Preoperative Gabapentin for Acute Post-thoracotomy Analgesia

A Randomized, Double-Blinded, Active Placebo-Controlled Study

Michelle A O Kinney, Carlos Bernardo Mantilla, Paul E. Carns, Melissa A. Passe, Michael J. Brown, W. Michael Hooten, Timothy B Curry, Timothy R. Long, C. Thomas Wass, Peter R. Wilson, Toby N. Weingarten, Marc A. Huntoon, Richard H. Rho, William D. Mauck, Juan N. Pulido, Mark S. Allen, Stephen D. Cassivi, Claude Deschamps, Francis C. Nichols, K. Robert Shen & 5 others Dennis A Wigle, Sheila L. Hoehn, Sherry L. Alexander, Andrew C. Hanson, Darrell R. Schroeder

Research output: Contribution to journalArticle

46 Citations (Scopus)

Abstract

Background: The role of preoperative gabapentin in postoperative pain management is not clear, particularly in patients receiving regional blockade. Patients undergoing thoracotomy benefit from epidural analgesia but still may experience significant postoperative pain. We examined the effect of preoperative gabapentin in thoracotomy patients. Methods: Adults undergoing elective thoracotomy were enrolled in this prospective, randomized, double-blinded, placebo-controlled study, and randomly assigned to receive 600mg gabapentin or active placebo (12.5mg diphenhydramine) orally within 2hours preoperatively. Standardized management included thoracic epidural infusion, intravenous patient-controlled opioid analgesia, acetaminophen and ketorolac. Pain scores, opioid use and side effects were recorded for 48hours. Pain was also assessed at 3months. Results: One hundred twenty patients (63 placebo and 57 gabapentin) were studied. Pain scores did not significantly differ at any time point (P=0.53). Parenteral and oral opioid consumption was not significantly different between groups on postoperative day 1 or 2 (P>0.05 in both cases). The frequency of side effects such as nausea and vomiting or respiratory depression was not significantly different between groups, but gabapentin was associated with decreased frequency of pruritus requiring nalbuphine (14% gabapentin vs. 43% control group, P<0.001). The frequency of patients experiencing pain at 3months post-thoracotomy was also comparable between groups (70% gabapentin vs. 66% placebo group, P=0.72). Conclusions: A single preoperative oral dose of gabapentin (600mg) did not reduce pain scores or opioid consumption following elective thoracotomy, and did not confer any analgesic benefit in the setting of effective multimodal analgesia that included thoracic epidural infusion.

Original languageEnglish (US)
Pages (from-to)175-183
Number of pages9
JournalPain Practice
Volume12
Issue number3
DOIs
StatePublished - Mar 2012

Fingerprint

Thoracotomy
Analgesia
Placebos
Opioid Analgesics
Pain
Postoperative Pain
Thorax
Nalbuphine
Ketorolac
Diphenhydramine
Patient-Controlled Analgesia
Epidural Analgesia
gabapentin
Pain Management
Pruritus
Acetaminophen
Intravenous Infusions
Respiratory Insufficiency
Nausea
Vomiting

Keywords

  • Acute pain service
  • Gabapentin
  • Pain
  • Patient-controlled epidural analgesia
  • Post-thoracotomy pain
  • Postoperative
  • Preanesthetic medication

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Preoperative Gabapentin for Acute Post-thoracotomy Analgesia : A Randomized, Double-Blinded, Active Placebo-Controlled Study. / Kinney, Michelle A O; Mantilla, Carlos Bernardo; Carns, Paul E.; Passe, Melissa A.; Brown, Michael J.; Michael Hooten, W.; Curry, Timothy B; Long, Timothy R.; Thomas Wass, C.; Wilson, Peter R.; Weingarten, Toby N.; Huntoon, Marc A.; Rho, Richard H.; Mauck, William D.; Pulido, Juan N.; Allen, Mark S.; Cassivi, Stephen D.; Deschamps, Claude; Nichols, Francis C.; Robert Shen, K.; Wigle, Dennis A; Hoehn, Sheila L.; Alexander, Sherry L.; Hanson, Andrew C.; Schroeder, Darrell R.

In: Pain Practice, Vol. 12, No. 3, 03.2012, p. 175-183.

Research output: Contribution to journalArticle

Kinney, MAO, Mantilla, CB, Carns, PE, Passe, MA, Brown, MJ, Michael Hooten, W, Curry, TB, Long, TR, Thomas Wass, C, Wilson, PR, Weingarten, TN, Huntoon, MA, Rho, RH, Mauck, WD, Pulido, JN, Allen, MS, Cassivi, SD, Deschamps, C, Nichols, FC, Robert Shen, K, Wigle, DA, Hoehn, SL, Alexander, SL, Hanson, AC & Schroeder, DR 2012, 'Preoperative Gabapentin for Acute Post-thoracotomy Analgesia: A Randomized, Double-Blinded, Active Placebo-Controlled Study', Pain Practice, vol. 12, no. 3, pp. 175-183. https://doi.org/10.1111/j.1533-2500.2011.00480.x
Kinney, Michelle A O ; Mantilla, Carlos Bernardo ; Carns, Paul E. ; Passe, Melissa A. ; Brown, Michael J. ; Michael Hooten, W. ; Curry, Timothy B ; Long, Timothy R. ; Thomas Wass, C. ; Wilson, Peter R. ; Weingarten, Toby N. ; Huntoon, Marc A. ; Rho, Richard H. ; Mauck, William D. ; Pulido, Juan N. ; Allen, Mark S. ; Cassivi, Stephen D. ; Deschamps, Claude ; Nichols, Francis C. ; Robert Shen, K. ; Wigle, Dennis A ; Hoehn, Sheila L. ; Alexander, Sherry L. ; Hanson, Andrew C. ; Schroeder, Darrell R. / Preoperative Gabapentin for Acute Post-thoracotomy Analgesia : A Randomized, Double-Blinded, Active Placebo-Controlled Study. In: Pain Practice. 2012 ; Vol. 12, No. 3. pp. 175-183.
@article{16eb4e2303a04b0d8c028ce81f40d496,
title = "Preoperative Gabapentin for Acute Post-thoracotomy Analgesia: A Randomized, Double-Blinded, Active Placebo-Controlled Study",
abstract = "Background: The role of preoperative gabapentin in postoperative pain management is not clear, particularly in patients receiving regional blockade. Patients undergoing thoracotomy benefit from epidural analgesia but still may experience significant postoperative pain. We examined the effect of preoperative gabapentin in thoracotomy patients. Methods: Adults undergoing elective thoracotomy were enrolled in this prospective, randomized, double-blinded, placebo-controlled study, and randomly assigned to receive 600mg gabapentin or active placebo (12.5mg diphenhydramine) orally within 2hours preoperatively. Standardized management included thoracic epidural infusion, intravenous patient-controlled opioid analgesia, acetaminophen and ketorolac. Pain scores, opioid use and side effects were recorded for 48hours. Pain was also assessed at 3months. Results: One hundred twenty patients (63 placebo and 57 gabapentin) were studied. Pain scores did not significantly differ at any time point (P=0.53). Parenteral and oral opioid consumption was not significantly different between groups on postoperative day 1 or 2 (P>0.05 in both cases). The frequency of side effects such as nausea and vomiting or respiratory depression was not significantly different between groups, but gabapentin was associated with decreased frequency of pruritus requiring nalbuphine (14{\%} gabapentin vs. 43{\%} control group, P<0.001). The frequency of patients experiencing pain at 3months post-thoracotomy was also comparable between groups (70{\%} gabapentin vs. 66{\%} placebo group, P=0.72). Conclusions: A single preoperative oral dose of gabapentin (600mg) did not reduce pain scores or opioid consumption following elective thoracotomy, and did not confer any analgesic benefit in the setting of effective multimodal analgesia that included thoracic epidural infusion.",
keywords = "Acute pain service, Gabapentin, Pain, Patient-controlled epidural analgesia, Post-thoracotomy pain, Postoperative, Preanesthetic medication",
author = "Kinney, {Michelle A O} and Mantilla, {Carlos Bernardo} and Carns, {Paul E.} and Passe, {Melissa A.} and Brown, {Michael J.} and {Michael Hooten}, W. and Curry, {Timothy B} and Long, {Timothy R.} and {Thomas Wass}, C. and Wilson, {Peter R.} and Weingarten, {Toby N.} and Huntoon, {Marc A.} and Rho, {Richard H.} and Mauck, {William D.} and Pulido, {Juan N.} and Allen, {Mark S.} and Cassivi, {Stephen D.} and Claude Deschamps and Nichols, {Francis C.} and {Robert Shen}, K. and Wigle, {Dennis A} and Hoehn, {Sheila L.} and Alexander, {Sherry L.} and Hanson, {Andrew C.} and Schroeder, {Darrell R.}",
year = "2012",
month = "3",
doi = "10.1111/j.1533-2500.2011.00480.x",
language = "English (US)",
volume = "12",
pages = "175--183",
journal = "Pain Practice",
issn = "1530-7085",
publisher = "Wiley-Blackwell",
number = "3",

}

TY - JOUR

T1 - Preoperative Gabapentin for Acute Post-thoracotomy Analgesia

T2 - A Randomized, Double-Blinded, Active Placebo-Controlled Study

AU - Kinney, Michelle A O

AU - Mantilla, Carlos Bernardo

AU - Carns, Paul E.

AU - Passe, Melissa A.

AU - Brown, Michael J.

AU - Michael Hooten, W.

AU - Curry, Timothy B

AU - Long, Timothy R.

AU - Thomas Wass, C.

AU - Wilson, Peter R.

AU - Weingarten, Toby N.

AU - Huntoon, Marc A.

AU - Rho, Richard H.

AU - Mauck, William D.

AU - Pulido, Juan N.

AU - Allen, Mark S.

AU - Cassivi, Stephen D.

AU - Deschamps, Claude

AU - Nichols, Francis C.

AU - Robert Shen, K.

AU - Wigle, Dennis A

AU - Hoehn, Sheila L.

AU - Alexander, Sherry L.

AU - Hanson, Andrew C.

AU - Schroeder, Darrell R.

PY - 2012/3

Y1 - 2012/3

N2 - Background: The role of preoperative gabapentin in postoperative pain management is not clear, particularly in patients receiving regional blockade. Patients undergoing thoracotomy benefit from epidural analgesia but still may experience significant postoperative pain. We examined the effect of preoperative gabapentin in thoracotomy patients. Methods: Adults undergoing elective thoracotomy were enrolled in this prospective, randomized, double-blinded, placebo-controlled study, and randomly assigned to receive 600mg gabapentin or active placebo (12.5mg diphenhydramine) orally within 2hours preoperatively. Standardized management included thoracic epidural infusion, intravenous patient-controlled opioid analgesia, acetaminophen and ketorolac. Pain scores, opioid use and side effects were recorded for 48hours. Pain was also assessed at 3months. Results: One hundred twenty patients (63 placebo and 57 gabapentin) were studied. Pain scores did not significantly differ at any time point (P=0.53). Parenteral and oral opioid consumption was not significantly different between groups on postoperative day 1 or 2 (P>0.05 in both cases). The frequency of side effects such as nausea and vomiting or respiratory depression was not significantly different between groups, but gabapentin was associated with decreased frequency of pruritus requiring nalbuphine (14% gabapentin vs. 43% control group, P<0.001). The frequency of patients experiencing pain at 3months post-thoracotomy was also comparable between groups (70% gabapentin vs. 66% placebo group, P=0.72). Conclusions: A single preoperative oral dose of gabapentin (600mg) did not reduce pain scores or opioid consumption following elective thoracotomy, and did not confer any analgesic benefit in the setting of effective multimodal analgesia that included thoracic epidural infusion.

AB - Background: The role of preoperative gabapentin in postoperative pain management is not clear, particularly in patients receiving regional blockade. Patients undergoing thoracotomy benefit from epidural analgesia but still may experience significant postoperative pain. We examined the effect of preoperative gabapentin in thoracotomy patients. Methods: Adults undergoing elective thoracotomy were enrolled in this prospective, randomized, double-blinded, placebo-controlled study, and randomly assigned to receive 600mg gabapentin or active placebo (12.5mg diphenhydramine) orally within 2hours preoperatively. Standardized management included thoracic epidural infusion, intravenous patient-controlled opioid analgesia, acetaminophen and ketorolac. Pain scores, opioid use and side effects were recorded for 48hours. Pain was also assessed at 3months. Results: One hundred twenty patients (63 placebo and 57 gabapentin) were studied. Pain scores did not significantly differ at any time point (P=0.53). Parenteral and oral opioid consumption was not significantly different between groups on postoperative day 1 or 2 (P>0.05 in both cases). The frequency of side effects such as nausea and vomiting or respiratory depression was not significantly different between groups, but gabapentin was associated with decreased frequency of pruritus requiring nalbuphine (14% gabapentin vs. 43% control group, P<0.001). The frequency of patients experiencing pain at 3months post-thoracotomy was also comparable between groups (70% gabapentin vs. 66% placebo group, P=0.72). Conclusions: A single preoperative oral dose of gabapentin (600mg) did not reduce pain scores or opioid consumption following elective thoracotomy, and did not confer any analgesic benefit in the setting of effective multimodal analgesia that included thoracic epidural infusion.

KW - Acute pain service

KW - Gabapentin

KW - Pain

KW - Patient-controlled epidural analgesia

KW - Post-thoracotomy pain

KW - Postoperative

KW - Preanesthetic medication

UR - http://www.scopus.com/inward/record.url?scp=84858006580&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84858006580&partnerID=8YFLogxK

U2 - 10.1111/j.1533-2500.2011.00480.x

DO - 10.1111/j.1533-2500.2011.00480.x

M3 - Article

VL - 12

SP - 175

EP - 183

JO - Pain Practice

JF - Pain Practice

SN - 1530-7085

IS - 3

ER -