title: Randomized controlled trial of gabapentin as an adjunct to perioperative analgesia in total hip arthroplasty patients.
abstract: OBJECTIVE
  Gabapentin was investigated as a single-dose adjunct to morphine for postoperative pain management. The primary objective was to determine if gabapentin given preoperatively and for two days postoperatively as part of multimodal analgesia would decrease postoperative morphine consumption in patients undergoing primary total hip arthroplasty (THA).
  
  
  METHODS
  The study group included 102 patients aged 19-90 years who were undergoing primary THA in a single joint with no contraindications to the study medications, no chronic pain syndrome, and no chronic opioid use. Intervention group patients (n = 48) received gabapentin 600 mg po preoperatively and 200 mg postoperatively on the day of surgery. They were continued on gabapentin at 200 mg three times daily for two days. Control group patients (n = 54) received placebo in a similar fashion. Preoperatively, all patients were given 30 mg of ketorolac intravenously and acetaminophen 1000 mg po. Postoperatively, they received intravenous patient-controlled analgesia with morphine, along with ketorolac 15 mg iv and acetaminophen 1000 mg po every six hours.
  
  
  RESULTS
  The primary outcome was mean (SD) postoperative morphine consumption at 72 hr which was 55.8 (39.2) mg in the gabapentin groups vs 60.7 (37.2) mg for the control group (mean difference, -4.91 mg, 95% confidence intervals [CI]: -21.2 to 11.35; P = 0.550). There were no significant differences between the groups regarding secondary outcomes: pain scores, side effects, range of motion. Patient satisfaction on day 3 was more favourable in the placebo group. Length of hospitalization was marginally shorter in the placebo group.
  
  
  CONCLUSIONS
  This trial indicated that gabapentin treatment had no clinically important reduction in postoperative morphine consumption at 72 hr in patients undergoing THA. Multimodal analgesia may account for the similar primary and secondary outcomes found in the groups. This trial was registered at ClinicalTrials.gov, number: NCT01307202.
authors.affiliation: Department of Anesthesia (HSC-2V2), McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada, paulj@mcmaster.ca.
authors.forename: James E
authors.initials: JE
authors.lastname: Paul
authors.forename: Manyat
authors.initials: M
authors.lastname: Nantha-Aree
authors.forename: Norman
authors.initials: N
authors.lastname: Buckley
authors.forename: Uswa
authors.initials: U
authors.lastname: Shahzad
authors.forename: Ji
authors.initials: J
authors.lastname: Cheng
authors.forename: Lehana
authors.initials: L
authors.lastname: Thabane
authors.forename: Antonella
authors.initials: A
authors.lastname: Tidy
authors.forename: Justin
authors.initials: J
authors.lastname: DeBeer
authors.forename: Mitchell
authors.initials: M
authors.lastname: Winemaker
authors.forename: David
authors.initials: D
authors.lastname: Wismer
authors.forename: Dinshaw
authors.initials: D
authors.lastname: Punthakee
authors.forename: Victoria
authors.initials: V
authors.lastname: Avram
mesh_terms: D000082:Acetaminophen / Q000008:administration & dosage / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000588:Amines / Q000008:administration & dosage* / Q000627:therapeutic use; D016058:Analgesia, Patient-Controlled / Q000379:methods; D000700:Analgesics / Q000008:administration & dosage* / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D003509:Cyclohexanecarboxylic Acids / Q000008:administration & dosage* / Q000627:therapeutic use; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D000077206:Gabapentin; D006801:Humans; D020910:Ketorolac / Q000008:administration & dosage / Q000627:therapeutic use; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage / Q000627:therapeutic use; D010149:Postoperative Pain / Q000188:drug therapy*; D055815:Young Adult; D005680:gamma-Aminobutyric Acid / Q000008:administration & dosage* / Q000627:therapeutic use
chemical_list: D000588:Amines; D000700:Analgesics; D000701:Analgesics, Opioid; D003509:Cyclohexanecarboxylic Acids; D000082:Acetaminophen; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin; D009020:Morphine; D020910:Ketorolac