Evaluation of the Optimal Preemptive Dose of Gabapentin for Postoperative Pain Relief After Lumbar Diskectomy

Abstract

We evaluated the optimal preemptive dose of gabapentin for postoperative pain relief after single-level lumbar diskectomy and its effect on fentanyl consumption during the initial 24 hours in a randomized, double-blinded, placebo-controlled study in 100 patients with American Society of Anesthesiologists physical status I and II. Patients were divided into five groups to receive placebo or gabapentin 300, 600, 900, or 1200 mg 2 hours before surgery. After surgery, patients were transferred to the postanesthesia care unit (PACU). A blinded anesthesiologist recorded the pain scores at time points of 6, 12, 18, and 24 hours in the PACU on a Visual Analog Scale (VAS; 0-10 cm) at rest. Patients received patient-controlled analgesia (fentanyl 1.0 mug/kg on each demand with lockout interval of 10 minutes); total fentanyl consumption during initial 24 hours was recorded. Data were entered into the statistical software package SPSS 9.0 for analysis (one-way analysis of variance and Student-Newman-Keuls test). Patients who received gabapentin 300 mg had significantly lower VAS score at all time points. They consumed less fentanyl (patients who received placebo processed 1217.5 +/- 182.0 versus 987.5 +/- 129.6 mug; P < 0.05). Patients who received gabapentin 600, 900, and 1200 mg had lower VAS scores at all time points than patients who received gabapentin 300 mg (P < 0.05). Increasing the dose of gabapentin from 600 to 1200 mg did not decrease the VAS score, nor did the increasing dose of gabapentin significantly decrease fentanyl consumption (702.5, 635, and 626.5 microg). Thus, gabapentin 600 mg is the optimal dose for postoperative pain relief following lumbar diskectomy.

Gabapentin decreases morphine consumption and improves functional recovery following total knee arthroplasty

“…Over the past eight years, many trials have examined the efficacy of GBP for the treatment of early postsurgical pain. The surgical populations studied include abdominal or pelvic surgery (9-16), musculoskeletal surgery (5,(17)(18)(19)(20)(21)(22)(23), head and neck surgery (24)(25)(26), breast surgery (27)(28)(29)(30), varicocele surgery (31) and thoracic surgery (32). Of these randomized controlled trials, most consisted of a single dose of GBP given before surgery.…”

“…The optimal preoperative dose of GBP has been evaluated in a dose-response study by Pandey et al (19), who randomly assigned patients undergoing lumbar discectomy to receive a one-time dose of placebo, or GBP 300 mg, 600 mg, 900 mg or 1200 mg preoperatively. The optimal dose was 600 mg; at higher doses (900 and 1200 mg), an analgesic ceiling effect was observed, in which patients exhibited more side effects with no additional reduction in pain.…”

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

“…Some studies suggest starting with a 300-mg dose for acute pain, although a preoperative dose of more than 600 mg was not effective at reducing postoperative pain [29]. We gave gabapentin 600 mg 2 h preoperatively and 300 mg for 3 nights postoperatively.…”

Gabapentin a pre-emptive analgesic in post-operative pain: a randomised double blind placebo controlled study

“…The authors also concluded that increasing the dose from 600 mg to 1200 mg did not result in further fall in pain score. 8 At the same time some studies did not find any benefit in using gabapentin in pain. A study done in patients undergoing laparoscopic cholecystectomy did not find 300 mg gabapentin given 1 hour before surgery to be useful in reducing pain.…”

“…8 All the above studies have found single dose of gabapentin given preoperatively to be effective in controlling post-operative pain up to a period of 24 hours, irrespective of its half-life which is approximately 8 hours. This finding has also been substantiated in the animal studies where gabapentin given before the injury, prevented development of hyperalgesia and tactile allodynia in a rat model of postoperative pain for a period of 2 days.…”