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

Clarke, Hance; Pereira, S.; Kennedy, Deborah; Gilron, Ian; Katz, J; Gollish, Jeffrey; Kày, J. M.

doi:10.1016/j.acpain.2009.10.008

Cited by 30 publications

(56 citation statements)

References 51 publications

(84 reference statements)

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“…We identified two trials comparing multimodal analgesic regimens to placebo in the published literature, both of which demonstrated positive preventive effects at 3 months [72] and the other at 1 year [73] following surgery. Multimodal pain regimens that include gabapentin, NSAIDs, acetaminophen, and regional anesthesia were effective in controlling perioperative pain and decreasing perioperative opioid use following arthroplasty surgery [74,75]. The literature has highlighted the need for studies focused on multimodal analgesic protocols for colorectal [76], thoracic, amputation, mastectomy [77], orthopaedic [37], and liver resection surgeries [65].…”

Section: Multimodal Analgesiamentioning

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: Multimodal Analgesiamentioning

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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“…22 Gabapentin is a 3-alkylated analogue of gamma-amino butyric acid (GABA) that has been shown to be effective in reducing pain scores and opioid consumption in a number of surgical settings. [23][24][25][26] Also, when used in combination with a COX-2 inhibitor, gabapentin has been shown to have specific efficacy in reducing pain evoked by movement and respiration after surgery. 9 Furthermore, gabapentin, both alone and in combination with a COX-2 inhibitor, led to improvement in indices of pulmonary function during the recovery period after abdominal surgery.…”

Section: Discussionmentioning

confidence: 99%

Cardiopulmonary bypass does not affect plasma concentration of preoperatively administered gabapentin

Parlow

Gilron

Milne

et al. 2010

Can J Anesth/J Can Anesth

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Purpose Drug effects can be unpredictable during cardiac surgery due to factors that may influence drug concentration, such as extracorporeal oxygenation and hemodilution. The primary aim of the current investigation was to determine whether plasma gabapentin concentration is altered by cardiopulmonary bypass (CPB). Methods Following approval from the Research Ethics Board and written informed consent, we conducted this open-label prospective cohort investigation. A convenience sample of 16 patients, who were scheduled for coronary bypass surgery, received oral gabapentin 600 mg as follows: 90 min prior to induction of anesthesia, following tracheal extubation, and then every eight hours for a total of four doses. Plasma gabapentin concentration, as well as pain and sedation scores, were documented. Results Plasma gabapentin concentrations were unaltered during CPB (31.9 ± 12.7 lmolÁL -1 prior to CPB, 35.6 ± 12.9 to 37.2 ± 9.6 lmolÁL -1 during CPB). However, using the current protocol, drug accumulation (reflected by increased drug concentrations) was observed following the third (58.2 ± 19.5 lmolÁL -1 ) and the fourth (71.9 ± 34.3 lmolÁL -1 ) doses. Pain and sedation scores and opioid requirements were comparable with those found in other studies. Conclusion Plasma gabapentin concentration is unaltered during CPB following preoperative administration.

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“…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].…”

Section: Discussionmentioning

confidence: 99%

“…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].…”

Section: Discussionmentioning

confidence: 99%

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

Khuvtsagaan

Lundeg

2017

Anesth Pain Med

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

Cited by 30 publications

References 51 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

Cardiopulmonary bypass does not affect plasma concentration of preoperatively administered gabapentin

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

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