Gabapentin and postoperative pain: a qualitative and quantitative systematic review, with focus on procedure

Abstract

Background: Gabapentin is an antiepileptic drug used in a variety of chronic pain conditions. Increasing numbers of randomized trials indicate that gabapentin is effective as a postoperative analgesic. This procedure-specific systematic review aims to analyse the 24-hour postoperative effect of gabapentin on acute pain in adults.

Effects of gabapentin on cocaine self-administration, cocaine-triggered relapse and cocaine-enhanced nucleus accumbens dopamine in rats

“…It may be argued that such direct comparisons between a single animal dose and multiple human doses may be inaccurate or inappropriate. However, we point out that although the doses used in the present study are higher than the majority of doses reported in the literature for controlling pain and seizures (see review by Mathiesen et al, 2007), such high doses of gabapentin still had no effect on cocaine self-administration and cocainetriggered reinstatement in experimental animals, and thus may be taken as an a forteriori demonstration of lack of effect.…”

“…Third, by conversion of animal doses to human equivalent doses (i.e., rat dose in mg/ kg × 0.16, as recommended by the U.S. Department of Health and Human Services, Food and Drug Administration, Center for Drug Evaluation and Research) (U.S. Department of Health and Human Services, 2005), the doses (25-200 mg/kg) of gabapentin we used in the present study in rats are equivalent to 4-30 mg/kg in humans. This is equivalent to the daily effective doses used for relieving pain (300-1200 mg/day, ≈5-20 mg/kg based on average body weight of 60 kg) (Mathiesen et al, 2007) or for controlling partial seizures (300-1800 mg/day, ≈5-30 mg/kg/day) (Morris, 1999) or for cocaine use (600-2400 mg/day, ≈10-40 mg/kg/day) in other clinical trials (Hart et al, 2004;Myrick et al, 2001;Raby, 2000;Raby and Coomaraswamy, 2004). It may be argued that such direct comparisons between a single animal dose and multiple human doses may be inaccurate or inappropriate.…”

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

“…There is evidence that gabapentin safely reduces the VAS pain score, increases patient satisfaction and decreases postoperative nausea, vomiting and pruritus [6][7][8][9][10][11]17]. Gabapentin has been used to treat postoperative acute and chronic pain following major lower limb surgery [7,[18][19][20][21].…”

“…Recent postoperative pain treatment methods include several analgesic drugs with different mechanisms of action [3]. Gabapentin is primarily used as an anticonvulsant, but many studies have demonstrated that it also has antihyperalgesic effects [6][7][8][9][10][11]. Presurgical treatment with gabapentin may prevent abnormal pain responses such as hyperalgesia and allodynia and it reduced acetic acid-induced visceral nociception in animal studies [13,14].…”

“…It is effective for neuropathic pain, such as diabetic neuropathy and postherpetic neuralgia [4,5]. post-surgical pain management [6][7][8][9][10][11]. However, a recent study suggested that gabapentin cannot prevent acute postoperative pain in TKA [12].…”