‘Protective premedication’: an option with gabapentin and related drugs?

Abstract

Substantial progress has been made during the last decades in our understanding of acute pain mechanisms, and this knowledge has encouraged the search for novel treatments. Of particular interest has been the observation that tissue injury initiates a number of modulations of both the peripheral and the central pain pathways, which convert the system from a 'physiological' to a 'pathological' mode of processing afferent information. Gabapentin, which binds to the alpha(2)delta subunit of the voltage-dependent calcium channel, is active in animal models of 'pathological' but not in models of 'physiological' pain. Consequently, attention has so far been focused on neuropathic pain as a target for the clinical use of gabapentin and analogues. Recently, several reports have indicated that gabapentin may have a place in the treatment of post-operative pain. This article presents a brief summary of the potential mechanisms of post-operative pain, and a systematic review of the available data of gabapentin and pregabalin for post-operative analgesia. It is concluded that the results with gabapentin and pregabalin in post-operative pain treatment published so far are promising. It is suggested that future studies should explore the effects of 'protective premedication' with combinations of various antihyperanalgesic and analgesic drugs for post-operative analgesia.

Eficacia analgésica de una dosis única de dexametasona perineural en el bloqueo ecoguiado del nervio femoral en cirugía de prótesis total de rodilla

“…A pesar de los resultados esperanzadores obtenidos con la gabapentina y la pregabalina, no podemos recomendarlas para el postoperatorio de la PTR por la escasa evidencia que hay en este tipo de cirugía (Recomendación D, Evidencia 4) 81,82 .…”

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

“…9,30 Common lidocaine-related side effects (e.g. metallic taste, oral paresthesia and tinnitus) were also not increased through using gabapentin.…”

“…6,7 Gabapentin is known to reduce dorsal horn neuron excitability and central sensitization through various mechanisms. [8][9][10] A review of the literature suggested that the incidence of postoperative chronic pain was reduced through using gabapentin perioperatively. 11 However, a study on a single preoperative 300 or 600 mg dose of gabapentin prior to caesarean section did not show any improvement in pain control.…”

A Comparative Study of Effect of Intravenous Lidocaine Infusion, Gabapentin and Their Combination on Postoperative Analgesia after Thyroid Surgery

“…Although both IV lidocaine infusion [13] lower VAS values and reduced postoperative analgesic consumption, but some studies and meta-analyses showed contrasting results regarding the analgesic effect of lidocaine [25] and gabapentin due to differences in used doses and used regimens or time of application [21]- [27] with the need of more researches to specify the actual value of both drugs for providing sufficient analgesia in various surgical procedures.…”