Gabapentin Attenuates Late but Not Early Postoperative Pain After Thyroidectomy with Superficial Cervical Plexus Block

Brogly, N.; Wattier, Jean-Michel; Andrieu, Guillaume P.; Peres, Daliana; Robin, Emmanuel; Kipnis, Éric; Arnalsteen, Laurent; Thielemans, Béatrice; Carnaille, B.; Pattou, François; Vallet, B.; Lebuffe, Gilles

doi:10.1213/ane.0b013e318185cf73

Cited by 78 publications

(85 citation statements)

References 26 publications

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“…Although the conclusion from Chaparro et al was that that gabapentin does not reduce the incidence of CPSP, the small sample size of the studies limits these interpretations, especially when considering that these results derive from heterogeneous surgical procedures. Brogly et al [28] found that 1200 mg of gabapentin administered before surgery reduced chronic but not early acute postoperative pain following superficial cervical plexus block [28]. The lack of standardized gabapentin doses between studies may have contributed to inconsistencies in the drug's efficacy at reducing the incidence and severity of CPSP.…”

Section: Gabapentinmentioning

confidence: 99%

Preventive Analgesia and Novel Strategies for the Prevention of Chronic Post-Surgical Pain

Clarke

Poon

Weinrib

et al. 2015

Drugs

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Chronic post-surgical pain (CPSP) is a serious complication of major surgery that can impair a patient's quality of life. The development of CPSP is a complex process which involves biologic, psychosocial, and environmental mechanisms that have yet to be fully understood. Currently perioperative pharmacologic interventions aim to suppress and prevent sensitization with the aim of reducing pain and analgesic requirement in acute as well as long-term pain . Despite the detrimental effects of CPSP on patients, the body of literature focused on treatment strategies to reduce CPSP remains limited and continues to be understudied. This article reviews the main pharmacologic candidates for the treatment of CPSP, discusses the future of preventive analgesia, and considers novel strategies to help treat acute postoperative pain and lessen the risk that it becomes chronic. In addition, this article highlights important areas of focus for clinical practice including: multimodal management of CPSP patients, psychological modifiers of the pain experience, and the development of a Transitional Pain Service specifically designed to manage patients at high risk of developing chronic post-surgical pain. Key PointsThe development of chronic post-surgical pain (CPSP) is a complex process which involves biologic, psychosocial, and environmental mechanisms.Ketamine (an NMDA antagonist) appears to be the pharmacologic agent with the most consistent positive preventive analgesic results.The variation in patient response to pharmacologic agents can be explained, in part, by genetic polymorphisms.Understanding the heritability of CPSP will be useful when developing predictive algorithms to determine the preoperative risk for developing CPSP.Psychological treatments delivered before and after surgery have the potential to influence the trajectory of CPSP from the earliest days, in combination with multimodal, preventive analgesia.

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Section: Gabapentinmentioning

confidence: 99%

Preventive Analgesia and Novel Strategies for the Prevention of Chronic Post-Surgical Pain

Clarke

Poon

Weinrib

et al. 2015

Drugs

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“…All the RCTs administered pre-emptive gabapentin or its combination with other analgesic drugs. Thirteen of all presented RCTs evaluated pre (10 RCTs) [50,52,54,56,58,61,63,64,67,68] and both pre/post-operative (3 RCTs) [48,49,59] doses of GBP alone vs placebo patients. Eight RCTs studied gabapentin in confront with other analgesics (dexamethasone, lornoxicam, celecoxib, rofecoxib, acetaminophen, clonidine); five of them used only pre-emptive analgesia [53,55,57,62,65] and 3 considered both pre and post-operative mixture administration [47,51,66].…”

Section: Gabapentin Rctsmentioning

confidence: 99%

“…No studies established the optimal post surgical GBP treatment duration. Pain assessment has been performed using a Visual Analogue Scale (VAS) in 18 RCTs [48,50,[52][53][54][55][56][57][58][59][60][61][62][63][64][65][66][67], meanwhile three studies used a 11-point [47,49] or 4-point [51] Verbal Rating Scale (VRS). One study did not consider pain evaluation but only postoperative PCA fentanyl consump-tion, focusing the attention to the anti-emetic gabapentin effects [68].…”

Section: Gabapentin Rctsmentioning

confidence: 99%

Gabapentin and Pregabalin for the Acute Post-operative Pain Management. A Systematic-narrative Review of the Recent Clinical Evidences

Dauri¹,

Faria

Gatti³

et al. 2009

CDT

143

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Background: Gabapentin and pregabalin inhibit Ca 2+ currents via high-voltage-activated channels containing the 2 -1 subunit, reducing neurotransmitter release and attenuating the postsynaptic excitability. They are antiepileptic drugs successfully used also for the chronic pain treatment. A large number of clinical trials indicate that gabapentin and pregabalin could be effective as postoperative analgesics. This systematic-narrative review aims to analyse the most recent evidences regarding the effect of gabapentinoids on postoperative pain treatment.Methods: Medline, The Cochrane Library, EMBASE and CINHAL were searched for recent (2006)(2007)(2008)(2009) randomized clinical trials (RCTs) of gabapentin-pregabalin for postoperative pain relief in adults. Quality of RCTs was evaluated according to Jadad method. Visual analogue scale (VAS), opioid consumption and side-effects (nausea, vomiting, dizziness and sedation) were considered the most important outcomes.Results: An overall of 22 gabapentin (1640 patients), 8 pregabalin (707 patients) RCTs and seven meta-analysis were involved in this review. Gabapentin provided better post-operative analgesia and rescue analgesics sparing than placebo in 6 of the 10 RCTs that administered only pre-emptive analgesia. Fourteen RCTs suggested that gabapentin did not reduce PONV when compared with placebo, clonidine or lornoxicam. Pregabalin provided better post-operative analgesia and rescue analgesics sparing than placebo in two of the three RCTs that evaluated the effects of pregabalin alone vs placebo. Four studies reported no pregabalin effects on preventing the PONV. Conclusion:Gabapentin and pregabalin reduce pain and opioid consumption after surgery in confront with placebo, but comparisons with other standard post-operative regimens are not sufficient. Gabapentin and pregabalin seem not to have any influence on the prevention of PONV.

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“…17 The current report only assessed patients until six months of follow-up. However, evaluation after six months would most likely not find any differences in POCP, given that the pain intensity was already mild in both groups at six months.…”

Section: Resultsmentioning

confidence: 99%

Effect of preoperative gabapentin on pain intensity and development of chronic pain after carpal tunnel syndrome surgical treatment in women: randomized, double-blind, placebo-controlled study

et al. 2016

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Effect of preoperative gabapentin on pain intensity and development of chronic pain after carpal tunnel syndrome surgical treatment in women: randomized, double-blind, placebo-controlled study Efeito da gabapentina pré-operatória na intensidade da dor e desenvolvimento de dor crônica após o tratamento cirúrgico da síndrome do túnel do carpo em mulheres: estudo randomizado duplo-cego controlado com placebo METHODS: Forty patients aged 18 years or over were randomized into two groups: Gabapentin Group received 600 mg of gabapentin preoperatively, one hour prior to surgery, and Control Group received placebo. All the patients received intravenous regional anesthesia comprising 1% lidocaine. Midazolam was used for sedation if needed. Paracetamol was administered for postoperative analgesia as needed. Codeine was used additionally if the paracetamol was insufficient. The following were evaluated: postoperative pain intensity (over a six-month period), incidence of postoperative neuropathic pain (over a sixmonth period), need for intraoperative sedation, and use of postoperative paracetamol and codeine. The presence of neuropathic pain was established using the DN4 (Douleur Neuropathique 4) questionnaire. Complex regional pain syndrome was diagnosed using the Budapest questionnaire. RESULTS: No differences in the need for sedation, control over postoperative pain or incidence of chronic pain syndromes (neuropathic or complex regional pain syndrome) were observed. No differences in postoperative paracetamol and codeine consumption were observed. CONCLUSIONS: Preoperative gabapentin (600 mg) did not improve postoperative pain control, and did not reduce the incidence of chronic pain among patients undergoing carpal tunnel syndrome surgery. RESUMO CONTEXTO E OBJETIVOS:Analgesia pós-operatória eficaz é importante para reduzir a incidência de dor crônica. Este estudo avaliou o efeito da gabapentina pré-operatória na analgesia pós-operatória e na incidência de dor crônica em pacientes submetidos à cirurgia para tratamento da síndrome do túnel do carpo. DESENHO E LOCAL: Randomizado, duplo cego, Universidade Federal de São Paulo. MÉTODOS: Os 40 pacientes com 18 anos ou mais de idade foram distribuídos aleatoriamente em dois grupos: o Grupo Gabapentina recebeu 600 mg de gabapentina no pré-operatório uma hora antes da cirurgia, e o Grupo Controle recebeu placebo. Todos os pacientes receberam anestesia regional intravenosa com lidocaína a 1%. Midazolam foi utilizado para sedação, se necessário. Paracetamol foi administrado para analgesia pós-operatória, conforme necessário, e codeína, se o paracetamol fosse insuficiente. Foram avaliados: a intensidade da dor pós-operatória (durante seis meses), a incidência de dor neuropática pós-operatória (durante seis meses), a necessidade de sedação intra-operatória e o uso de paracetamol e codeína no pós-operatório. A presença de dor neuropática foi estabelecida utilizando-se o questionário DN4 (dor neuropática 4). Síndrome de dor regional complexa foi diagnosticada através do questionário ...

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Gabapentin Attenuates Late but Not Early Postoperative Pain After Thyroidectomy with Superficial Cervical Plexus Block

Abstract: Oral preoperative administration of gabapentin did not modify immediate pain management in thyroidectomy patients receiving SCPB, but prevented delayed neuropathic pain at 6 mo.

Cited by 78 publications

References 26 publications

Preventive Analgesia and Novel Strategies for the Prevention of Chronic Post-Surgical Pain

Preventive Analgesia and Novel Strategies for the Prevention of Chronic Post-Surgical Pain

Gabapentin and Pregabalin for the Acute Post-operative Pain Management. A Systematic-narrative Review of the Recent Clinical Evidences

Effect of preoperative gabapentin on pain intensity and development of chronic pain after carpal tunnel syndrome surgical treatment in women: randomized, double-blind, placebo-controlled study

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