TY - JOUR
T1 - Perioperative gabapentin for the prevention of persistent pain after thoracotomy
T2 - a randomized controlled trial
AU - Grosen, Kasper
AU - Drewes, Asbjørn Mohr
AU - Højsgaard, Anette
AU - Pfeiffer-Jensen, Mogens
AU - Hjortdal, Vibeke Elisabeth
AU - Pilegaard, Hans Kristian
N1 - © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
PY - 2014/7
Y1 - 2014/7
N2 - OBJECTIVES: To evaluate the effect of perioperative gabapentin treatment for the prevention of persistent post-thoracotomy pain and to establish whether gabapentin has a significant therapeutic impact on acute postoperative pain.METHODS: Consecutive patients with pulmonary malignancies scheduled for anterior thoracotomy were enrolled in this randomized, double-blinded, placebo-controlled trial. Patients were given 1200 mg gabapentin or placebo 2 h before surgery followed by increasing doses during 5 postoperative days: 600 mg for day 1; 900 mg for day 2; and 1200 mg for days 3-5. Effective pain relief was provided with perioperative multimodal analgesia with epidural infusion of bupivacaine and morphine for 72 h, and oral acetaminophen, ibuprofen and morphine. The main outcome was persistent post-thoracotomy pain at 6 months. Secondary outcomes included measures of early postoperative post-thoracotomy pain, morphine requirements, recovery and analgesia-related adverse effects over the first 3 weeks as well as persistent post-thoracotomy pain at 3 months.RESULTS: A total of 104 patients were randomly assigned to the intervention or control group; 86 (83%) patients were available for the 14-day analysis, 76 (73%) for the 3-month analysis and 67 (64%) for the 6-month follow-up. At 6 months postoperatively, 47% of patients treated with gabapentin reported persistent post-thoracotomy pain compared with 49% in the placebo group (P = 0.9). No overall clinically or statistically significant differences were observed between groups receiving placebo and gabapentin, respectively, for the secondary outcome measures and treatment-related adverse events.CONCLUSIONS: We found no evidence for the superiority of gabapentin over placebo for the treatment of acute pain following thoracotomy or for the prevention of persistent post-thoracotomy pain.
AB - OBJECTIVES: To evaluate the effect of perioperative gabapentin treatment for the prevention of persistent post-thoracotomy pain and to establish whether gabapentin has a significant therapeutic impact on acute postoperative pain.METHODS: Consecutive patients with pulmonary malignancies scheduled for anterior thoracotomy were enrolled in this randomized, double-blinded, placebo-controlled trial. Patients were given 1200 mg gabapentin or placebo 2 h before surgery followed by increasing doses during 5 postoperative days: 600 mg for day 1; 900 mg for day 2; and 1200 mg for days 3-5. Effective pain relief was provided with perioperative multimodal analgesia with epidural infusion of bupivacaine and morphine for 72 h, and oral acetaminophen, ibuprofen and morphine. The main outcome was persistent post-thoracotomy pain at 6 months. Secondary outcomes included measures of early postoperative post-thoracotomy pain, morphine requirements, recovery and analgesia-related adverse effects over the first 3 weeks as well as persistent post-thoracotomy pain at 3 months.RESULTS: A total of 104 patients were randomly assigned to the intervention or control group; 86 (83%) patients were available for the 14-day analysis, 76 (73%) for the 3-month analysis and 67 (64%) for the 6-month follow-up. At 6 months postoperatively, 47% of patients treated with gabapentin reported persistent post-thoracotomy pain compared with 49% in the placebo group (P = 0.9). No overall clinically or statistically significant differences were observed between groups receiving placebo and gabapentin, respectively, for the secondary outcome measures and treatment-related adverse events.CONCLUSIONS: We found no evidence for the superiority of gabapentin over placebo for the treatment of acute pain following thoracotomy or for the prevention of persistent post-thoracotomy pain.
KW - Adult
KW - Aged
KW - Amines/administration & dosage
KW - Analgesics, Opioid/therapeutic use
KW - Analgesics/administration & dosage
KW - Anesthetics, Local/therapeutic use
KW - Cyclohexanecarboxylic Acids/administration & dosage
KW - Dose-Response Relationship, Drug
KW - Double-Blind Method
KW - Drug Administration Schedule
KW - Drug Therapy, Combination
KW - Female
KW - Gabapentin
KW - Humans
KW - Lung Neoplasms/surgery
KW - Male
KW - Middle Aged
KW - Pain Measurement
KW - Pain, Postoperative/prevention & control
KW - Perioperative Care
KW - Thoracotomy
KW - Young Adult
KW - gamma-Aminobutyric Acid/administration & dosage
U2 - 10.1093/ejcts/ezu032
DO - 10.1093/ejcts/ezu032
M3 - Journal article
C2 - 24574444
SN - 1010-7940
VL - 46
SP - 76
EP - 85
JO - European Journal of Cardio-Thoracic Surgery
JF - European Journal of Cardio-Thoracic Surgery
IS - 1
ER -