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.
BACKGROUND
Hysterectomy and spinal surgery inpatient trials suggest favorable interactions between cyclooxgenase-2 inhibitors and gabapentin/pregabalin on postoperative days 1-2. We present the first trial of meloxicam-gabapentin combination after outpatient laparoscopic cholecystectomy.


METHODS
This was a randomized, double-blind trial comparing daily oral administration of 1) meloxicam 15 mg, 2) gabapentin 1200-1600 mg, and 3) a combination of the two starting 1 h before until 2 days after surgery. Primary outcomes included day of surgery spontaneous and movement-evoked pain. Secondary outcomes included pain on Days 1, 2, and 30, adverse effects, opioid consumption, spirometry, pain-related interference, hospital discharge time, return to work time, and patient satisfaction.


RESULTS
On the day of surgery, 60-min rest pain (0-10 numerical rating scale +/- sd) was significantly lower (P < 0.05) with gabapentin alone (2.0 +/- 1.6) versus meloxicam alone (3.6 +/- 2.1). Observed pain differences between the combination (2.9 +/- 2.1) and gabapentin alone were fairly small in favor of gabapentin alone (P > 0.05). Secondary analyses indicated that nausea was significantly less frequent with the combination (24%) versus the single-drug meloxicam (57%) only.


CONCLUSIONS
Although nausea was reduced with combination therapy, this trial provides little or no support for the combined use of meloxicam and gabapentin for pain relief on the day of surgery. This suggests that perioperative analgesic polypharmacy may not always be necessary or appropriate.
Gilron
Ian
I
Department of Anesthesiology, Kingston General Hospital, Ontario, Canada. gilroni@post.queensu.ca
Orr
Elizabeth
E
Tu
Dongsheng
D
Mercer
C Dale
CD
Bond
David
D
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000556:Ambulatory Surgical Procedures; D000588:Amines / Q000009:adverse effects / Q000627:therapeutic use*; D018712:Analgesics, Non-Narcotic / Q000009:adverse effects / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D017081:Cholecystectomy, Laparoscopic; D003509:Cyclohexanecarboxylic Acids / Q000009:adverse effects / Q000627:therapeutic use*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D000077206:Gabapentin; D006801:Humans; D008297:Male; D000077239:Meloxicam; D008875:Middle Aged; D009068:Movement; D010102:Oxygen Inhalation Therapy; D010147:Pain Measurement / Q000187:drug effects; D010149:Postoperative Pain / Q000517:prevention & control*; D017060:Patient Satisfaction; D013147:Spirometry; D013843:Thiazines / Q000627:therapeutic use*; D013844:Thiazoles / Q000627:therapeutic use*; D016896:Treatment Outcome; D055815:Young Adult; D005680:gamma-Aminobutyric Acid / Q000009:adverse effects / Q000627:therapeutic use*
D000588:Amines; D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D003509:Cyclohexanecarboxylic Acids; D013843:Thiazines; D013844:Thiazoles; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin; D000077239:Meloxicam