1 Obstetrics & Gynecology Department, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
2 Public Health Department, Faculty of Medicine, University of Exeter, Exeter, United Kingdom
Aims: Pain is the main concern after surgery. Gabapentin was recently suggested as a pain killer to be used after various surgeries. The purpose of the present study was to evaluate the effects of gabapentin on pain relief and need for opiates after total abdominal hysterectomy.
Materials & Methods: This randomized double-blind placebo-controlled clinical trial was performed on 85 women who underwent total abdominal hysterectomy from March 2014 to March 2016 in Akbarabadi teaching hospital and Firoozgar teaching hospital in Tehran, Iran. Samples were selected using consecutive sampling method and were randomly assigned into the 2 groups. In case group (n=44) gabapentin (800mg) was orally administered one hour before surgery and in the placebo group (n=41) placebo which was similar to gabapentin administered. The pain score was assessed in 2, 6, 12 and 24 hours after surgery. Nausea and vomiting were also compared between the 2 groups. Data were analyzed by SPSS 19 software using statistical tests.
Findings: The two groups did not have significant differences according to pain score in the recovery room (point 0). Mean score of pain was lower in the case group in 2, 6, 12 and 24 hours after surgery (p=0.005). Meperidine (pethidine) use was less in the case group (p=0.003). There was no difference between the 2 groups for nausea and vomiting.
Conclusion: Using gabapentin before surgery can lower the pain after surgery and reduces the need for opiates. However, it doesn’t have an effect on nausea and vomiting.
- Mathiesen O, Møiniche S, Dahl JB. Gabapentin and postoperative pain: A qualitative and quantitative systematic review, with focus on procedure. BMC Anesthesiol. 2007;7:6. [DOI:10.1186/1471-2253-7-6] [PMID]
- Dirks J, Fredensborg BB, Christensen D, Fomsgaard JS, Flyger H, Dahl JB. A randomized study of the effects of single-dose gabapentin versus placebo on postoperative pain and morphine consumption after mastectomy. Anesthesiology. 2002;97(3):560-4. [DOI:10.1097/00000542-200209000-00007] [PMID]
- Gilron I, Biederman J, Jhamandas K, Hong M. Gabapentin blocks and reverses antinociceptive morphine tolerance in the rat paw-pressure and tail-flick tests. Anesthesiology. 2003;98(5):1288-92. [DOI:10.1097/00000542-200305000-00037] [PMID]
- Parikh HG, Dash SK, Upasani CB. Study of the effect of oral gabapentin used as preemptive analgesia to attenuate post-operative pain in patients undergoing abdominal surgery under general anesthesia. Saudi J Anaesth. 2010;4(3):137-41. [DOI:10.4103/1658-354X.71409] [PMID]
- Turan A, Karamanlioğlu B, Memiş D, Usar P, Pamukçu Z, Türe M. The analgesic effects of gabapentin after total abdominal hysterectomy. Anesth Analg. 2004;98(5):1370-3. [DOI:10.1213/01.ANE.0000108964.70485.B2] [PMID]
- Gilron I, Orr E, Tu D, Mercer CD, Bond D. A randomized, double-blind, controlled trial of perioperative administration of gabapentin, meloxicam and their combination for spontaneous and movement-evoked pain after ambulatory laparoscopic cholecystectomy. Anesth Analg. 2009;108(2):623-30. [DOI:10.1213/ane.0b013e318193cd1b] [PMID]
- Fassoulaki A, Stamatakis E, Petropoulos G, Siafaka I, Hassiakos D, Sarantopoulos C. Gabapentin attenuates late but not acute pain after abdominal hysterectomy. Eur J Anaesthesiol. 2006;23(2):136-41. [DOI:10.1017/S0265021505002048] [PMID]
- Pandey CK, Priye S, Singh S, Singh U, Singh RB, Singh PK. Preemptive use of gabapentin significantly decreases postoperative pain and rescue analgesic requirements in laparoscopic cholecystectomy. Can J Anaesth. 2004;51(4):358-63. [DOI:10.1007/BF03018240] [PMID]
- Mahoori A, Noroozinia H, Hasani E, Hosainzadeh S. The effect of pre-operative administration of gabapentin on post-operative pain relief after herniorrhaphy. Saudi J Anaesth. 2014;8(2):220-3. [DOI:10.4103/1658-354X.130722] [PMID]
- Amr YM, Yousef AA. Evaluation of efficacy of the perioperative administration of Venlafaxine or gabapentin on acute and chronic postmastectomy pain. Clin J Pain. 2010;26(5):381-5. [DOI:10.1097/AJP.0b013e3181cb406e] [PMID]
- Pandey CK, Navkar DV, Giri PJ, Raza M, Behari S, Singh RB, et al. Evaluation of the optimal preemptive dose of gabapentin for postoperative pain relief after lumbar diskectomy: A randomized, double-blind, placebo-controlled study. J Neurosurg Anesthesiol. 2005;17(2):65-8. [DOI:10.1097/01.ana.0000151407.62650.51] [PMID]
- Radhakrishnan M, Bithal PK, Chaturvedi A. Effect of preemptive gabapentin on postoperative pain relief and morphine consumption following lumbar laminectomy and discectomy: A randomized, double-blinded, placebo-controlled study. J Neurosurg Anesthesiol. 2005;17(3):125-8. [DOI:10.1097/01.ana.0000167147.90544.ab] [PMID]
- Sekhavat L, Zare F, Mojibian M. The Postoperative analgesic effects of low-dose gabapentin in patients undergoing abdominal hysterectomy. South Afr J Obstet Gynaecol. 2009;15(1):37-40.
- Bartholdy J, Hilsted KL, Hjortsoe NC, Engbaek J, Dahl JB. Effect of Gabapentin on morphine demand and pain after laparoscopic sterilization using Filshie clips. A double blind randomized clinical trial. BMC Anesthesiol. 2006;6:12. [DOI:10.1186/1471-2253-6-12] [PMID]
- Al-Mujadi H, A-Refai AR, Katzarov MG, Dehrab NA, Batra YK, Al-Qattan AR. Preemptive gabapentin reduces postoperative pain and opioid demand following thyroid surgery. Can J Anaesth. 2006;53(3):268-73. [DOI:10.1007/BF03022214] [PMID]
- Ménigaux C, Adam F, Guignard B, Sessler DI, Chauvin M. Preoperative gabapentin decreases anxiety and improves early functional recovery from knee surgery. Anesth Analg. 2005;100(5):1394-9. [DOI:10.1213/01.ANE.0000152010.74739.B8] [PMID]
- Turan A, White PF, Karamanlioglu B, Pamukçu Z. Premedication with gabapentin: The effect on tourniquet pain and quality of intravenous regional anesthesia. Anesth Analg, 2007;104(1):97-101. [DOI:10.1213/01.ane.0000250408.56586.88] [PMID]
- Rorarius MG, Mennander S, Suominen P, Rintala S, Puura A, Pirhonen R, et al. Gabapentin for the prevention of postoperative pain after vaginal hysterectomy. Pain. 2004;110(1-2):175-81. [DOI:10.1016/j.pain.2004.03.023] [PMID]
- Turan A, White PF, Karamanlioglu B, Memis D, Tasdogan M, et al. Gabapentin: An alternative to the cyclooxygenase-2 inhibitors for perioperative pain management. Anesth Analg. 2006;102(1):175-81. [DOI:10.1213/01.ane.0000184824.43411.63] [PMID]
- Durmus M, Kadir But A, Saricicek V, Ilksen Toprak H, Ozcan Ersoy M. The post-operative analgesic effects of a combination of gabapentin and paracetamol in patients undergoing abdominal hysterectomy: A randomized clinical trial. Acta Anaesthesiol Scand. 2007;51(3):299-304. [DOI:10.1111/j.1399-6576.2006.01237.x] [PMID]
- Eckhardt K, Ammon S, Hofmann U, Riebe A, Gugeler N, Mikus G. Gabapentin enhances the analgesic effect of morphine in healthy volunteers. Anesth Analg. 2000;91(1):185-91. https://doi.org/10.1213/00000539-200007000-00035 [DOI:10.1097/00000539-200007000-00035]
- Doleman B, Heinink TP, Read DJ, Faleiro RJ, Lund JN, Williams JP. A systematic review and meta-regression analysis of prophylactic gabapentin for postoperative pain. Anaesthesia. 2015;70(10):1186-204. [DOI:10.1111/anae.13179] [PMID]
- Tuncer S, Bariskaner H, Reisli R, Sarkilar G, Cicekci F, Otelcioglu S. Effect of gabapentin on postoperative pain: A randomized, placebo-controlled clinical study. The pain clinic. 2005;17(1):95-9. [DOI:10.1163/1568569053421645]
- Sen H, Sizlan A, Yanarates O, Emirkadi H, Ozkan S, et al. A comparison of gabapentin and ketamine in acute and chronic pain after hysterectomy. Anesth Analg. 2009;109(5):1645-50. [DOI:10.1213/ANE.0b013e3181b65ea0] [PMID]
- Sutton KG, Martin DJ, Pinnock RD, Lee K, Scott RH. Gabapentin inhibits high-threshold calcium channel currents in cultured rat dorsal root ganglion neurons. Br J Pharmacol. 2002;135(1):257-65. [DOI:10.1038/sj.bjp.0704439] [PMID]
- Kehlet H, Dahl JB. Anaesthesia, surgery, and challenges in postoperative recovery. Lancet. 2003;362(9399):1921-8. [DOI:10.1016/S0140-6736(03)14966-5]
- Alayed N, Alghanaim N, Tan X, Tulandi T. Preemptive use of gabapentin in abdominal hysterectomy: A systematic review and meta-analysis. Obstet Gynecol. 2014;123(6):1221-9. [DOI:10.1097/AOG.0000000000000289] [PMID]
- Dierking G, Duedahl TH, Rasmussen ML, Fomsgaard JS, Møiniche S, et al. Effects of gabapentin on postoperative morphine consumption and pain after abdominal hysterectomy: A randomized, double-blind trial. Acta Anaesthesiol Scand. 2004;48(3):322-7. [DOI:10.1111/j.0001-5172.2004.0329.x] [PMID]
- Adam F, Ménigaux C, Sessler DI, Chauvin M. A single preoperative dose of gabapentin (800 milligrams) does not augment postoperative analgesia in patients given interscalene brachial plexus blocks for arthroscopic shoulder surgery. Anesth Analg. 2006;103(5):1278-82. [DOI:10.1213/01.ane.0000237300.78508.f1] [PMID]
- Adam F, Bordenave L, Sessler DI, Chauvin M. Effects of a single 1200-mg preoperative dose of gabapentin on anxiety and memory. Ann Fr Anesth Reanim. 2012;31(10):e223-7. [DOI:10.1016/j.annfar.2012.05.006] [PMID]
- Achuthan S, Singh I, Varthya SB, Srinivasan A, Chakrabarti A, Hota D. Gabapentin prophylaxis for postoperative nausea and vomiting in abdominal surgeries: A quantitative analysis of evidence from randomized controlled clinical trials. Br J Anaesth. 2015;114(4):588-97. [DOI:10.1093/bja/aeu449] [PMID]