The Analgesic Effect of Gabapentin and Mexiletine After Breast Surgery for Cancer

Fassoulaki, Argyro; Patris, Konstantinos; Sarantopoulos, Constantine; Hogan, Quinn H.

doi:10.1213/00000539-200210000-00036

Cited by 213 publications

(86 citation statements)

References 17 publications

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“…In a randomized, placebo-controlled trial, the incidence of CPSP and pain scores did not differ between study arms. Similarly, in their second trial comparing mexiletine to gabapentin and placebo, no significant difference was found between trial groups [64]. Within the past year, an additional five studies have been published evaluating the use of local anesthetics for CPSP [12][13][14][15][16].…”

Section: Local Anestheticsmentioning

confidence: 99%

“…Utilizing different classes of medication to target different peripheral and CNS mechanisms to reduce acute pain, reducing opioid analgesic requirements postoperatively and improving opioid related side effects has been shown to be successful in clinical trials [60,64]. However, RCTs that examine specific surgery-related multimodal regimens versus placebo and follow patients for preventive analgesic effects (i.e., 3 months or greater following surgery) are limited.…”

Section: Multimodal Analgesiamentioning

confidence: 99%

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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: Local Anestheticsmentioning

confidence: 99%

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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“…Both drugs, in earlier clinical trials, have been used as a preemptive analgesic and found to be safe and effective. [3][4][5]12,13 The preemptive administration of gabapentin and tramadol approximately two hours before surgery appears rational in order to attain maximal plasma concentrations at the time of surgical stimuli. It has also been demonstrated that a single dose of 600 mg of gabapentin added to 60 mg slow release morphine increases pain tolerance to the cold pressure test in humans.…”

Section: Objectifmentioning

confidence: 99%

“…12 Although gabapentin has been used in the treatment of neuropathic pain syndromes, it has also demonstrated potent antihyperalgesic proprieties in preclinical and clinical studies, without affecting acute nociception. 5,6,[12][13][14][15][16] In experimental studies gabapentin suppressed experimentally induced hyperalgesia and its intrathecal administration reduced tactile allodynia after incision. Gabapentin enhanced pain behaviour in rats after formalin-induced pain and reduced mechanical hyperalgesia in a rat model of postoperative pain.…”

Section: Méthodementioning

confidence: 99%

“…1,2 Gabapentin and tramadol both have demonstrated analgesic effects in clinical trials as a preemptive analgesic and in acute postoperative pain management; however experience with gabapentin is limited. [3][4][5][6] We investigated whether preemptive use of gabapentin 300 mg and tramadol 100 mg orally could reduce postoperative pain and fentanyl consumption in the initial 24 hr after laparoscopic cholecystectomy. We used a small dose of gabapentin (300 mg) as its bioavailability is 60% and decreases with increasing doses.…”

mentioning

confidence: 99%

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L’usage préventif de gabapentine diminue significativement la douleur postopératoire et les besoins d’analgésique de secours lors d’une cholécystectomie laparoscopique

Pandey

Priye

Singh

et al. 2004

Can J Anesth/J Can Anesth

192

150

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P Pu ur rp po os se e: : To evaluate the comparative preemptive effects of gabapentin and tramadol on postoperative pain and fentanyl requirement in laparoscopic cholecystectomy.M Me et th ho od ds s: : Four hundred fifty-nine ASA I and II patients were randomly assigned to receive 300 mg gabapentin, 100 mg tramadol or placebo in a double-blind manner two hours before laparoscopic cholecystectomy under general anesthesia. Postoperatively, patients' pain scores were recorded on a visual analogue scale every two hours for the initial 12 hr and thereafter every three hours for the next 12 hr. Patients received fentanyl 2 µg·kg -1 intravenously on demand. The total fentanyl consumption for each patient was recorded.R Re es su ul lt ts s: : Patients in the gabapentin group had significantly lower pain scores at all time intervals (2.65 ± 3.00, 1.99 ± 1.48, 1.40 ± 0.95, 0.65 ± 0.61) in comparison to tramadol (2.97 ± 2.35, 2.37 ± 1.45, 1.89 ± 1.16, 0.87 ± 0.50) and placebo (5.53 ± 2.22, 3.33 ± 1.37, 2.41 ± 1.19, 1.19 ± 0.56). Significantly less fentanyl was consumed in the gabapentin group (221.16 ± 52.39 µg) than in the tramadol (269.60 ± 44.17 µg) and placebo groups (355.86 ± 42.04 µg; P < 0.05). Sedation (33.98%), nausea/retching/vomiting (24.8%) were the commonest side effects in the gabapentin group whereas respiratory depression (3.9%) was the commonest in the tramadol group and vertigo (7.8%) in the placebo group. C Co on nc cl lu us si io on n: : Preemptive use of gabapentin significantly decreases postoperative pain and rescue analgesic requirement in laparoscopic cholecystectomy. (2,65 ± 3,00; 1,99 ± 1,48; 1,40 ± 0,95; 0,65 ± 0,61) que ceux du groupe tramadol (2,97 ± 2,35; 2,37 ± 1,45; 1,89 ± 1,16; 0,87 ± 0,50) ou placebo (5,53 ± 2,22; 3,33 ± 1,37; 2,41 ± 1,19; 1,19 ± 0,56). La demande de fentanyl a été significativement plus basse avec la gabapentine (221,16 ± 52,39 µg) qu'avec le tramadol (269,60 ± 44,17 µg) ou le placebo (355,86 ± 42,04 µg; P < 0,05). La sédation (33,98 %), les nausées/haut-lecoeur/vomissements (24,8 %) ERIPHERAL tissue injury provokes peripheral sensitization (a reduction in the threshold of nociceptor afferent peripheral terminals) and central sensitization (an activity dependent increase in the excitability of spinal neurons). 1,2 These changes contribute to the postinjury pain hypersensitivity state which manifests as an increase in the responsiveness to noxious stimuli and a decrease in the pain threshold, both at the site of injury and in the surrounding uninjured tissue. 1,2 The optimal form of treatment is that applied pre, intra and postoperatively to preempt the establishment of pain hypersensitivity during and after surgery. The preemptive treatment could be directed at the periphery, at inputs along sensory axons, and at central neurons. Different treatment regimens could be used at different times relative to surgery to maximize the prevention of pain in response to different levels of sensory inputs. 1,2 Gabapentin and tramadol both have demonstrated analgesic effect...

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Systemic administration of local anesthetic agents to relieve neuropathic pain

Challapalli¹,

Tremont‐Lukats

McNicol

et al. 2005

Cochrane Database of Systematic Reviews

148

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The Analgesic Effect of Gabapentin and Mexiletine After Breast Surgery for Cancer

Cited by 213 publications

References 17 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

L’usage préventif de gabapentine diminue significativement la douleur postopératoire et les besoins d’analgésique de secours lors d’une cholécystectomie laparoscopique

Systemic administration of local anesthetic agents to relieve neuropathic pain

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