Effects of gabapentin on postoperative morphine consumption and pain after abdominal hysterectomy: a randomized, double-blind trial.
BACKGROUND
Preliminary clinical studies have suggested that gabapentin may produce analgesia and reduce the need for opioids in postoperative patients. The aim of the present study was to investigate the opioid-sparing and analgesic effects of gabapentin administered during the first 24 h after abdominal hysterectomy.


METHODS
In a randomized, double-blind study, 80 patients received oral gabapentin 1200 mg or placebo 1 h before surgery, followed by oral gabapentin 600 mg or placebo 8, 16 and 24 h after the initial dose. Patients received patient-controlled analgesia with morphine at doses of 2.5 mg with a lock-out time of 10 min for 24 h postoperatively. Pain was assessed on a visual analogue scale (VAS) at rest and during mobilization, nausea, somnolence and dizziness on a four-point verbal scale, and vomiting as present/not present at 2, 4, 22 and 24 h postoperatively.


RESULTS
Thirty-nine patients in the gabapentin group, and 32 patients in the placebo group completed the study. Gabapentin reduced total morphine consumption from median 63 (interquartile range 53-88) mg to 43 (28-60) mg (P < 0.001). We observed a significant inverse association between plasma levels of gabapentin at 2 h postoperatively, and morphine usage from 0 to 2 h, and from 0 to 4 h postoperatively (R2 = 0.30, P = 0.003 and R2 = 0.24 P = 0.008, respectively). No significant differences in pain at rest or during mobilization, or in side-effects, were observed between groups.


CONCLUSIONS
Gabapentin in a total dose of 3000 mg, administered before and during the first 24 h after abdominal hysterectomy, reduced morphine consumption with 32%, without significant effects on pain scores. No significant differences in side-effects were observed between study-groups.
Department of Anaesthesiology, Glostrup University Hospital, Glostrup, Denmark.
G
G
Dierking
T H
TH
Duedahl
M L
ML
Rasmussen
J S
JS
Fomsgaard
S
S
Møiniche
J
J
Rømsing
J B
JB
Dahl
D000085:Acetates / Q000097:blood / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000588:Amines; D016058:Analgesia, Patient-Controlled; D000700:Analgesics / Q000097:blood / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use*; D003509:Cyclohexanecarboxylic Acids; D004244:Dizziness / Q000209:etiology; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D000077206:Gabapentin; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage / Q000627:therapeutic use*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D010919:Placebos; D020250:Postoperative Nausea and Vomiting / Q000209:etiology; D011292:Premedication; D012894:Sleep Stages / Q000187:drug effects; D016896:Treatment Outcome; D005680:gamma-Aminobutyric Acid
D000085:Acetates; D000588:Amines; D000700:Analgesics; D000701:Analgesics, Opioid; D003509:Cyclohexanecarboxylic Acids; D010919:Placebos; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin; D009020:Morphine