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/administration & dosage

KW - Analgesics, Opioid/therapeutic use

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

VL - 46

SP - 76

EP - 85

JO - European Journal of Cardio-thoracic Surgery

JF - European Journal of Cardio-thoracic Surgery

SN - 1010-7940

IS - 1

ER -