Revisão sobre o uso de gabapentina para controle da dor pós-operatória
Review of the use of gabapentin in the control of postoperative pain
Jefferson Clivatti; Rioko Kimiko Sakata; Adriana Machado Issy
Resumo
Palavras-chave
Abstract
BACKGROUND AND OBJECTIVES: Gabapentin has been used as adjuvant in the treatment of postoperative pain with a neuropathic component. It is responsible for the inhibition of central sensitization, decreasing postoperative pain. CONTENTS: All clinical, randomized studies that evaluated the effects of gabapentin on postoperative pain in humans between 2002 and 2007 for a total of 26 studies were selected. In 17 studies, patients received a single preoperative dose, which ranged from 300 to 1,200 mg, 30 minutes to two hours before surgery. In the remaining studies, the administration of the drug was initiated one to 24 hours before the procedure and continued for 10 days, in doses that ranged from 1,200 to 1,800 mg.day-1. To measure pain severity, the Visual Analog or Numeric Rating Scale was used. In 75% of patients who received a single dose of gabapentin, scores were lower, and the same was seen in 55.6¨% of patients who received the drugs pre- and postoperatively. Opioid consumption was reduced in 82.4% of patients who received a single dose, and in 77.8% of patients who received pre- and postoperative gabapentin. Among the studies using a single dose of gabapentin, four did not describe adverse effects; 52.9% showed no differences, 11.8% detected more nausea or vomiting, 5.9% experienced more dizziness, 5.9% more sedation, less nausea or vomiting in one, and less urinary retention in one. Among the studies with pre- and postoperative administration of gabapentin, four did not describe adverse effects; 22.2% showed no differences, 11.1% had more nausea or vomiting, 22.2% more dizziness, and 11.1% more sedation. CONCLUSIONS: Gabapentin, used before as well as before and after surgery, decreased pain severity and the need of analgesic supplementation.
References
Woolf CJ, Max MB. Mechanism-based pain diagnosis: issues for analgesic drug development. Anesthesiology. 2001;95:241-249.
Scholz J, Woolf CJ. Can we conquer pain?. Nat Neurosci. 2002;5:1062-1067.
Kehlet H. Controlling acute pain: Role of pre-emptive analgesia, peripheral treatment, and balanced analgesia, and effects on outcome. Pain. 1999:459-462.
Breivik H. Postoperative pain: toward optimal pharmacological and epidural analgesia. Pain. 2002:337-349.
Van Elstraete AC, Pastureau F, Lebrun T. Caudal clonidine for postoperative analgesia in adults. Br J Anaesth. 2000;84:401-402.
Rowbotham MC. Treatment of neuropathic pain: perspectives on current options. Pain. 2005:107-19.
Gidal B, Billington R. New and emerging treatment options for neuropathic pain. Am J Manag Care. 2006;12:269-278.
Elwes RDB, Binnie CD. Clinical pharmacokinetics of newer antiepileptic drugs: Lamotrigine, vigabatrin, gabapentin and oxcarbazepine. Clin Pharmacokinet. 1996;30:403-415.
Comstock TI, Sica DA, Bockbrader HN. Gabapentin pharmacokinetics in subjects with various degrees of renal function. J Clin Pharmacol. 1990;30:862.
Maneuf YP, Gonzalez MI, Sutton KS. Cellular and molecular action of the putative GABAmimetic, gabapentin. Cell Mol Life Sci. 2003;60:742-750.
Taylor CP, Gee NS, Su TZ. A summary of mechanistic hypotheses of gabapentin pharmacology. Epilepsy Res. 1998;29:233-249.
Dahl JB, Mathiesen O, Moiniche S. Protective premedication: an option with gabapentin and related drugs? An review of gabapentin and pregabalin in the treatment of postoperative pain. Acta Anaesthesiol Scand. 2004;48:1130-1136.
Sills GJ. Not another gabapentin mechanism. Epilepsy Curr. 2005;5:75-77.
Markman JD, Dworkin RH. Ion channel targets and treatment efficacy in neuropathic pain. J Pain. 2006;7:538-547.
Dirks J, Fredensborg BB, Christensen D. A randomized study of the effects of single-dose gabapentin versus placebo on postoperative pain and morphine consumption after mastectomy. Anesthesiology. 2002;97:560-564.
Pandey CK, Sahay S, Gupta D. Preemptive gabapentin decreases postoperative pain after lumbar discoidectomy. Can J Anesth. 2004;51:986-989.
Rorarius MGF, Mennander S, Suominen P. Gabapentin for the prevention of postoperative pain after vaginal hysterectomy. Pain. 2004;110:175-181.
Turan A, Memis D, Karamanlioglu B. The analgesic effects of gabapentin in monitored anesthesia care for ear-nose-throat surgery. Anesth Analg. 2004;99:375-378.
Turan A, Karamanlioglu B, Memis D. The analgesic effects of gabapentin after total abdominal hysterectomy. Anesth Analg. 2004;98:1370 -1373.
Turan A, Karamanlioglu B, Memis D. Analgesic effects of gabapentin after spinal surgery. Anesthesiology. 2004;100:935-938.
Pandey CK, Priye S, Singh S. Preemptive use of gabapentin significantly decreases postoperative pain and rescue analgesic requirements in laparoscopic cholecystectomy. Can J Anaesth. 2004;51:358-363.
Pandey CK, Singhal V, Kumar M. Gabapentin provides effective postoperative analgesia whether administered pre-emptively or post-incision. Can J Anaesth. 2005;52:827-831.
Radhakrishnan M, Bithal PK, Chaturvedi A. Effect of preemptive gabapentin on postoperative pain relief and morphine consumption following lumbar laminectomy and discectomy: a randomized, double-blinded, placebo-controlled study. J Neurosurg Anesthesiol. 2005;17:125-128.
Menigaux C, Adam F, Guignard B. Preoperative gabapentin decreases anxiety and improves early functional recovery from knee surgery. Anesth Analg. 2005;100:1394 -1399.
Pandey CK, Navkar DV, Giri PJ. Evaluation of the optimal preemptive dose of gabapentin for postoperative pain relief after lumbar diskectomy: a randomized, double-blind, placebo-controlled study. J Neurosurg Anesthesiol. 2005;17:65-68.
Bartholdy J, Hilsted KL, Hjortsoe NC. Effect of gabapentin on morphine demand and pain after laparoscopic sterilization using Filshie clips: A double blind randomized clinical Trial. BMC Anesthesiol. 2006;6:12.
Adam F, Meniguax C, Sessler DI. A single preoperative dose of gabapentin (800 milligrams) does not augment postoperative analgesia in patients given interscalene brachial plexus blocks for arthroscopic shoulder surgery. Anesth Analg. 2006;103:1278 -1282.
Al-Mujadi H, A-Refai AR, Katzarov MG. Preemptive gabapentin reduces postoperative pain and opioid demand following thyroid surgery. Can J Anesth. 2006;53:268-273.
Hayashida K, DeGoes S, Curry R. Gabapentin activates spinal noradrenergic activity in rats and humans and reduces hypersensitivity after surgery. Anesthesiology. 2007;106:557-562.
Durmus M, Kadir But A, Saricicek V. The post-operative analgesic effects of a combination of gabapentin and paracetamol in patients undergoing abdominal hysterectomy: a randomized clinical trial. Acta Anaesthesiol Scand. 2007;51:299-304.
Turan A, White PF, Karamanlioglu B. Premedication with gabapentin: the effect on tourniquet pain and quality of intravenous regional anesthesia. Anesth Analg. 2007;104:97-101.
Fassoulaki A, Patris K, Sarantopoulos C. The analgesic effect of gabapentin and mexiletine after breast surgery for cancer. Anesth Analg. 2002;95:985-991.
Dierking G, Duedahl TH, Rasmussen ML. Effects of gabapentin on postoperative morphine consumption and pain after abdominal hysterectomy: a randomized, double-blind trial. Acta Anaesthesiol Scand. 2004;48:322-327.
Fassoulaki A, Triga A, Melemeni A. Multimodal analgesia with gabapentin and local anesthetics prevents acute and chronic pain after breast surgery for cancer. Anesth Analg. 2005;101:1427-1432.
Gilron I, Orr E, Tu D. A placebo-controlled randomized clinical trial of perioperative administration of gabapentin, rofecoxib and their combination for spontaneous and movement-evoked pain after abdominal hysterectomy. Pain. 2005;113:191-200.
Mikkelsen S, Hilsted KL, Andersen PJ. The effect of gabapentin on post-operative pain following tonsillectomy in adults. Acta Anaesthesiol Scand. 2006;50:809-815.
Fassoulaki A, Stamatakis E, Petropoulos G. Gabapentin attenuates late but not acute pain after abdominal hysterectomy. Eur J Anaesth. 2006;23:136-141.
Turan A, Kaya A, Karamanlioglu B. Effect of oral gabapentin on postoperative epidural analgesia. Br J Anaesth. 2006;96:242-246.
Turan A, White PF, Karamanlioglu B. Gabapentin: an alternative to the cyclooxygenase-2 inhibitors for perioperative pain management. Anesth Analg. 2006;102:175-181.
Fassoulaki A, Melemeni A, Stamatakis E. A combination of gabapentin and local anaesthetics attenuates acute and late pain after abdominal hysterectomy. Eur J Anaesthesiol. 2007;24:521-528.
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