Gabapentin prophylaxis for postoperative nausea and vomiting in abdominal surgeries: a quantitative analysis of evidence from randomized controlled clinical trials

Achuthan, S.; Singh, Inderjeet; Varthya, Shoban Babu; Srinivasan, Anand; Chakrabarti, Amitava; Hota, Debasish

doi:10.1093/bja/aeu449

Cited by 34 publications

(21 citation statements)

References 39 publications

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“…This is clinically meaningful when considering the report that the PONV symptoms can appear up to at least 72 h after discharge from PACU [38]. This finding might be explained in part by the possibility of long-lasting (> possibly 24 h) antiemetic effect of gabapentin [2]. Further clinical trials are required to address this issue.…”

Section: Discussionmentioning

confidence: 83%

“…A previous study by Achuthan et al [2] of the use of gabapentin in patients undergoing abdominal surgery demonstrated the differential antiemetic efficacy of gabapentin with respect to the use of propofol, either as an induction or maintenance agent. Preoperative gabapentin as pharmacotherapy for preventing PONV was effective when propofol was not used.…”

Section: Discussionmentioning

confidence: 99%

“…Although PONV is generally self-limited, it can cause rare but serious medical complications, such as aspiration of gastric contents, suture dehiscence, esophageal rupture, subcutaneous emphysema or pneumothorax [2], all of which can significantly increase overall health care costs [3, 4]. …”

Section: Introductionmentioning

confidence: 99%

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Combination of gabapentin and ramosetron for the prevention of postoperative nausea and vomiting after gynecologic laparoscopic surgery: a prospective randomized comparative study

et al. 2017

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BackgroundAs a drug originally introduced for its anticonvulsant effects, gabapentin has been recently shown to be effective in the treatment of nausea and vomiting in various clinical settings. This study compared the antiemetic efficacy of oral gabapentin, intravenous ramosetron and gabapentin plus ramosetron in patients receiving fentanyl-based patient-controlled analgesia after laparoscopic gynecologic surgery.MethodsOne hundred and thirty two patients undergoing laparoscopic gynecologic surgery under general anesthesia were allocated randomly into three groups: group G received 300 mg oral gabapentin 1 h before anesthesia, group R received 0.3 mg intravenous ramosetron at the end of surgery, and group GR received a combination of 300 mg oral gabapentin 1 h before anesthesia and 0.3 mg intravenous ramosetron at the end of surgery. Postoperative nausea, retching, vomiting, rescue antiemetic drug use, pain, rescue analgesic requirements and adverse effects were assessed at 0–2, 2–24 and 24–48 h after surgery. Postoperative nausea and vomiting (PONV) was defined as the presence of nausea, retching or vomiting.ResultsThe incidence of complete response (no PONV and no rescue antiemetics up to 48 h postoperatively) was significantly higher in group GR (26/40, 65%) than group G (16/40, 40%; P = 0.025) and group R (18/44, 41%; P = 0.027), whereas there was no significant difference between group G and group R (P = 0.932). There were no significant between-group differences in the incidence of emetic episodes, use of rescue antiemetics, severe emesis, use of rescue analgesics or any adverse effects. Postoperative pain scores were also similar among groups.ConclusionsThe combination with gabapentin and ramosetron is superior to either drug alone for prevention of PONV after laparoscopic gynecologic surgery.Trial registrationClinicalTrials.gov NCT02617121, registered November 25, 2015.

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Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 99%

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Combination of gabapentin and ramosetron for the prevention of postoperative nausea and vomiting after gynecologic laparoscopic surgery: a prospective randomized comparative study

et al. 2017

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“…The recent studies suggested that using oral gabapentin (an anticonvulsant) before surgery significantly reduced the incidence of postoperative nausea and vomiting after open cholecystectomy. [30–33] It has been suggested that antiemetic effect of gabapentin is caused by reducing the activity of tachykinin neurotransmitter. [2,9] Furthermore, vitamin B6 has been known to possess antiemetic effects since 1942.…”

Section: Discussionmentioning

confidence: 99%

The comparative preemptive analgesic efficacy of addition of vitamin B complex to gabapentin versus gabapentin alone in women undergoing cesarean section under spinal anesthesia

Khezri

Nasseh²,

Soltanian³

2017

Medicine

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Background:Development of new multimodal analgesic regimens have led to substantial improvement in postoperative pain relief. We designed this study to compare the effect of combined vitamin B complex—gabapentin versus gabapentin alone on postoperative pain in women undergoing cesarean section under spinal anesthesia.Methods:One hundred twenty-eight women who underwent cesarean section under spinal anesthesia were randomized to receive orally 300 mg gabapentin (group G) or 300 mg of gabapentin plus 2 vitamin B complex (group GB) tablets 30 minutes before surgery. Postoperative pain intensity and total analgesic consumption during 12 hours after surgery, vomiting, and drowsiness during recovery were assessed.Results:The pain intensity in the gabapentin plus vitamin B complex group was lower than gabapentin group during 12 hours after surgery (95% CI: 1.4–2.2; P < .001). Meanwhile, the total analgesic consumption in this group was less than gabapentin alone (95% CI: 1.07–1.24; P = 0.034). The incidence of vomiting in patients who receive combined gabapentin—vitamin B complex group was similar to gabapentin alone (P = .206). The difference of the distribution of the relative frequency of sedation according to Ramsay sedation scores in patients between 2 groups were insignificant (P = .82). All newborns in our study were free of any adverse effects.Conclusion:Addition of vitamin B complex to gabapentin reduced intensity of postoperative pain and also the total amount of analgesic consumption within the first 12 hours postoperative following cesarean section.

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“…7 A recent meta-analysis has also identified the benefits of gabapentin with regard to preoperative anxiety and chronic pain at the expense of an increase in sedation. 8 Over the last decade, randomized-controlled trials have been published indicating that gabapentin may also be useful in attenuating the hemodynamic response to intubation.…”

Section: Résumémentioning

confidence: 99%

Gabapentin for the hemodynamic response to intubation: systematic review and meta-analysis

Doleman

Sherwin

Lund

et al. 2016

Can J Anesth/J Can Anesth

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Purpose Endotracheal intubation is the gold standard for securing the airway before surgery. Nevertheless, this procedure can produce an activation of the sympathetic nervous system and result in a hemodynamic response which, in high-risk patients, may lead to cardiovascular instability and myocardial ischemia. The aim of this review was to evaluate whether gabapentin can attenuate this response and whether such an attenuation could translate into reduced myocardial ischemia and mortality. Source We searched MEDLINE Ò , EMBASE TM , CINAHL, AMED, and unpublished clinical trial databases for randomized-controlled trials that compared gabapentin with control, fentanyl, clonidine, or beta blockers for attenuating the hemodynamic response to intubation. Primary outcomes were mortality, myocardial infarction, and myocardial ischemia. Secondary outcomes were hemodynamic changes following intubation. Principal findings We included 29 randomized trials with only two studies at low risk of bias. No data were provided for the primary outcomes and no studies included high-risk patients. The use of gabapentin resulted in attenuation in the rise in mean arterial blood pressure [mean difference (MD), -12 mmHg; 95% confidence interval (CI), -17 to -8] and heart rate (MD, -8 beatsÁmin -1 ; 95% CI, -11 to -5) one minute after intubation. Gabapentin also reduced the risk of hypertension or tachycardia requiring treatment (risk ratio, 0.15; 95% CI, 0.05 to 0.48). Data were limited on adverse hemodynamic events such as bradycardia and hypotension. Conclusion It remains unknown whether gabapentin improves clinically relevant outcomes such as death and myocardial infarction since studies failed to report on these. Nevertheless, gabapentin attenuated increases in heart rate and blood pressure following intubation when compared with the control group. Even so, the studies included in this review were at potential risk of bias. Moreover, they did not include high-risk patients or report adverse hemodynamic outcomes. Future studies are required to address these limitations. RésuméObjectif L'intubation endotrachéale constitue l'étalon or de la prise en charge des voies aériennes avant une chirurgie. Toutefois, cette intervention peut entraîner une activation du système nerveux sympathique et provoquer une réponse hémodynamique qui, chez les patients courant un risque élevé, pourrait mener à une instabilité cardiovasculaire et une ischémie myocardique. L'objectif de ce compte rendu était d'examiner si la gabapentine pouvait atténuer cette réponse et si une telle atténuation pouvait se traduire en une réduction de l'ischémie myocardique et de la mortalité. Source Nous avons effectué des recherches dans les bases de données MEDLINE Ò , EMBASE TM , CINAHL, AMED, ainsi que dans les bases de données d'études cliniques non publiées afin d'en extraire les études randomisées contrô lées comparant la capacité de la gabapentine par rapport à un groupe témoin, au fentanyl, à la clonidine ou à des bêta-bloquants, à atténuer la réponse hémodynam...

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Gabapentin prophylaxis for postoperative nausea and vomiting in abdominal surgeries: a quantitative analysis of evidence from randomized controlled clinical trials

Abstract: The present analysis provides evidence supporting preoperative gabapentin as a pharmacotherapy for prevention of PONV in patients undergoing abdominal surgeries. Future studies comparing preoperative gabapentin with 5HT3 antagonists are needed to precisely define its role in PONV.

Cited by 34 publications

References 39 publications

Combination of gabapentin and ramosetron for the prevention of postoperative nausea and vomiting after gynecologic laparoscopic surgery: a prospective randomized comparative study

Combination of gabapentin and ramosetron for the prevention of postoperative nausea and vomiting after gynecologic laparoscopic surgery: a prospective randomized comparative study

The comparative preemptive analgesic efficacy of addition of vitamin B complex to gabapentin versus gabapentin alone in women undergoing cesarean section under spinal anesthesia

Gabapentin for the hemodynamic response to intubation: systematic review and meta-analysis

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