title: Comparison between the combination of gabapentin, ketamine, lornoxicam, and local ropivacaine and each of these drugs alone for pain after laparoscopic cholecystectomy: a randomized trial.
abstract: BACKGROUND
  The main purpose of the study was to test whether the combination of gabapentin (600 mg 4 hours before surgery, 600 mg after 24 hours), ketamine (0.3 mg/kg before anesthesia), lornoxicam (8 mg before anesthesia and 8 mg/12 hours), and local ropivacaine (5 mL 7.5% at insertion sites) provides superior analgesia to each of these drugs alone in the first 24 hours after laparoscopic cholecystectomy. The secondary purpose was to examine whether this combination has less opioid-related side effects.
  
  
  METHODS
  This was a 2-center randomized placebo-controlled trial. One hundred forty-eight patients, between 18 and 70 years of age, were randomly assigned to 6 groups (28 in each group) with the use of computer software: A(gabapentin/ketamine/lornoxicam/ropivacaine); B(gabapentin/placebo/placebo/placebo); C (placebo/ketamine/placebo/placebo); D (placebo/placebo/lornoxicam/placebo); E (placebo/placebo/placebo/ropivacaine); and F (placebo/placebo/placebo/placebo). Only the principal investigator was aware of patients' allocation and provided drugs and placebo in covered prefilled syringes. The primary outcome of the study was the 24-hour morphine consumption. Secondary outcomes were frequency of opioid-related side effects (nausea, vomiting, sedation, pruritus, and dysuria).
  
  
  RESULTS
  Only groups A (6.4 mg), B (9.46 mg), and D (9.36 mg) had lower morphine consumption than control group (20.29 mg) (P < 0.001, P = 0.01, and P = 0.008, respectively). Group A was not different from B and D (P = 0.92, P = 0.93). The only difference was in episodes of nausea between groups A (n = 5) and the control group (n = 12) (P = 0.018).
  
  
  CONCLUSIONS
  The combination of gabapentin, ketamine, lornoxicam, and local ropivacaine does not provide superior analgesia than gabapentin alone or lornoxicam alone after laparoscopic cholecystectomy. The combination reduces only the frequency of postoperative nausea, but larger studies are needed for safer results.
authors.affiliation: Department of Anesthesia and Intensive Care, 424 Military Hospital of Thessaloniki, Thessaloniki, Greece.
authors.forename: Georgios
authors.initials: G
authors.lastname: Kotsovolis
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Karakoulas
authors.forename: Vasileios
authors.initials: V
authors.lastname: Grosomanidis
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Tziris
mesh_terms: D000328:Adult; D000577:Amides / Q000008:administration & dosage*; D000588:Amines / Q000008:administration & dosage*; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D003509:Cyclohexanecarboxylic Acids / Q000008:administration & dosage*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D000077206:Gabapentin; D006801:Humans; D007649:Ketamine / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000379:methods; D010147:Pain Measurement / Q000187:drug effects / Q000379:methods; D010149:Postoperative Pain / Q000175:diagnosis / Q000188:drug therapy*; D010894:Piroxicam / Q000008:administration & dosage / Q000031:analogs & derivatives*; D000077212:Ropivacaine; D005680:gamma-Aminobutyric Acid / Q000008:administration & dosage*
chemical_list: D000577:Amides; D000588:Amines; D003509:Cyclohexanecarboxylic Acids; D010894:Piroxicam; D005680:gamma-Aminobutyric Acid; D007649:Ketamine; D000077206:Gabapentin; D000077212:Ropivacaine; C059451:lornoxicam
keywords: RCT; gabapentin; ketamine; laparoscopic surgery; lornoxicam; multimodal treatment; postoperative pain; randomized controlled trial; ropivacaine