Comparison Effect of Pre-Emptive Gabapentin and Oxycodone on Pain After Abdominal Hysterectomy: A Double Blind Randomized Clinical Trial
AbstractGabapentin is popular analgesic adjuvants for improving postoperative pain management. The aim of this study was to compare the preventive effects of pre-emptive oxycodone and gabapentin on acute pain after elective abdominal hysterectomy. One hundred patients undergoing abdominal hysterectomy were randomly assigned to oxycodone group received 10 mg of oxycodone and gabapentin group received 10 mg of gabapentin 1 hour before surgery. The anesthetic technique was standardized, and the postoperative assessments included the amount of meperidine consumption, PONV and VAS for postoperative pain at arrival to recovery, 6, 12 and 24 h after surgery. Bleeding loss assessed during surgery. Postoperative pain scores were significantly lower in the gabapentin group compared with the oxycodone group. (P=0.0001) The total meperidine used in the gabapentin group was significantly less than in the oxycodone group. Postoperative nausea and vomiting (PONV) and blood loss during surgery were significantly decreased in gabapentin group. Based on the results of this study, Pre-emptive use of gabapentin 1200 mg orally, significantly decreases postoperative pain and PONV, rescues analgesic requirements and also bleeding loss during surgery in patients who undergo abdominal hysterectomy. Significant side effects were not observed.
Kehlet H, Jensen TS, Woolf CJ. Persistent postsurgical pain: risk factors and prevention. Lancet 2006;367:1618–25.
Turan A, Karamanlioglu B, Memi D, Usar P, Pamukcu Z, Ture M. The analgesic effects of gabapentin after total abdominal hysterectomy. Anesth Analg 2004;98:1370-3.
De Cosmo G, Aceto P, Gualtieri E, Congedo E. Analgesia in thoracic surgery: review. Minerva Anestesiol 2008;75:393–400.
Kehlet H, Dahl JB. Anaesthesia, surgery, and challenges in postoperative recovery. Lancet 2003;362:1921–1928.
De Beer Jde V, Winemaker MJ, Donnelly GA et al. EYcacy and safety of controlled-released oxycodone and standard therapies for postoperative pain after knee or hip replacement. Can J Surg 2005;48(4):277–283
Recart A, Duchene D, White PF et al. EYcacy and safety of fast-track recovery strategy for patients undergoing laparoscopic nephrectomy. J Endourol 2005;19(10):1165–1169
Watcha MF, Issioui T, Klein KW et al. Costs and eVectiveness of refocoxibe, celecoxib and acetaminophen for preventing pain after ambulatory otolaryngologic surgery. Anesth Analg 2003;96(4):987–994
Qin N, Yagel S, Momplaisir ML, Codd EE, D’Andrea MR. Molecular cloning and characterization of the human voltagegated calcium channel alpha(2)delta-4 subunit. Mol Pharmacol 2002;62:485–96
Hurley RW, Cohen SP, Williams KA et al. The analgesic eVects of perioperative gabapentin on postoperative pain. Reg Anesth Pain Med 2006;31(3):237–247
Gupta A, Perniola A, Axelsson K et al. Postoperative Pain After Abdominal Hysterectomy: A Double-Blind Comparison Between Placebo and Local Anesthetic Infused Intraperitoneally. Anesth Analg 2004;99(4):1173–1179
Sen H, Sizlan A, Yanarates O et al. A comparison of gabapentin and ketamine in acute and chronic pain after hysterectomy. Anesth Analg 2009;109(5):1645–1650.
Moore A, Costello J, Wieczorek P et al. Gabapentin improves postcesarean delivery pain management: A randomized placebo controlled trial. Anesth Analg 2011;112(1):167–173.
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 Sep;4(3):137-41.
Kong VKF, Irwin MG. Gabapentin: a multimodal perioperative drug? Br J Anaest 2007;99(6):775–786.
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 Mar;53(3):268-73.
Sutton KG, Martin DJ, Pinnock RD, Lee K, Scott RH. Gabapentin inhibits high-threshold calcium channel currents in cultured rat dorsal root ganglion neurones. Br J Pharmacol. 2002 Jan;135(1):257-65.
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 Mar;51(3):299-304.
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 Jun;26(5):381-5.
Dierking G, Duedahl TH, Rasmussen ML, Fomsgaard JS, Møiniche S, Rømsing J, Dahl JB. Effects of gabapentin on postoperative morphine consumption and pain after abdominal hysterectomy: a randomized, double-blind trial. Acta Anaesthesiol Scand. 2004 Mar;48(3):322-7.
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 Jul;17(3):125-8.
Cohen MM, Duncan PG, DeBoer DP, Tweed WA. The postoperative interview: assessing risk factors for nausea and vomiting. Anesth Analg 1994;78:7–16.
Comstock TJ, Sica DA, Bockbrader HN et al. Gabapentin pharmacokinetics in subjects with various degrees of renal function. J Clin Pharmacol 1990;30:862.
Myles PS, Williams DL, Hendrata M, Anderson H, Weeks AM Patient satisfaction after anaesthesia and surgery: results of a prospective survey of 10811 patients. Br J Anaesth 2000;84:6–10