Gabapentin: An Alternative to the Cyclooxygenase-2 Inhibitors for Perioperative Pain Management

Abstract

The cyclooxygenase-2 inhibitor, rofecoxib, was a popular analgesic adjuvant for improving perioperative pain management. We designed this placebo-controlled study to test the hypothesis that gabapentin could produce similar reductions in postoperative pain and opioid analgesic usage, thereby improving the recovery process. One hundred patients undergoing abdominal hysterectomy procedures were randomly assigned to one of four treatment groups: 1) control group received placebo capsules and pills before and for 2 days after surgery, 2) rofecoxib group received 50 mg/d PO and placebo capsules before and after surgery and, 3) gabapentin group received 1.2 g/d PO and placebo pills before and after surgery, and 4) combination group received rofecoxib 50 mg/d and gabapentin 1.2 g/d PO before and after surgery. The anesthetic technique was standardized and the postoperative assessments included verbal rating scales for pain and sedation, IV morphine usage, quality of recovery assessment, recovery of bowel function, resumption of normal activities, and patient satisfaction with their pain management. Postoperative pain scores were significantly reduced in all three analgesic treatment groups (versus control group). Compared with the control group, patient-controlled analgesia morphine usage was also significantly reduced in the 3 analgesic treatment groups at 1, 8, 24, and 30 h after surgery. Total PCA morphine usage was decreased by 43%, 24%, and 50% in groups 2, 3, and 4, respectively, compared with group 1. Oral analgesic consumption was also smaller in groups 2 and 4 when compared with the control group. The opioid-sparing effects of rofecoxib and gabapentin lead to a faster recovery of bowel function. Discharge eligibility scores in groups 2 and 4 were improved at 24 h when compared with group 1, and patient satisfaction with postoperative pain management was significantly higher at 24 h in all 3 analgesic treatment groups. At the 72 h follow-up, all of the patients in group 4 were completely satisfied with their pain management compared with only 32%, 64%, and 72% in groups 1, 2, and 3, respectively. Gabapentin (1.2 g/d PO) appears to be an acceptable alternative to rofecoxib (50 mg/d PO) for short-term use as an adjuvant to opioid analgesics in patients undergoing lower abdominal surgery.

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

“…Much more work needs to be done with regard to the optimal dosing of GBP in various surgical populations and this medication's efficacy at treating postoperative pain beyond the immediate 24 h or 48 h. Because many of the GBP trials published to this point have demonstrated a significant reduction in movementevoked pain (5,11,14,16,24,27,29), we hypothesized that continuing GBP into the rehabilitation period would lead to decreased pain during rehabilitation treatments and improved functional recovery (ie, a greater range of motion).…”

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

“…16 In a comparitive study of rofecoxib (50mg), gabapentin (1200mg), combination (rofecoxib 50mg+ gabapentin1200mg) and a placebo, a reduction in fentanyl and acetaminophen consumption was found in the gabapentin group as compared to a placebo. 17 From this study it was concluded that gabapentin 1200 mg/day was similar to rofecoxib (50mg/day) in improving pain control and decreasing opioid consumption.…”

Hysterectomy: Advances in Perioperative Care

“…It should also be noted that dexamethasone at 8 mg dose given before surgery causes significant hyperglycaemia within the first six postoperative hours (Eberhart, 2011). The value of gabapentin and pregabalin are confirmed in studies published after the Prospect review and may in fact also lead to faster recovery of bowel function (Turan, 2006;Durmus, 2007). The combination of gabapentin and a cox-2 inhibitor seems to be superior to either single agent for postoperative pain, as well as improvements in mood and sleep quality (Gilron, 2005).…”