title: Gabapentin is ineffective as an analgesic adjunct in the immediate postburn period.
abstract: Successful treatment of burn pain requires a multimodality approach. Although opioid agents are the mainstay, other nonopioid agents, such as anticonvulsants, are frequently employed for pain control, with unknown benefits. The authors sought to determine the efficacy of gabapentin in acute burn pain management. Patients admitted to the burn center with burns more than 5% total body surface area and expected length of stay more than 48 hours were randomized and prospectively enrolled in this double-blind, placebo-controlled study from February 2010 to September 2011. Drug escalation and titration were done by protocol. Pain was assessed by unit protocol with the Numeric Rating Scale. Neuropathic pain and anxiety were recorded at least biweekly. Psychosocial adjustment was assessed at follow-up. Opioid medications were converted to morphine equivalents. Differences between pain levels and opioid consumption were analyzed between groups with the Student's t-test and χ test, respectively. The study was designed to detect a difference of 22% in opioid use between the two study groups with an enrollment of 50 patients with α of 0.05 and β of 80%. P < .5 was considered significant. Fifty-three patients consented for the study and received the loading dose. Four patients withdrew. Both an intention-to-treat and actual treatment analysis were performed on all 53 patients. The placebo and drug populations were well matched for demographic variables, body surface area burned, and need for surgical intervention. The average length of stay was 11 ± 6.8 days and did not vary between groups. The study drug group received 10.8 ± 0.67 days of study drug, with eight patients receiving a dosage of 300 mg thrice daily (TID), 24 receiving 600 mg TID, 14 receiving 800 mg TID, and seven receiving 1200 mg TID. The incidence of neuropathic pain was 39% in the study drug arm and 38% in the placebo group. Neither pain scores (rest and procedural) nor opioid consumption differed between the groups. Forty-three patients (81.1%) were assessed at their first clinic visit. There was no difference in psychosocial functioning in either treatment group. In this randomized, double-blind, placebo-controlled study, the use of gabapentin in acute burn pain management did not decrease pain scores or lessen opioid requirements. Further research into nonopioid alternatives for burn pain analgesia is needed.
authors.affiliation: From the Departments of *Surgery and †Anesthesiology, University of Iowa Hospitals and Clinics; and ‡Department of Pain Management, Cleveland Clinic, Ohio.
authors.forename: Lucy
authors.initials: L
authors.lastname: Wibbenmeyer
authors.forename: Anas
authors.initials: A
authors.lastname: Eid
authors.forename: Junlin
authors.initials: J
authors.lastname: Liao
authors.forename: Jason
authors.initials: J
authors.lastname: Heard
authors.forename: Aaron
authors.initials: A
authors.lastname: Horsfield
authors.forename: Lee
authors.initials: L
authors.lastname: Kral
authors.forename: Pat
authors.initials: P
authors.lastname: Kealey
authors.forename: Richard
authors.initials: R
authors.lastname: Rosenquist
mesh_terms: D000328:Adult; D000588:Amines / Q000008:administration & dosage / Q000627:therapeutic use*; D000700:Analgesics / Q000008:administration & dosage / Q000627:therapeutic use*; D002053:Burn Units; D002056:Burns / Q000150:complications*; D003509:Cyclohexanecarboxylic Acids / Q000008:administration & dosage / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D000077206:Gabapentin; D006801:Humans; D008297:Male; D010146:Pain / Q000188:drug therapy* / Q000209:etiology*; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D010919:Placebos; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D005680:gamma-Aminobutyric Acid / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D000588:Amines; D000700:Analgesics; D003509:Cyclohexanecarboxylic Acids; D010919:Placebos; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin