Effect of pre-operative Gabapentin on early post operative pain, nausea, vomiting and analgesic consumption following laparotomy in AGMC & G B P Hospitalâ€

Prevention and control of post operative pain, nausea, and vomiting continues to be a major challenge in post operative care. Opioid analgesics and NSAIDS continues to represent a cornerstone in post operative pain control and testing new analgesics in order to reduce the need for opioids, is a key area in acute pain research. Gabapentin has been used in the treatment of neuropathic pain as well as post operative pain with good result. Gabapentin have demonstrated analgesic effect in clinical trials as a preemptive analgesic and in acute post operative pain management; however experience with gabapentin is limited.

This study was designed to compare the effcts of small dose of oral Gabapentin with placebo as pre medication on early post operative pain, nausea, vomiting, total analgesic consumption in patients undergoing elective laparoscopic cholecystectomy in AGMC and GBP Hospital.

A prospective, double blind, randomized study was conducted among 80 patients undergoing elective cholecystectomy. The patients were divided into two groups having 40 patients each of either sex and were randomly assigned to receive oral Gabapentin 300 mg or placebo as pre medication 2 hr before surgery. Patients were anaesthetized with the same anesthetic techniques and pre medications. Severity of pain, nausea, vomiting and total analgesic consumption was compared between the study groups.

Demographic data were not statistically different between study groups. There were significant differences in median VAS scores measurements at all time points. In placebo group the pain score (Mean ± SEM) in VAS at 2, 6, & 24 hrs was (57.0 ± 1.7), (43.5 ±1.7), (34.2 ± 3.0) respectively. But statistically significant less pain score (39.7 ± 2.0) (p<0.001), (25.5 ± 2.0) (p<0.001), (23.2 ± 3.1) (p<0.05) was observed in Gabapentin group at 2, 6, & 24 hrs respectively. Total dose of analgesic consumption in Gabapentin group was (0.90 ± 0.04, 1.2 ± 0.7, 1.6 ± 0.12) respectively in 2, 6 & 24 hrs post operatively. Whereas in the placebo group it total dose of analgesic consumption was (1.0 ± 0.00), (1.8 ± 0.07), (2.50 ± 0.13) at 2, 6 and 24 hour respectively postoperatively which are statistically higher than gabapentin group. There is no statistically significant difference of nausea at 2hr and 6hr and vomiting at 2, 6 & 24 hours between Gabapentin and placebo group subjects. Only at 24 hrs nausea was significantly less (p<0.05) in gabapentin group. No patient in any group reported any adverse effect like somnolence, ataxia, lightheadedness, pruritus or visual disturbances. Only in 2 patients in each group there was complain of drowsiness which disappeared with continued therapy. To conclude, this study showed that pre operative administration of low dose Gabapentin 300 mg 2 hrs before cholecystectomy surgery decreased post operative pain, nausea and total analgesic consumption and delayed the need of supplementary analgesics with a very minimal insignificant adverse effects suggesting that gabapentin has clinical potential in the treatment of post operative pain without significant side effects.

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