Active Ingredient: Gabapentin
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Nortriptyline and gabapentin, alone and in combination for neuropathic pain: a double-blind, randomised controlled crossover trial.
Ann Intern Med. Evid Based Med.
Standard perioperative pain management often relies on opioids as the primary pain medication, but they are relatively ineffective for severe movement-associated pain, and are associated with significant side effects such as nausea, vomiting, sedation, pruritus, constipation, urinary retention and respiratory depression 4.
The preoperative use of gabapentin GBP, a nonopioid medication, has been shown to be effective in reducing opioid use and accelerating functional recovery for 48 h after anterior cruciate ligament repair 5. GBP, a structural analogue of gamma-amino butyric acid, has been used as an anticonvulsant and antinociceptive drug.
GBP is effective for neuropathic pain, diabetic neuropathy, postherpetic neuralgia and reflex sympathetic dystrophy 7.
GBP has antihyperalgesic actions that selectively affect central sensitization 8. Over the past eight years, many trials have examined the efficacy of GBP for the treatment of early postsurgical pain.
The surgical populations studied include abdominal or pelvic surgery 9 — 16, musculoskeletal surgery 5, 17 — 23, head and neck surgery 24 — 26, breast surgery 27 — 30, varicocele surgery 31 and thoracic surgery 32.
Of these randomized controlled trials, most consisted of a single dose of GBP given before surgery. Only four of the above trials failed to demonstrate a decrease in pain scores or an opioid-sparing effect in the early postsurgical period 10, 17, 18, 21.
The optimal preoperative dose of GBP has been evaluated in a dose-response study by Pandey et al 19, who randomly assigned patients undergoing lumbar discectomy to receive a one-time dose of placebo, or GBP 300 mg, 600 mg, 900 mg or 1200 mg preoperatively.
The optimal dose was 600 mg; at higher doses 900 and 1200 mg, an analgesic ceiling effect was observed, in which patients exhibited more side effects with no additional reduction in pain.