Gabapentin: An Alternative to the Cyclooxygenase-2 Inhibitors for Perioperative Pain Management

Turan, A MD*; White, P F. PhD, MD‡; Karamanlioğlu, B MD*; Memis, D MD*; Taşdoğan, M MD*; Pamukçu, Z MD*; Yavuz, E MD†

Section Editor(s): Stein, Christoph

doi: 10.1213/01.ane.0000184824.43411.63
Pain Medicine: Research Report

The cyclooxygenase-2 inhibitor, rofecoxib, was a popular analgesic adjuvant for improving perioperative pain management. We designed this placebo-controlled study to test the hypothesis that gabapentin could produce similar reductions in postoperative pain and opioid analgesic usage, thereby improving the recovery process. One hundred patients undergoing abdominal hysterectomy procedures were randomly assigned to one of four treatment groups: 1) control group received placebo capsules and pills before and for 2 days after surgery, 2) rofecoxib group received 50 mg/d PO and placebo capsules before and after surgery and, 3) gabapentin group received 1.2 g/d PO and placebo pills before and after surgery, and 4) combination group received rofecoxib 50 mg/d and gabapentin 1.2 g/d PO before and after surgery. The anesthetic technique was standardized and the postoperative assessments included verbal rating scales for pain and sedation, IV morphine usage, quality of recovery assessment, recovery of bowel function, resumption of normal activities, and patient satisfaction with their pain management. Postoperative pain scores were significantly reduced in all three analgesic treatment groups (versus control group). Compared with the control group, patient-controlled analgesia morphine usage was also significantly reduced in the 3 analgesic treatment groups at 1, 8, 24, and 30 h after surgery. Total PCA morphine usage was decreased by 43%, 24%, and 50% in groups 2, 3, and 4, respectively, compared with group 1. Oral analgesic consumption was also smaller in groups 2 and 4 when compared with the control group. The opioid-sparing effects of rofecoxib and gabapentin lead to a faster recovery of bowel function. Discharge eligibility scores in groups 2 and 4 were improved at 24 h when compared with group 1, and patient satisfaction with postoperative pain management was significantly higher at 24 h in all 3 analgesic treatment groups. At the 72 h follow-up, all of the patients in group 4 were completely satisfied with their pain management compared with only 32%, 64%, and 72% in groups 1, 2, and 3, respectively. Gabapentin (1.2 g/d PO) appears to be an acceptable alternative to rofecoxib (50 mg/d PO) for short-term use as an adjuvant to opioid analgesics in patients undergoing lower abdominal surgery.

IMPLICATIONS: We examined the effects of perioperative oral gabapentin 1.2 g, rofecoxib 50 mg, and their combination on postoperative pain and morphine consumption, as well as recovery of bowel function, resumption of normal activities, and patient satisfaction. Gabapentin, 1.2 g per os, appears to be a possible alternative to rofecoxib, 50 mg per os, for use as an adjuvant to patient-controlled analgesia morphine after abdominal hysterectomy procedures. Analogous to the cyclooxygenase-2 inhibitor, the use of gabapentin reduced postoperative pain and the need for opioid analgesic medication, thereby facilitating recovery of bowel function and significantly increasing patient satisfaction with pain management.

*Department of Anaesthesiology and †Biostatistics, Trakya University, Edirne, Turkey; and ‡Department of Anesthesiology & Pain Management, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas

Accepted for publication August 16, 2006.

Supported, in part, by institutional and/or departmental sources at Trakya University in Trakya, Turkey, as well as the endowment funds from the Margaret Milam McDermott Distinguished Chair in Anesthesiology at University of Texas Southwestern Medical Center in Dallas to Dr. White.

Address correspondence and reprint requests to Paul F. White, PhD, MD, Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9068. Address e-mail to paul.white@utsouthwestern.edu.

© 2006 International Anesthesia Research Society