthopedic literature demonstrates either minimal or no benefit from perioperative gabapentin. [10][11][12] Common limitations of these gabapentin studies include the heterogeneity of patients and operations being evaluated. Gabapentin use in sinonasal surgery has largely been limited to the intraoperative and immediate postoperative periods.…”

Managing Perioperative Pain After Anterior Cruciate Ligament (ACL) Reconstruction: Perspectives from a Sports Medicine Surgeon

“…79,80 Gabapentin administered preoperatively has been studied as potential agent in multimodal pain management after ACLR; however, studies have been mixed regarding its potential to decrease pain scores and postoperative opioid consumption. 81,82 Similar RCTs have been conducted with the use of 150 mg of preoperative and postoperative pregabalin and have demonstrated reduced subjective pain scores and postoperative opioid consumption. 83,84 However, these results were in conflict with another RCT involving the use of preoperative and postoperative pregabalin in ACLR that indicated the drug no better than placebo in regard to reducing postoperative pain and opioid consumption.…”