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 600 mg gabapentin or active placebo (12.5 mg diphenhydramine) orally within 2 hours 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 48 hours. Pain was also assessed at 3 months.
  
  
  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 3 months post-thoracotomy was also comparable between groups (70% gabapentin vs. 66% placebo group, P = 0.72).
  
  
  CONCLUSIONS
  A single preoperative oral dose of gabapentin (600 mg) 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.
authors.affiliation: Department of Anesthesiology, College of Medicine Mayo Clinic, Rochester, Minnesota, USA. kinney.michelle@mayo.edu
authors.forename: Michelle A O
authors.initials: MA
authors.lastname: Kinney
authors.forename: Carlos B
authors.initials: CB
authors.lastname: Mantilla
authors.forename: Paul E
authors.initials: PE
authors.lastname: Carns
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Passe
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Brown
authors.forename: W Michael
authors.initials: WM
authors.lastname: Hooten
authors.forename: Timothy B
authors.initials: TB
authors.lastname: Curry
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Long
authors.forename: C Thomas
authors.initials: CT
authors.lastname: Wass
authors.forename: Peter R
authors.initials: PR
authors.lastname: Wilson
authors.forename: Toby N
authors.initials: TN
authors.lastname: Weingarten
authors.forename: Marc A
authors.initials: MA
authors.lastname: Huntoon
authors.forename: Richard H
authors.initials: RH
authors.lastname: Rho
authors.forename: William D
authors.initials: WD
authors.lastname: Mauck
authors.forename: Juan N
authors.initials: JN
authors.lastname: Pulido
authors.forename: Mark S
authors.initials: MS
authors.lastname: Allen
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Cassivi
authors.forename: Claude
authors.initials: C
authors.lastname: Deschamps
authors.forename: Francis C
authors.initials: FC
authors.lastname: Nichols
authors.forename: K Robert
authors.initials: KR
authors.lastname: Shen
authors.forename: Dennis A
authors.initials: DA
authors.lastname: Wigle
authors.forename: Sheila L
authors.initials: SL
authors.lastname: Hoehn
authors.forename: Sherry L
authors.initials: SL
authors.lastname: Alexander
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Hanson
authors.forename: Darrell R
authors.initials: DR
authors.lastname: Schroeder
mesh_terms: D000368:Aged; D000588:Amines / Q000009:adverse effects / Q000627:therapeutic use*; D000700:Analgesics / Q000009:adverse effects / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000767:Anesthesia, Epidural; D003509:Cyclohexanecarboxylic Acids / Q000009:adverse effects / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D000077206:Gabapentin; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy* / Q000517:prevention & control*; D013908:Thoracotomy; D005680:gamma-Aminobutyric Acid / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D000588:Amines; D000700:Analgesics; D000701:Analgesics, Opioid; D003509:Cyclohexanecarboxylic Acids; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin