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Razak A, Corman B, Servider J, Mavarez-Martinez A, Jin Z, Mushlin H, Bergese SD. Postoperative analgesic options after spine surgery: finding the optimal treatment strategies. Expert Rev Neurother 2024; 24:191-200. [PMID: 38155560 DOI: 10.1080/14737175.2023.2298824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 12/20/2023] [Indexed: 12/30/2023]
Abstract
INTRODUCTION Spine surgery is one of the most common types of surgeries performed in the United States; however, managing postoperative pain following spine surgery has proven to be challenging. Patients with spine pathologies have higher incidences of chronic pain and resultant opioid use and potential for tolerance. Implementing a multimodal plan for postoperative analgesia after spine surgery can lead to enhanced recovery and outcomes. AREAS COVERED This review presents several options for analgesia following spine surgery with an emphasis on multimodal techniques to best aid this specific patient population. In addition to traditional therapeutics, such as acetaminophen, non-steroidal anti-inflammatory medications, and opioids, we discuss intrathecal morphine administration and emerging regional anesthesia techniques. EXPERT OPINION Several adjuncts to improve analgesia following spine surgery are efficacious in the postoperative period. Intrathecal morphine provides sustained analgesia and can be instilled intraoperatively by the surgical team under direct visualization. Local anesthetics deposited under ultrasound guidance by an anesthesiologist trained in regional techniques also provide the opportunity for single injections or continuous analgesia via an indwelling catheter.
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Affiliation(s)
- Alina Razak
- Department of Anesthesiology, Stony Brook University Health Science Center, Stony Brook, NY, USA
| | - Benjamin Corman
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - John Servider
- Department of Neurological Surgery, Stony Brook University Health Science Center, Stony Brook, NY, USA
| | - Ana Mavarez-Martinez
- Department of Anesthesiology, Stony Brook University Health Science Center, Stony Brook, NY, USA
| | - Zhaosheng Jin
- Department of Anesthesiology, Stony Brook University Health Science Center, Stony Brook, NY, USA
| | - Harry Mushlin
- Department of Neurological Surgery, Stony Brook University Health Science Center, Stony Brook, NY, USA
| | - Sergio D Bergese
- Department of Anesthesiology, Stony Brook University Health Science Center, Stony Brook, NY, USA
- Department of Neurological Surgery, Stony Brook University Health Science Center, Stony Brook, NY, USA
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Wang D, Wang T, Yang H, Yang J, Shi Z. Spectroscopy and visible-light driven photocatalytic properties of a microcrystalline Cu-complex derived from a novel Gabapentin Schiff base. SPECTROCHIMICA ACTA. PART A, MOLECULAR AND BIOMOLECULAR SPECTROSCOPY 2023; 302:123138. [PMID: 37453380 DOI: 10.1016/j.saa.2023.123138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 06/13/2023] [Accepted: 07/11/2023] [Indexed: 07/18/2023]
Abstract
A novel Gabapentin derivative Schiff base Gasa was synthesized by condensing Gabapentin with salicylaldehyde, which was further coordinated with Cu2+ in methanol to give a microcrystalline Cu(II) complex Cu(Gasa)2. The synthesized Gasa and Cu(Gasa)2 were further characterized by single-crystal X-ray diffraction, scanning electron microscopy (SEM), as well as the FT-IR, Raman, electronic and fluorescence spectra. Cu(Gasa)2 exhibited excellent visible-light driven photocatalytic activities in removal of Congo red (CR) and Methylene blue (MB) dyes from aqueous solution in the presence of H2O2 as oxidant. It was revealed that ∙OH radicals played the most important role in the photodegradation processes of organic dyes, and the photodegradation of CR and MB fitted well with the pseudo-first-order kinetic model. In addition, solid state luminescent properties of Gasa and Cu(Gasa)2 were also studied in detail.
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Affiliation(s)
- Dawei Wang
- Key Laboratory for Forest Resources Conservation and Utilization in the Southwest Mountains of China, Ministry of Education, Southwest Forestry University, Kunming 650224, PR China.
| | - Tao Wang
- School of Chemistry and Chemical Engineering, Nanjing University, Nanjing 210023, PR China
| | - Haiyan Yang
- Key Laboratory of State Forestry and Grassland Administration on Highly-Efficient Utilization of Forestry Biomass Resources in Southwest China, Southwest Forestry University, Kunming 650224, PR China
| | - Jing Yang
- Key Laboratory of State Forestry and Grassland Administration on Highly-Efficient Utilization of Forestry Biomass Resources in Southwest China, Southwest Forestry University, Kunming 650224, PR China
| | - Zhengjun Shi
- Key Laboratory for Forest Resources Conservation and Utilization in the Southwest Mountains of China, Ministry of Education, Southwest Forestry University, Kunming 650224, PR China.
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Hassanzadeh S, Bagheri S, Majid Ahmadi S, Ahmadi SA, Moradishibany I, Dolatkhah H, Reisi S. Effectiveness of oral clonidine and gabapentin on peripheral neuropathy in diabetic patients in southwestern Iran: a randomized clinical trial. BMC Endocr Disord 2023; 23:224. [PMID: 37845651 PMCID: PMC10577942 DOI: 10.1186/s12902-023-01486-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 10/11/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Peripheral neuropathy is not only the most prevalent consequence of diabetes but also the main reason for foot ulceration, disability, and amputation. Therefore, the current study aims to determine the effectiveness of oral clonidine and gabapentin on peripheral neuropathy in diabetic patients. METHODS This 12-week, randomized, and parallel-group trial was conducted to compare the efficacy of oral clonidine and gabapentin with gabapentin alone in diabetic patients in southwest Iran during the first half of 2021. Thirty patients with type 2 diabetes with peripheral neuropathy as assessed by a visual analog scale (VAS) and divided into two groups of 15 patients, treated for up to three months. The data were analyzed using SPSS-21 software. In order to report the results, descriptive indices, independent t-test, one-way analysis of covariance (ANCOVA) and analysis of variance with repeated measures were used. RESULTS The mean and standard deviation of the age of the participants in the clonidine + gabapentin group was equal to 50.20 ± 7.44, and in the gabapentin group was equal to 50.47 ± 7.57 (t = 0.10, P-value = 0.923). This research showed a significant difference between the clonidine + gabapentin group and with gabapentin group in terms of neuropathic pain and the severity of neuropathic pain (P < 0.001). CONCLUSIONS According to this research results, clonidine + gabapentin can reduce neuropathic pain and the severity of neuropathic pain in diabetic patients. Therefore, it is recommended that healthcare professionals with diabetes expertise prescribe these medications to reduce neuropathic pain and its severity. TRIAL REGISTRATION This study was registered in the Iranian Clinical Trials System with the ID (IRCT20211106052983N1) on 14/01/2022.
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Affiliation(s)
- Sajad Hassanzadeh
- Department of Internal Medicine, School of Medicine, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Soraya Bagheri
- Department of Internal Medicine, School of Medicine, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Seyed Majid Ahmadi
- Department of Internal Medicine, School of Medicine, Yasuj University of Medical Sciences, Yasuj, Iran.
| | | | - Isaac Moradishibany
- Department of Internal Medicine, School of Medicine, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Hosein Dolatkhah
- Department of Internal Medicine, School of Medicine, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Sajjad Reisi
- Genetic and Environmental Adventures Research Center, School of Abarkouh Paramedicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
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Farrell N, Greenfield PT, Rutkowski PT, Weller WJ. Perioperative Pain Management for Distal Radius Fractures. Orthop Clin North Am 2023; 54:463-470. [PMID: 37718085 DOI: 10.1016/j.ocl.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Distal radius fractures have a high incidence among both young and elderly patients, and in many instances require operative intervention. When operative intervention is employed, adequate pain management is essential to decrease postoperative complications, such as chronic pain and disability, while minimizing the risk of prolonged opioid use and dependence. Strategies to optimize pain management include regional anesthesia, preoperative dosing of medication, multimodal regimens, long-acting selective opioids at the time of surgery, corticosteroids, and non-pharmacologic therapies.
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Affiliation(s)
- Nolan Farrell
- Campbell Clinic, Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center, Memphis, TN, USA.
| | - Paul T Greenfield
- Campbell Clinic, Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Paul T Rutkowski
- Campbell Clinic, Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center, Memphis, TN, USA
| | - William Jacob Weller
- Campbell Clinic, Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center, Memphis, TN, USA
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Kaur S, Turka S, Kaur Bindra T, Tuteja RD, Kumar M, Jit Singh Bajwa S, Kurdi MS, Sutagatti AJ. Comparison of the Efficacy of Pregabalin and Gabapentin for Preemptive Analgesia in Laparoscopic Cholecystectomy Patients: A Randomised Double-Blind Study. Cureus 2023; 15:e46719. [PMID: 38021908 PMCID: PMC10630708 DOI: 10.7759/cureus.46719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Preemptive analgesia is now an essential step of perioperative pain management. Pregabalin and gabapentin, which are drugs primarily used in the treatment of neuropathic pain, are now being contemplated for use as preemptive analgesics. This study aimed to assess the effectiveness of gabapentin and pregabalin as preemptive analgesics. The primary objective of the study was to compare pregabalin and gabapentin versus placebo with regard to a visual analogue scale (VAS) score for postoperative pain for 24 hours, time to first rescue analgesia, and total analgesic consumption over 24 hours. The level of sedation with the help of a modified Ramsay sedation score was also compared. Methods This randomised, double-blind study was conducted on 90 patients aged 18-60 years of the American Society of Anesthesiologists (ASA) physical status I and II undergoing elective laparoscopic cholecystectomy under general anaesthesia at a tertiary health care institute. The patients were randomly divided into three groups of 30 each, namely, Group A (gabapentin - oral two capsules of 300 mg gabapentin), Group B (pregabalin - oral two capsules of 150 mg pregabalin), and Group C (placebo - oral two capsules). The various parameters that were recorded in both groups included a VAS score for pain, total dose of tramadol consumed in 24 hours, modified Ramsay sedation scores in the immediate postoperative period, and adverse effects related to the study drugs (at zero and one hour and two, four, six, 12, and 24 hours). The data were analysed using the Statistical Package for the Social Sciences (SPSS) (version 25; IBM SPSS Statistics for Windows, Armonk, NY) software. Results VAS scores were significantly lower in groups A and B when compared to Group C. However, the scores were comparable in Group A (gabapentin) and Group B (pregabalin). The difference in the mean time of rescue analgesia was statistically highly significant when Group A (gabapentin) was compared with Group C (placebo) (P value<0.001) and when Group B (pregabalin) was compared with Group C (placebo) (P value<0.001). Thus, gabapentin and pregabalin provide a longer postoperative pain-free period (382.6 min and 502.3 min, respectively) when compared to the placebo group (137.8 min). Moreover, the mean dose of tramadol consumption in 24 hours was significantly lower in pregabalin (170 mg) and gabapentin groups (176.7 mg) when compared to the placebo group (286.7 mg). However, there was no significant difference in the total tramadol consumption between the gabapentin and pregabalin groups. The level of sedation up to six hours postoperatively was higher in Group B (pregabalin) and Group A (gabapentin) patients compared to Group C (placebo). On comparing the mean Ramsay sedation scores of Group A (gabapentin) versus Group C (placebo) and Group B (pregabalin) versus Group C (placebo), it was found that there was a highly significant difference at zero and one-hour time intervals (P value<0.001 in both comparisons). Conclusion A single preoperative dose of pregabalin 300 mg or gabapentin 600 mg can be used for effective preemptive analgesia in patients undergoing laparoscopic cholecystectomy.
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Affiliation(s)
- Simrit Kaur
- Department of Anaesthesia and Intensive Care, Government Medical College (GMC) Patiala, Patiala, IND
| | - Sartaj Turka
- Department of Medicine and Surgery, Government Medical College (GMC) Patiala, Patiala, IND
| | - Tripat Kaur Bindra
- Department of Anaesthesia and Intensive Care, Government Medical College (GMC) Patiala, Patiala, IND
| | - Rajan D Tuteja
- Department of Anaesthesia and Intensive Care, Government Medical College (GMC) Patiala, Patiala, IND
| | - Manoj Kumar
- Department of Anaesthesia, Anugrah Narayan Magadh Medical College and Hospital, Gaya, IND
| | | | - Madhuri S Kurdi
- Department of Anaesthesiology, Karnataka Institute of Medical Sciences, Hubli, IND
| | - Apoorva J Sutagatti
- Department of Medicine and Surgery, S. Nijalingappa Medical College and H.S.K. Hospital and Research Centre, Bagalkot, IND
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Xie S, Xie M, Shen Y, Cheng D. Gabapentin for chronic refractory cough: A system review and meta-analysis. Heliyon 2023; 9:e15579. [PMID: 37131438 PMCID: PMC10149207 DOI: 10.1016/j.heliyon.2023.e15579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 04/11/2023] [Accepted: 04/14/2023] [Indexed: 05/04/2023] Open
Abstract
Objective To evaluate the efficacy and safety of gabapentin in the treatment of chronic refractory cough by Meta-Analysis. Methods Literatures were retrieved from PubMed, Embase (OvidIP), Cochrane Library, CNKI, VIP, Wanfang Database and China Biomedical Management System and eligible prospective studies were screened. Data were extracted and analyzed by using RevMan 5.4.1 software. Results Six articles (2 RCTs and 4 prospective studies) with 536 participants were finally included. Meta-analysis showed that gabapentin was better than placebo in cough-specific quality of life (LCQ score, MD = 4.02, 95%CI [3.26,4,78], Z = 10.34, P < 0.00001), cough severity (VAS score, MD = -29.36, 95% CI (-39.46, -19.26), Z = 5.7, P < 0.00001), cough frequency (MD = -29.87, 95% CI [- 43.84, -15.91], Z = 4.19, P < 0.0001) and therapeutic efficacy (RR = 1.37,95%CI [1.13,1.65], Z = 3.27, P = 0.001), and equal in safety (RR = 1.32,95%CI [0.47,3.7], Z = 0.53, P = 0.59). Gabapentin was similar to other neuromodulators in therapeutic efficacy (RR = 1.07,95%CI [0.87,1.32], Z = 0.64, P = 0.52), but its safety was better. Conclusion Gabapentin is effective in the treatment of chronic refractory cough in both subjective and objective evaluations, and its safety is better than other neuromodulators.
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Affiliation(s)
- Sheng Xie
- Department of Pulmonary and Critical Care Medicine, Chengdu First People's Hospital, Sichuan, China
| | - Meiling Xie
- Department of Traditional Chinese Medicine, Sichuan Electric Power Hospital, Sichuan, China
| | - Yongchun Shen
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Sichuan, China
| | - Deyun Cheng
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Sichuan, China
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Khizer Z, Akram MR, Tahir MA, Liu W, Lou S, Conway BR, Ghori MU. Personalised 3D-Printed Mucoadhesive Gastroretentive Hydrophilic Matrices for Managing Overactive Bladder (OAB). Pharmaceuticals (Basel) 2023; 16:ph16030372. [PMID: 36986471 PMCID: PMC10056888 DOI: 10.3390/ph16030372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/14/2023] [Accepted: 02/20/2023] [Indexed: 03/06/2023] Open
Abstract
Overactive bladder (OAB) is a symptomatic complex condition characterised by frequent urinary urgency, nocturia, and urinary incontinence with or without urgency. Gabapentin is an effective treatment for OAB, but its narrow absorption window is a concern, as it is preferentially absorbed from the upper small intestine, resulting in poor bioavailability. We aimed to develop an extended release, intragastric floating system to overcome this drawback. For this purpose, plasticiser-free filaments of PEO (polyethylene oxide) and the drug (gabapentin) were developed using hot melt extrusion. The filaments were extruded successfully with 98% drug loading, possessed good mechanical properties, and successfully produced printed tablets using fused deposition modelling (FDM). Tablets were printed with varying shell numbers and infill density to investigate their floating capacity. Among the seven matrix tablet formulations, F2 (2 shells, 0% infill) showed the highest floating time, i.e., more than 10 h. The drug release rates fell as the infill density and shell number increased. However, F2 was the best performing formulation in terms of floating and release and was chosen for in vivo (pharmacokinetic) studies. The pharmacokinetic findings exhibit improved gabapentin absorption compared to the control (oral solution). Overall, it can be concluded that 3D printing technology is an easy-to-use approach which demonstrated its benefits in developing medicines based on a mucoadhesive gastroretentive strategy, improving the absorption of gabapentin with potential for the improved management of OAB.
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Affiliation(s)
- Zara Khizer
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield HD1 3DH, UK
| | - Muhammad R. Akram
- College of Pharmacy, University of Sargodha, Sargodha 40100, Pakistan
| | - Muhammad Azam Tahir
- Institute of Pharmaceutical Technology and Biopharmaceutics, University of Bonn, 53113 Bonn, Germany
- Department of Pharmacy, Khalid Mahmood Institute of Medical Sciences, Sialkot 51310, Pakistan
| | - Weidong Liu
- School of Computing and Engineering, University of Huddersfield, Huddersfield HD1 3DH, UK
| | - Shan Lou
- School of Computing and Engineering, University of Huddersfield, Huddersfield HD1 3DH, UK
| | - Barbara R. Conway
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield HD1 3DH, UK
| | - Muhammad Usman Ghori
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield HD1 3DH, UK
- Correspondence: ; Tel.: +44-(0)-1484-256950
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Petroianu GA, Aloum L, Adem A. Neuropathic pain: Mechanisms and therapeutic strategies. Front Cell Dev Biol 2023; 11:1072629. [PMID: 36727110 PMCID: PMC9884983 DOI: 10.3389/fcell.2023.1072629] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 01/06/2023] [Indexed: 01/18/2023] Open
Abstract
The physiopathology and neurotransmission of pain are of an owe inspiring complexity. Our ability to satisfactorily suppress neuropathic or other forms of chronic pain is limited. The number of pharmacodynamically distinct and clinically available medications is low and the successes achieved modest. Pain Medicine practitioners are confronted with the ethical dichotomy imposed by Hippocrates: On one hand the mandate of primum non nocere, on the other hand, the promise of heavenly joys if successful divinum est opus sedare dolorem. We briefly summarize the concepts associated with nociceptive pain from nociceptive input (afferents from periphery), modulatory output [descending noradrenergic (NE) and serotoninergic (5-HT) fibers] to local control. The local control is comprised of the "inflammatory soup" at the site of pain origin and synaptic relay stations, with an ATP-rich environment promoting inflammation and nociception while an adenosine-rich environment having the opposite effect. Subsequently, we address the transition from nociceptor pain to neuropathic pain (independent of nociceptor activation) and the process of sensitization and pain chronification (transient pain progressing into persistent pain). Having sketched a model of pain perception and processing we attempt to identify the sites and modes of action of clinically available drugs used in chronic pain treatment, focusing on adjuvant (co-analgesic) medication.
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Towfighi P, Hill A, Crossley JR, Walsh A, Leonard JA, Giurintano JP, Pierce ML, Reilly MJ. A retrospective analysis of pain and opioid usage in head and neck free flap reconstruction. World J Otorhinolaryngol Head Neck Surg 2023. [DOI: 10.1002/wjo2.87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- Parhom Towfighi
- Georgetown University School of Medicine Washington District of Columbia USA
| | - Alison Hill
- Georgetown University School of Medicine Washington District of Columbia USA
| | - Jason R. Crossley
- Department of Otolaryngology—Head and Neck Surgery Medstar Georgetown Washington District of Columbia USA
| | - Amanda Walsh
- Department of Otolaryngology—Head and Neck Surgery Medstar Georgetown Washington District of Columbia USA
| | - James A. Leonard
- Department of Otolaryngology—Head and Neck Surgery Medstar Georgetown Washington District of Columbia USA
| | - Jonathan P. Giurintano
- Department of Otolaryngology—Head and Neck Surgery Medstar Georgetown Washington District of Columbia USA
| | - Matthew L. Pierce
- Department of Otolaryngology—Head and Neck Surgery Medstar Georgetown Washington District of Columbia USA
| | - Michael J. Reilly
- Department of Otolaryngology—Head and Neck Surgery Medstar Georgetown Washington District of Columbia USA
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Tamimi Z, Abusamak M, Al-Waeli H, Al-Tamimi M, Al Habashneh R, Ghanim M, Al-Nusair M, Gao Q, Nicolau B, Tamimi F. NSAID chronotherapy after impacted third molar extraction: a randomized controlled trial. Oral Maxillofac Surg 2022; 26:663-672. [PMID: 35064366 DOI: 10.1007/s10006-021-01029-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 12/10/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Postoperative pain management impacts patients' quality of life and morbidity. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen are widely used for this following a 3-doses-per-day regime. However, pain and inflammation follow a circadian rhythm, and animal models assessing the scheduling of NSAID administration (e.g., chronotherapy) have shown that while their use during the active phase of the day enhances postoperative recovery, their administration during the resting phase could have detrimental effects. This observation has led us to hypothesize that night administration of NSAID might be unnecessary in post-surgical scenarios. Therefore, a randomized clinical trial was conducted to test this hypothesis in surgical third molar extractions. MATERIALS AND METHODS Seventy (18-35 years) healthy participants requiring surgical removal of impacted lower third molars were recruited and randomized into a double-blind placebo-controlled study. For three days postoperatively, the treatment group (n = 33) received ibuprofen (400 mg) at 8 AM, 1 PM, and a placebo at 8 PM, while the control group (n = 37) received ibuprofen (400 mg) at 8 AM, 1 PM, and 8 PM. Pain severity was assessed by visual analog scale (VAS) and healing indicators including facial swelling, mouth opening, and C-reactive protein blood levels were also measured. RESULTS Pain VAS measures showed a circadian variation peaking at night. Also, no significant differences were observed between the two groups of the study in terms of postoperative pain scores (estimate: 0.50, 95% CI = [- 0.38, 1.39]) or any other healing indicator. CONCLUSIONS Postoperative pain follows a circadian rhythm. Moreover, night administration of ibuprofen might not provide any significant benefits in terms of pain management and control of inflammation, and two doses during the day only could be sufficient for pain management after surgical interventions. KNOWLEDGE TRANSFER STATEMENT Even though this study cannot rule out the possibility that a reduced regime is different than a standard regime, nocturnal doses of ibuprofen seem to have no clinical significance in the short term, and the results of this study provide evidence in favor of reducing ibuprofen administration from three doses to two doses only after third molar surgery.
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Affiliation(s)
- Zaid Tamimi
- Faculty of Dentistry, Jordan University of Science and Technology, Irbid, Jordan.
| | | | - Haider Al-Waeli
- Faculty of Dentistry, Dalhousie University, Halifax, NS, Canada
| | | | - Rola Al Habashneh
- Faculty of Dentistry, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohammad Ghanim
- Faculty of Dentistry, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohammed Al-Nusair
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Qiman Gao
- Faculty of Dentistry, McGill University, Montreal, QC, Canada
| | - Belinda Nicolau
- Faculty of Dentistry, McGill University, Montreal, QC, Canada
| | - Faleh Tamimi
- College of Dental Medicine, Qatar University, Doha, Qatar
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Verma J, Verma S, Margasahayam SV. Comparison of pretreatment gabapentin and pregabalin to control postoperative endodontic pain - a double-blind, randomized clinical trial. J Dent Anesth Pain Med 2022; 22:377-385. [PMID: 36246032 PMCID: PMC9536948 DOI: 10.17245/jdapm.2022.22.5.377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/03/2022] [Accepted: 09/18/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Postoperative endodontic pain is an enigma for the dentist. This study aimed to evaluate the analgesic effect of 300 mg gabapentin or 75 mg pregabalin in reducing postoperative endodontic pain compared with a placebo. METHODS Ninety patients who needed root canal treatment with an initial numerical rating scale (NRS) pain score of > 4 (T0) were randomly divided into three groups (n=30). Patients were then administered either 300 mg gabapentin (group A), 75 mg pregabalin (group B), or a placebo (group C) 30 min prior to the start of endodontic treatment. A single operator performed single-visit endodontics, and pain was evaluated immediately after endodontic treatment (T1) and at 4 h (T2), 8 h (T3), 12 h (T4), 24 h (T5), 48 h (T6), and 72 h (T7) using the NRS. Ibuprofen/paracetamol (400 mg/325 mg) was administered as a rescue dose if needed. RESULTS Pregabalin performed significantly better when compared with gabapentin at all time points except at 72 h after treatment (P=0.170). The placebo group showed significantly higher pain scores than the other two groups. The percentage of pain relief was maximum for pregabalin (92.1%), followed by gabapentin (87.6%) and placebo (69.1%) at 72 h after treatment completion. CONCLUSION This study showed that pretreatment with a single dose of pregabalin and gabapentin both had greater analgesic effects than a placebo. They can be effectively used to reduce postoperative endodontic pain.
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Affiliation(s)
- Jayeeta Verma
- Conservative Dentistry and Endodontics, MGM Dental College and Hospital, Navi Mumbai, India
| | - Sidharth Verma
- Anesthesiology, Dr. DY Patil Medical College, Navi Mumbai, India
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12
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Multimodal Analgesia in the Aesthetic Plastic Surgery: Concepts and Strategies. Plast Reconstr Surg Glob Open 2022; 10:e4310. [PMID: 35572190 PMCID: PMC9094416 DOI: 10.1097/gox.0000000000004310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 03/17/2022] [Indexed: 12/13/2022]
Abstract
Postoperative pain management is crucial for aesthetic plastic surgery procedures. Poorly controlled postoperative pain results in negative physiologic effects and can affect length of stay and patient satisfaction. In light of the growing opioid epidemic, plastic surgeons must be keenly familiar with opioid-sparing multimodal analgesia regimens to optimize postoperative pain control. Methods A review study based on multimodal analgesia was conducted. Results We present an overview of pain management strategies pertaining to aesthetic plastic surgery and offer a multimodal analgesia model for outpatient aesthetic surgery practices. Conclusion This review article presents an evidence-based approach to multimodal pain management for aesthetic plastic surgery.
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Ling HQ, Chen ZH, He L, Feng F, Weng CG, Cheng SJ, Rong LM, Xie PG. Comparative Efficacy and Safety of 11 Drugs as Therapies for Adults With Neuropathic Pain After Spinal Cord Injury: A Bayesian Network Analysis Based on 20 Randomized Controlled Trials. Front Neurol 2022; 13:818522. [PMID: 35386408 PMCID: PMC8977449 DOI: 10.3389/fneur.2022.818522] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 02/07/2022] [Indexed: 12/13/2022] Open
Abstract
Objective To provide an updated analysis of the efficacy and safety of drugs for the management of neuropathic pain (NP) after spinal cord injury (SCI) based on Bayesian network analysis. Methods A Bayesian network meta-analysis of literature searches within PubMed, Cochrane Library, Embase, and Web of Science databases from their inception to February 21 2021 was conducted without language restrictions. Paired and network meta-analyses of random effects were used to estimate the total standardized mean deviations (SMDs) and odds ratios (ORs). Results A total of 1,133 citations were identified and 20 RCTs (including 1,198 patients) involving 11 drugs and placebos for post-SCI NP selected. The 5 outcomes from all 11 drugs and placebos had no inconsistencies after Bayesian network analysis. BTX-A gave the most effective pain relief for the 4 weeks, following a primary outcome. No significant differences were found among drugs with regard to adverse events of the primary outcome. Gabapentin, BTX-A, and pregabalin were found to be the most helpful in relieving secondary outcomes of mental or sleep-related symptoms with differences in SMDs, ranging from −0.63 to −0.86. Tramadol triggered more serious adverse events than any of the other drugs with differences in ORs ranging from 0.09 to 0.11. Conclusion BTX-A, gabapentin, pregabalin, amitriptyline, ketamine, lamotrigine, and duloxetine were all effective for NP management following SCI. Lamotrigine and gabapentin caused fewer side effects and had better efficacy in relieving mental or sleep-related symptoms caused by SCI-related NP. Tramadol, levetiracetam, carbamazepine, and cannabinoids could not be recommended due to inferior safety or efficacy. Systematic Review Registration [https://inplasy.com/inplasy-2020-7-0061/], identifier [INPLASY202070061].
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Affiliation(s)
- Hai-Qian Ling
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangzhou, China.,Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, Guangzhou, China.,Department of Orthopedics, Longgang Orthopedics Hospital of Shenzhen, Shenzhen, China
| | - Zi-Hao Chen
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangzhou, China.,Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, Guangzhou, China
| | - Lei He
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangzhou, China.,Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, Guangzhou, China
| | - Feng Feng
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangzhou, China.,Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, Guangzhou, China
| | - Chuang-Gui Weng
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangzhou, China.,Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, Guangzhou, China
| | - Si-Jin Cheng
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangzhou, China.,Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, Guangzhou, China
| | - Li-Min Rong
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangzhou, China.,Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, Guangzhou, China
| | - Pei-Gen Xie
- Department of Spine Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Center for Quality Control of Minimally Invasive Spine Surgery, Guangzhou, China.,Guangdong Provincial Center for Engineering and Technology Research of Minimally Invasive Spine Surgery, Guangzhou, China
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Schnack LL, Oexeman S, Rodriguez-Collazo ER. An Update on the Practical Management of a Hexapod System in Lower Limb Orthoplastic Reconstruction for Acute Shortening and Relengthening Procedures. EPLASTY 2022; 22:e6. [PMID: 35602524 PMCID: PMC9097907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Background. The use of circular external fixation is a fundamental necessity in the armamentarium of a lower limb orthoplastic reconstructive surgeon. External fixation offers orthoplastic surgeons the ability to address soft tissue and osseous defects simultaneously. Using Ilizarov principles, the reconstructive surgeon must have the ability to address unique scenarios when performing orthoplastic principles. This article offers practical surgical management concepts based on experience using the TL-Hex Orthofix Truelok Hexapod System for acute shortening and relengthening. A soft tissue and osseous defect can be managed through this surgical approach as a limb salvage alternative to amputation. The information provided will lead to improved management strategies and outcomes for the practitioner and patient when presented with soft tissue and osseous defects.
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15
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Li KLM, Chen YM, Wang XQ, Hu HY. Bibliometric Analysis of Studies on Neuropathic Pain Associated With Depression or Anxiety Published From 2000 to 2020. Front Hum Neurosci 2021; 15:729587. [PMID: 34552477 PMCID: PMC8450598 DOI: 10.3389/fnhum.2021.729587] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 08/13/2021] [Indexed: 12/11/2022] Open
Abstract
Objective: Neuropathic pain (NP) associated with depression or anxiety is highly prevalent in clinical practice. Publications about NP associated with depression or anxiety increased exponentially from 2000 to 2020. However, studies that applied the bibliometric method in analyzing global scientific research about NP associated with depression or anxiety are rare. This work used the bibliometric method to analyze the publications on NP associated with depression or anxiety between 2000 and 2020. Method: Publications from 2000 and 2020 were identified from the Thomson Reuters Web of Science (WoS) database. We employed CiteSpace V to conduct the bibliometric study. Results: A total of 915 articles or reviews were obtained from the WoS database. The number of publications has increased over the last two decades. The USA was the most productive among countries or regions in the field. According to the burst key words, neuroinflammation, hippocampus, safety, and modulation were the hot global research issues in the domain. Conclusion: Publications about NP associated with depression or anxiety have remarkably increased from 2000 to 2020. These historical opinions about NP associated with depression or anxiety could be an important practical basis for further research into potential development trends.
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Affiliation(s)
- Kai-Li-Mi Li
- School of Kinesiology, Shanghai University of Sport, Shanghai, China
| | - Yu-Meng Chen
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Xue-Qiang Wang
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China.,Shanghai Shangti Orthopaedic Hospital, Shanghai, China
| | - Hao-Yu Hu
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China.,Shanghai Shangti Orthopaedic Hospital, Shanghai, China
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16
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Karri SR, Jayaram K, Kumar A, Durga P. Comparison of efficacy of gabapentin and memantine premedication in laparoscopic cholecystectomies for postoperative pain relief - A randomised placebo controlled trial. Indian J Anaesth 2021; 65:539-544. [PMID: 34321685 PMCID: PMC8312383 DOI: 10.4103/ija.ija_140_21] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/06/2021] [Accepted: 06/30/2021] [Indexed: 11/16/2022] Open
Abstract
Background and Aims: The multiplicity of the mechanisms of the pain in laparoscopic cholecystectomy inclines us to the usage of multimodal analgesia. Gabapentin is known for its analgesic efficacy when given as premedication in many surgeries. N-methyl-D-aspartate (NMDA) antagonists are used for both acute and chronic pain, but the use of memantine in the perioperative period is less studied. The aim of this randomised controlled study was to subjectively and objectively compare postoperative pain relief using gabapentin, memantine and placebo as premedication. Methods: Sixty-six patients posted for laparoscopic cholecystectomy were randomised into three groups. During the preoperative assessment, the baseline threshold and tolerance values of pain were measured using an algesiometer. Patients were pre-medicated with oral gabapentin 600 mg or memantine 20 mg or placebo an hour before surgery. Following extubation, pain scores were reassessed (both subjectively and objectively) along with Ramsay sedation scores at different time intervals for 4 h postoperatively. Results: Gabapentin group had lower Numerical Rating Scale scores at 15 min and 1 h postoperatively when compared to the other two groups. Memantine group had a longer time for the first request for rescue analgesia (50.53 min) compared to gabapentin and placebo. The objective assessment of pain with analgesiometer showed no statistical significance between the three groups for both threshold and tolerance values. Ramsay sedation scores were higher in the gabapentin group compared to the other two. Conclusion: Gabapentin provides better postoperative pain relief compared to memantine when given as single dose premedication for laparoscopic cholecystectomy.
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Affiliation(s)
- Sujitha Reddy Karri
- Department of Anaesthesiology and Critical Care, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Kavitha Jayaram
- Department of Anaesthesiology and Critical Care, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Annekiran Kumar
- Department of Anaesthesiology and Critical Care, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Padmaja Durga
- Department of Anaesthesiology and Critical Care, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
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Leong WMS, Samuel M, Chandran NS, Choi CEE, Yiong Huak C, Marsden H, Tam WWS. Interventions for inherited forms of epidermolysis bullosa. Hippokratia 2021. [DOI: 10.1002/14651858.cd014223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Wai Mun Sean Leong
- Department of Dermatology; National University Hospital; Singapore Singapore
| | - Miny Samuel
- Research Support Unit; NUS Yong Loo Lin School of Medicine; Singapore Singapore
| | | | - Ci En Ellie Choi
- Internal Medicine; National University Hospital Singapore; Singapore Singapore
| | - Chan Yiong Huak
- Biostatistics Unit; Yong Loo Lin School of Medicine; Singapore Singapore
| | - Harriet Marsden
- c/o Cochrane Skin Group; The University of Nottingham; Nottingham UK
| | - Wilson Wai San Tam
- Alice Lee Center for Nursing Studies, Yong Loo Lin School of Medicine; National University of Singapore, National University Health System; Singapore Singapore
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18
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Motavallian A, Bouzari S, Zamani E, Karimian P, Dabirian S, Molavi M, Torshkooh FA. An investigation of the anti-inflammatory effects of gabapentin on acetic acid-induced colitis in rats. Mol Biol Rep 2021; 48:3423-3430. [PMID: 33928442 DOI: 10.1007/s11033-021-06357-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 04/16/2021] [Indexed: 12/31/2022]
Abstract
Inflammatory bowel disease (IBD) is considered a chronic inflammatory gastrointestinal disease with treatment options which exhibit low efficacies and lead to considerable side effects. Hence, the challenge to alleviate IBD complications is remained to be resolved. The purpose of this study is evaluating anti-inflammatory impacts of gabapentin on acetic acid-induced colitis in rats. Colitis was induced by the instillation of 2 mL of 3% acetic acid solution into rat's colons. Rats were randomly allocated into six groups including normal group, colitis control group, gabapentin-treated groups (25, 50, and 100 mg/kg; i.p.), and dexamethasone-treated group (1 mg/kg; i.p.). Based on the macroscopic assessment besides histological and biochemical findings [myeloperoxidase (MPO), pro-inflammatory cytokines], the efficacy of gabapentin was investigated. Gabapentin (50 and 100 mg/kg), and dexamethasone considerably reduced macroscopic and microscopic colonic lesions induced by acetic acid in rats in comparison with colitis control group. These results were confirmed by reduced levels of MPO activity and colonic concentrations of interleukin-6, interleukin-1 beta, and tumor necrosis factor-alpha, in inflamed colon tissue. Our data demonstrated that gabapentin exerts profitable impacts in experimental colitis that might be ascribed to its anti-inflammatory features and thus can be a potential therapeutic agent for IBD treatment.
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Affiliation(s)
- Azadeh Motavallian
- Department of Pharmacology and Toxicology, School of Pharmacy, Guilan University of Medical Sciences, Rasht, Iran. .,Rhino-Sinus, Ear, and Skull Base Diseases Research Center, Department of Otolaryngology and Head and Neck Surgery, Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
| | - Saba Bouzari
- Student Research Committee, School of Pharmacy, Guilan University of Medical Sciences, Rasht, Iran
| | - Ehsan Zamani
- Department of Pharmacology and Toxicology, School of Pharmacy, Guilan University of Medical Sciences, Rasht, Iran
| | - Paridokht Karimian
- Department of Pathology and Histology, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Sara Dabirian
- Department of Pharmaceutical Biotechnology, School of Pharmacy, Guilan University of Medical Sciences, Rasht, Iran
| | - Mehdi Molavi
- Department of Internal Medicine, School of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Forough Aghajani Torshkooh
- Department of Pharmacology and Toxicology, School of Pharmacy, Guilan University of Medical Sciences, Rasht, Iran
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Pafili K, Papanas N. Considerations for single- versus multiple-drug pharmacotherapy in the management of painful diabetic neuropathy. Expert Opin Pharmacother 2021; 22:2267-2280. [PMID: 33819123 DOI: 10.1080/14656566.2021.1909570] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The efficacy of monotherapy to reduce pain from diabetic peripheral neuropathy (DPN) is frequently not satisfactory and guidelines do not provide unanimous treatment options. In this context, multiple drug pharmacotherapy may provide benefit. AREAS COVERED The aim of the present review is to describe the clinical trials addressing the pharmacotherapy of painful DPN. Studies discussing efficacy and tolerability of pharmacological agents that were assessed in monotherapy and in combination treatment are reported and discussed. EXPERT OPINION Several clinical trials have reported benefit of multiple-drug pharmacotherapy. Nevertheless, untoward effects of combination treatment are of concern. Importantly, some trials were restricted to comparison with placebo and other compared only with active comparator(s). Only limited clinical trials assessed selected cohorts of individuals experiencing different stages of painful DPN. Despite current limitations, some evidence of studies implicating a comparison to all active comparators points to safety and effectiveness of the combination of oxycodone with pregabalin and that of pregabalin with the 5% lidocaine plaster but future, clear-cut studies are required to drive evidence-based decisions in the clinical setting.
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Affiliation(s)
- Kalliopi Pafili
- Diabetes Centre, Second Department of Internal Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Nikolaos Papanas
- Diabetes Centre, Second Department of Internal Medicine, Democritus University of Thrace, Alexandroupolis, Greece
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20
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Fortune S, Frawley J. Optimizing Pain Control and Minimizing Opioid Use in Trauma Patients. AACN Adv Crit Care 2021; 32:89-104. [PMID: 33725102 DOI: 10.4037/aacnacc2021519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Adverse effects of opioids and the ongoing crisis of opioid abuse have prompted providers to reduce prescribing opioids and increase use of multiple nonpharmacologic therapies, nonopioid analgesics, and co-analgesics for pain management in trauma patients. Nonopioid agents, including acetaminophen, nonsteroidal anti-inflammatory drugs, gabapentinoids, ketamine, central α2 agonists, and lidocaine, can be used as adjuncts or alternatives to opioids in the trauma population. Complementary therapies such as acupuncture, virtual reality, and mirror therapy are modalities that also may be helpful in reducing pain. Performing pain assessments is fundamental to identify pain and evaluate treatment effectiveness in the critically ill trauma patient. The efficacy, safety, and availability of opioid-sparing therapies and multimodal pain regimens are reviewed.
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Affiliation(s)
- Shanna Fortune
- Shanna Fortune is Advanced Practice Registered Nurse, Trauma Acute Pain Management Service, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, Maryland
| | - Jennifer Frawley
- Jennifer Frawley is Trauma Critical Care Clinical Pharmacy Specialist, University of Maryland Medical Center, 22 S Greene St, Baltimore, MD 21201
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21
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Wang J, Fu G, Liu J, Yu Y, Wang N. Effect of preoperative gabapentin after transurethral prostate resection under general anesthesia. A randomized double-blind, placebo-controlled trial. Saudi Med J 2020; 41:640-644. [PMID: 32518932 PMCID: PMC7502946 DOI: 10.15537/smj.2020.6.25132] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Objectives: To investigate whether preoperative oral gabapentin could reduce postoperative pain, analgesic consumption and the occurrence of catheter-related bladder discomfort (CRBD). Methods: In this study, participants randomly received either 600 mg gabapentin or placebo orally 2 h prior to transurethral prostate resection. Visual analogue scale and Ramsay sedation scale was utilized to assess pain intensity and sedation status after surgery. Intravenous 1.5 mg.kg-1 tramadol was used for postoperative analgesia. Pain intensity, sedation status, CRBD, tramadol consumption, side effects and the overall satisfaction degree were assessed and recorded for 48 h after tracheal extubation. Results: Ninety participants given gabapentin and 91 participants given placebo completed the study. Lower visual analogue scale scores, less tramadol consumption, longer time to the first analgesic requirement, lower incidence of CRBD and nausea and higher satisfaction degree were detected in the patients receiving gabapentin compared with the patients receiving placebo. Conclusion: Preoperative oral gabapentin reduced postoperative visual analogue scale scores, tramadol consumption and the occurrence rate of CRBD and nausea, and consequently, increased the degree of patients’ satisfaction after transurethral prostate resection.
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Affiliation(s)
- Jinguo Wang
- Department of Urology, The First Hospital of Jilin University, Jilin, China. E-mail.
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Dubey P, Thapliyal GK, Ranjan A. A Comparative Study Between Ondansetron and Gabapentin for Prevention of Postoperative Nausea and Vomiting Following Maxillofacial Surgery. J Maxillofac Oral Surg 2020; 19:616-623. [PMID: 33071512 DOI: 10.1007/s12663-020-01366-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 04/02/2020] [Indexed: 11/25/2022] Open
Abstract
Background and Aim Gabapentin is an antiepileptic drug with antiemetic properties. We evaluated prophylactic oral gabapentin as compared with ondansetron for postoperative nausea and vomiting (PONV) in patients undergoing maxillo facial surgery. Settings and Design A double-blind, randomized study in a teaching hospital. Materials and Methods Seventy patients of ASA physical status I and II, scheduled to undergo maxillofacial surgery, were randomly assigned into two groups to receive 300 mg gabapentin or 8 mg ondansetron 1 h before surgery. Standard anaesthesia technique was used in all patients. Students' t test for difference of means between two groups was used for continuous variables. Chi square or Fisher's exact test was used for comparing proportion between two groups. Kaplan-Meier survival analysis was performed to compare the time to event observed between ondansetron and gabapentin groups. Log-rank test was performed to detect statistical significance of time to events between two groups. Results There was no significant difference in incidence of PONV between two groups within 2 h postoperatively. No incidence of PONV was observed in gabapentin group within 2-24 h as compared to ondansetron group in which PONV was observed in five cases. Conclusion Gabapentin effectively suppresses PONV in maxillo facial surgery.
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Affiliation(s)
- Preksha Dubey
- Department of Oral and Maxillofacial Surgery, ITS Dental College and Research Centre, Greater Noida, 201308 India
| | - Gopal K Thapliyal
- Department of Oral and Maxillofacial Surgery, ITS Dental College and Research Centre, Greater Noida, 201308 India
| | - Alok Ranjan
- Department of Social and Preventive Medicine, All India Institute of Medical Sciences, Patna, India
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Mariano ER, Schatman ME. A Commonsense Patient-Centered Approach to Multimodal Analgesia Within Surgical Enhanced Recovery Protocols. J Pain Res 2019; 12:3461-3466. [PMID: 31920369 PMCID: PMC6935269 DOI: 10.2147/jpr.s238772] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 12/14/2019] [Indexed: 12/18/2022] Open
Affiliation(s)
- Edward R Mariano
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA.,Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Michael E Schatman
- Department of Public Health & Community Medicine, Tufts University School of Medicine, Boston, MA, USA.,Department of Diagnostic Sciences, Tufts University School of Dental Medicine, Boston, MA, USA
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Lee TS, Wang LL, Yi DI, Prasanna PD, Kandl C. Opioid sparing multimodal analgesia treats pain after head and neck microvascular reconstruction. Laryngoscope 2019; 130:1686-1691. [DOI: 10.1002/lary.28402] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 09/22/2019] [Accepted: 10/15/2019] [Indexed: 01/06/2023]
Affiliation(s)
- Thomas S. Lee
- Department of Otolaryngology Head and Neck SurgeryVirginia Commonwealth University (VCU) Richmond Virginia U.S.A
| | - Lexie L. Wang
- Department of Otolaryngology Head and Neck SurgeryVirginia Commonwealth University (VCU) Richmond Virginia U.S.A
| | - Dae Ik Yi
- Department of Otolaryngology Head and Neck SurgeryVirginia Commonwealth University (VCU) Richmond Virginia U.S.A
| | - Praveen D. Prasanna
- Department of AnesthesiologyVirginia Commonwealth University (VCU) Richmond Virginia U.S.A
| | - Christopher Kandl
- Department of Otolaryngology Head and Neck SurgeryVirginia Commonwealth University (VCU) Richmond Virginia U.S.A
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Abstract
Given the strong influence of mental and social health on symptom intensity and magnitude of limitations, attempts to increase value in orthopedic trauma must attend to emotional and social recovery. Low value and potentially harmful interventions after trauma such as excessive reliance on medication, low value surgeries for "delayed healing" or "symptomatic implants," repeated visits with a physical therapist, and other biomedical interventions often reflect misdiagnosis and mismanagement of social and mental health. A better approach is to anticipate emotional and social recovery; to get social and mental health specialists involved immediately after injury; and to develop strategies that set firm limits on biomedical tests and treatments that are unlikely to contribute to health and risk reinforcing stress, distress, and less effective coping strategies.
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Townsend M, Liou T, Kallogjeri D, Schoer M, Scott-Wittenborn N, Lindburg M, Bottros M, Jackson RS, Nussenbaum B, Piccirillo JF. Effect of Perioperative Gabapentin Use on Postsurgical Pain in Patients Undergoing Head and Neck Mucosal Surgery: A Randomized Clinical Trial. JAMA Otolaryngol Head Neck Surg 2019; 144:959-966. [PMID: 29710075 DOI: 10.1001/jamaoto.2018.0282] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Importance Effective postoperative pain management increases patient satisfaction, reduces cost, reduces morbidity, and shortens hospitalizations. Previous studies investigating multimodal pain therapy in otolaryngology patients focused on homogenous patient groups with short postoperative follow-up times. Objective To investigate the effect of perioperative gabapentin treatment on postsurgical pain in patients undergoing head and neck mucosal surgery. Design, Setting, and Participants Adults undergoing head and neck mucosal surgery from July 25, 2016, through June 19, 2017, were included in this double-blinded, placebo-controlled randomized clinical trial and randomized to receive gabapentin, 300 mg twice daily, or placebo before surgery and up to 72 hours after surgery. Main Outcomes and Measures Primary outcome was hourly narcotic use calculated in morphine equivalents. Secondary outcomes included subjective visual analog scale pain scores captured for resting, coughing, and swallowing using a 0- to 100-mm scale (a 100-mm line anchored with no pain on the left end and worst possible pain on the right end). A change of 10 mm or more was deemed to be clinically meaningful. Additional secondary outcome measures included degree of pain control, patient satisfaction, and adverse effects. Results Of the 110 patients randomized to receive gabapentin or placebo, 11 and 10 withdrew from each group, respectively. Ninety patients were then analyzed: 44 in the gabapentin group (mean [SD] age, 61.1 [10.0] years; 33 [75%] male; 40 [91%] white) and 46 in the placebo group (mean [SD] age, 60.9 [11.3] years; 35 [78%] male; 43 [94%] white). Both groups had similar self-reported levels of preoperative pain and narcotic effectiveness. A median difference of 0.26 mg/h of morphine (95% CI, -0.27 to 0.94 mg/h) was found between groups. After controlling for comorbidity and self-reported baseline pain levels, mixed model analysis found the difference in marginal means of visual analog scale scores between groups to be lower in the gabapentin group compared with the placebo group for all categories (rest difference, 7.9 mm; 95% CI, -0.4 to 16.2 mm; cough difference, 8.9 mm; 95% CI, -0.5 to 18.3 mm; swallow difference, 9.4 mm; 95% CI, -1.2 to 20.0 mm). More patients in the gabapentin group reported that pain was always well controlled than in the placebo group (difference, 9.2%; 95% CI, -21% to 3%). Gabapentin and placebo groups reported similar levels of satisfaction with pain control (difference, 2%; 95% CI, -11% to 15%). There was no clinically meaningful difference in reported nausea between the 2 groups (difference, 6%; 95% CI, -14% to 26%). Conclusion and Relevance Perioperative gabapentin given 300 mg twice daily did not result in reduced narcotic use, but results were compatible with clinically meaningful reductions in pain scores. Satisfaction with pain control and adverse effects were similar between groups. Trial Registration ClinicalTrials.gov Identifier: NCT02926573.
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Affiliation(s)
- Melanie Townsend
- Department of Otolaryngology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Tina Liou
- Department of Otolaryngology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Dorina Kallogjeri
- Department of Otolaryngology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Morgan Schoer
- Department of Otolaryngology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Nicholas Scott-Wittenborn
- Department of Otolaryngology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Miranda Lindburg
- Department of Otolaryngology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Michael Bottros
- Department of Otolaryngology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Ryan S Jackson
- Department of Otolaryngology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Brian Nussenbaum
- Department of Otolaryngology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Jay F Piccirillo
- Department of Otolaryngology, Washington University School of Medicine in St Louis, St Louis, Missouri.,Editor
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Xu Z, Huang JW, Xia CJ, Zou SP, Xue YP, Zheng YG. Enhanced catalytic stability and reusability of nitrilase encapsulated in ethyleneamine-mediated biosilica for regioselective hydrolysis of 1-cyanocycloalkaneacetonitrile. Int J Biol Macromol 2019; 130:117-124. [DOI: 10.1016/j.ijbiomac.2019.02.131] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 02/22/2019] [Accepted: 02/22/2019] [Indexed: 01/08/2023]
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Bourazani M, Papageorgiou E, Zarkadas G, Petrakopoulou T, Kaba E, Fasoi G, Kelesi M. The Role of Muscle Relaxants – Spasmolytic (Thiocochlicoside) in Postoperative Pain Management after Mastectomy and Breast Reconstruction. Asian Pac J Cancer Prev 2019; 20:743-749. [PMID: 30909680 PMCID: PMC6825793 DOI: 10.31557/apjcp.2019.20.3.743] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Purpose: Post-operative pain after breast cancer surgery is a major problem and women undergoing mastectomy and breast reconstruction experience post-operative pain syndromes in approximately one-half of all cases. Patients who have undergone breast reconstruction after mastectomy can suffer from acute postoperative pain with moderate or strong tension. In some cases, chronic neuropathic pain syndromes may occur after surgery. Opioids are used to treat pain, with serious side effects. The systemic postoperative analgesic regimen as thiocochlicoside P.O. along with paracetamol and NSAIDs I.V., which may limit the administration of opioids without reducing pain relief, seems to be necessary. Materials and Methods: This study was a clinical trial randomizing 70 patients undergoing breast reconstruction. Two main protocols of systematic post-operative analgesia, one using thiocochlicoside (group A) and the other without them (group B), were used. Both groups received paracetamol X3 and lornoxicam X2 I.V. systematically. The pain measurement scale (NPS) used to measure post-operative pain. Likert scales were used to evaluate patient’s satisfaction and the difficulty from the side effects . An anonymous questionnaire was used for the data collection. Results: Statistically significant difference was found between pain on the day of surgery (p = 0.017) as well as the three subsequent days (p = 0.000). In group A , pain was reduced directly to half (Χ2 surgery pain = 93.888, p = 0.000) especially on the first post-operative day. In group A the satisfaction with analgesic treatment was higher than in group B (p = 0.002). Conclusion: The use of thiocochlicoside in post-operative analgesia in breast reconstruction after mastectomy contributes to reduce the pain intensity experienced by patients and to reduce the side effects of opioid analgesics as a result of reduced demand for opioid analgesics. Patients who received the analgesia using muscle relaxants-spasmolytic reported greater satisfaction.
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Affiliation(s)
- Maria Bourazani
- Department of Anesthesiology, Hellenic Anticancer Institute, Saint Savvas Hospital, Greece.
| | | | | | | | - Evridiki Kaba
- Department of Nursing, University of West Attikis, Greece
| | - Georgia Fasoi
- Department of Nursing, University of West Attikis, Greece
| | - Martha Kelesi
- Department of Nursing, Technological Educational Institute of Athens, Athens, Greece
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McConnell G, Woltz P, Bradford WT, Ledford JE, Williams JB. Enhanced recovery after cardiac surgery program to improve patient outcomes. Nursing 2018; 48:24-31. [PMID: 30286030 DOI: 10.1097/01.nurse.0000546453.18005.3f] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This article details the obstacles of implementing a cardiac-specific enhanced recovery after surgery (ERAS) program in a 919-bed not-for-profit community-based health system and the benefits of ERAS programs for different patient populations.
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Affiliation(s)
- Gina McConnell
- All authors are affiliated with WakeMed Health and Hospitals in Raleigh, N.C.: Gina McConnell and Patricia Woltz in the Department of Nursing, William T. Bradford in the Department of Anesthesia, J. Erin Ledford in the Department of Pharmacy, and Judson B. Williams in the Department of Surgery
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LC-MS/MS Quantification of Tramadol and Gabapentin Utilizing Solid Phase Extraction. Int J Anal Chem 2018; 2018:1605950. [PMID: 30510578 PMCID: PMC6230401 DOI: 10.1155/2018/1605950] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 06/11/2018] [Accepted: 07/11/2018] [Indexed: 11/17/2022] Open
Abstract
An accurate, highly sensitive, and precise method for quantitative analysis of tramadol (TMD) and gabapentin (GBP) by high performance liquid chromatography and tandem mass spectrometry in human plasma was proposed and validated successfully using venlafaxine and pregabalin as internal standards (ISTDs), respectively. An aliquot of 200 μL of plasma was mixed with internal standard dilution and extraction was performed by using solid phase extraction (SPE) technique. Peak resolution was achieved on Phenomenex PFP column (50×4.6 mm, 2.6 μm). The total analytical run time was 3.8 min. Both analytes were monitored using multiple reaction monitoring (MRM) scan and the mass spectrometer was operated in positive polarity mode. The method was validated for specificity, sensitivity, precision, accuracy, and other analytical parameters. The results found were satisfactory over the linear calibration range of 1-500 ng/mL and 10-6000 ng/mL for TMD and GBP, respectively. The developed method can be ready to use by scientific community for quantification of analytes in plasma samples from various clinical studies of different dose strengths.
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Ghaly RF, Plesca A, Rana S, Candido KD, Knezevic NN. Gabapentin-related suicide: Myth or fact? Surg Neurol Int 2018; 9:210. [PMID: 30488008 PMCID: PMC6213802 DOI: 10.4103/sni.sni_420_17] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 12/01/2017] [Indexed: 01/07/2023] Open
Abstract
Background: The opioid epidemic in America is real and is estimated to be the number one cause of death in adults under 50 years of age. Finding alternative analgesic medications is part of the effort to decrease the prescription of narcotics, with gabapentin being at the top of the list. Case Description: In the present case, we discuss the side-effects of gabapentin, used as part of the multimodal treatment approach of painful spinal degenerative disease. The patient stated that he had noticed personality changes after gabapentin was initiated, and that he had become more depressed, frustrated, and aggressive. His uncontrolled pain and acute mood changes led him to attempt suicide by hanging himself. Gabapentin was discontinued and the patient's suicidal ideation completely subsided. Conclusion: It is imperative to screen, identify, and appropriately manage patients with underlying psychiatric disorders prior to initiating pain management with gabapentin. Therefore, it is crucial to raise awareness of gabapentin as a potential cause of depression, aggressive behavior, and suicidal ideation.
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Affiliation(s)
- Ramsis F Ghaly
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA.,Ghaly Neurosurgical Associates, Aurora, Chicago, Illinois, USA.,Department of Anesthesiology, University of Illinois, Chicago, Illinois, USA
| | - Ana Plesca
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA
| | - Shalini Rana
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA
| | - Kenneth D Candido
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA.,Department of Anesthesiology, University of Illinois, Chicago, Illinois, USA
| | - Nebojsa Nick Knezevic
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA.,Department of Anesthesiology, University of Illinois, Chicago, Illinois, USA
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Effects of Gabapentinoids Premedication on Shoulder Pain and Rehabilitation Quality after Laparoscopic Cholecystectomy: Pregabalin versus Gabapentin. Pain Res Manag 2018; 2018:9834059. [PMID: 30123399 PMCID: PMC6079331 DOI: 10.1155/2018/9834059] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 06/25/2018] [Indexed: 12/22/2022]
Abstract
Introduction Gabapentinoids are increasingly used in preoperative premedication despite controversial results. The aim of our study was to evaluate the effects of preemptive use of gabapentin or pregabalin on postoperative shoulder pain and rehabilitation quality after laparoscopic cholecystectomy. Methods This is a clinical trial comparing the effects of a preoperative premedication with 600 mg of gabapentin or 150 mg of pregabalin versus placebo on postoperative pain and recovery quality after laparoscopic cholecystectomy. Premedication was taken 2 hours before the surgery beginning. Ninety patients were included and randomized into 3 groups (gabapentin, pregabalin, and placebo). The anesthetic protocol was the same for all patients. Primary endpoint was the shoulder pain intensity at the 48th postoperative hour. Secondary endpoints were postoperative nausea and vomiting (PONV), sleep quality during the first night, and the onset time for the first standing position. Results During the first 48 postoperative hours, the gabapentin and pregabalin groups had significantly lower shoulder pain than the placebo group (p < 0.05). In gabapentinoids groups, the incidence of PONV was lower and the sleep quality during the first postoperative night was better with significant results. Mean Spiegel scores were 22.43 ± 1.45, 22.30 ± 1.44, and 17.17 ± 1.66, respectively, in pregabalin, gabapentin, and placebo groups (p < 0.05). The delay for the first standing position was 14.9 ± 4.9 hours in the pregabalin group, 9.7 ± 3.6 hours in the gabapentin group, and 21.6 ± 2.1 hours in the placebo group. No superiority was found between gabapentin and pregabalin. Conclusion Preemptive premedication with gabapentinoids can enhance postoperative rehabilitation quality after laparoscopic cholecystectomy by reducing postoperative shoulder pain, decreasing PONV incidence, and improving sleep quality during the first postoperative night. This trial is registered with ClinicalTrial.gov (NCT03241875).
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Antiepileptic drugs as analgesics/adjuvants in inflammatory pain: current preclinical evidence. Pharmacol Ther 2018; 192:42-64. [PMID: 29909236 DOI: 10.1016/j.pharmthera.2018.06.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 06/04/2018] [Indexed: 12/20/2022]
Abstract
Inflammatory pain is the most common type of pain that is treated clinically. The use of currently available treatments (classic analgesics - NSAIDs, paracetamol and opioids) is limited by insufficient efficacy and/or side effects/tolerance development. Antiepileptic drugs (AEDs) are widely used in neuropathic pain treatment, but there is substantial preclinical evidence on their efficacy against inflammatory pain, too. In this review we focus on gabapentinoids (gabapentin and pregabalin) and dibenzazepine AEDs (carbamazepine, oxcarbazepine, and recently introduced eslicarbazepine acetate) and their potential for relieving inflammatory pain. In models of somatic, visceral and trigeminal inflammatory pain, that have a translational value for inflammatory conditions in locomotor system, viscera and head/face, AEDs have demonstrated analgesic activity. This activity was mostly consistent, dependent on the dose and largely independent on the site of inflammation and method of its induction, nociceptive stimuli, species, specific drug used, its route of administration and dosing schedule. AEDs exerted comparable efficacy with classic analgesics. Effective doses of AEDs are lower than toxic doses in animals and, when expressed as equivalent human doses, they are largely overlapping with AEDs doses already used in humans for treating epilepsy/neuropathic pain. The main mechanism of antinociceptive/antihyperalgesic action of gabapentinoids in inflammatory pain models seems to be α2δ-dependent suppression of voltage-gated calcium channels in primary sensory neurons that leads to reduced release of neurotransmitters in the spinal/medullar dorsal horn. The suppression of NMDA receptors via co-agonist binding site primarily at spinal sites, activation of various types of K+ channels at spinal and peripheral sites, and activation of noradrenergic and serotonergic descending pain modulatory pathways may also contribute. Inhibition of voltage-gated sodium channels along the pain pathway is probably the main mechanism of antinociceptive/antihyperalgesic effects of dibenzazepines. The recruitment of peripheral adrenergic and purinergic mechanisms and central GABAergic mechanisms may also contribute. When co-administered with classic/other alternative analgesics, AEDs exerted synergistic/additive interactions. Reviewed data could serve as a basis for clinical studies on the efficacy/safety of AEDs as analgesics/adjuvants in patients with inflammatory pain, and contribute to the improvement of the treatment of various inflammatory pain states.
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Dai H, Tilley DM, Mercedes G, Doherty C, Gulati A, Mehta N, Khalil A, Holzhaus K, Reynolds FM. Opiate-Free Pain Therapy Using Carbamazepine-Loaded Microparticles Provides Up to 2 Weeks of Pain Relief in a Neuropathic Pain Model. Pain Pract 2018; 18:1024-1035. [PMID: 29723917 DOI: 10.1111/papr.12705] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 04/19/2018] [Accepted: 04/22/2018] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Opioids remain a mainstay in the treatment of acute and chronic pain, despite numerous and potentially dangerous side effects. There is a great unmet medical need for alternative treatments for patients suffering from pain that do not result in addiction or adverse side effects. Anticonvulsants have been shown to be effective in managing pain, though high systemic levels and subsequent side effects limit their widespread usage. Our goal was to determine if the incorporation of an anticonvulsant, carbamazepine, into a biodegradable microparticle for local sustained perineural release would be an efficacious analgesic following a peripheral injury. METHODS Following induction of the chronic constriction injury model in Sprague-Dawley rats, mechanical allodynia testing was performed using von Frey filaments and thermal allodynia was evaluated using the Hargreaves method. Histology and blood work were performed to evaluate toxicity as well as to monitor drug and metabolite presence over time. RESULTS A 2-fold increase in hindpaw withdrawal thresholds in animals receiving carbamazepine-loaded microparticles relative to controls was observed for up to 14 days after treatment. Drug and metabolite had a peak blood concentration of 54.7 ng/mL and dropped off exponentially to < 5 ng/mL over a few days. CONCLUSION This formulation reduced systemic exposure to carbamazepine over 1,000-fold relative to traditional analgesic dosing regimens. This 2-component drug delivery system has been specifically engineered to release a controlled amount of carbamazepine over a 14-day period, providing significant pain relief with no toxicological or observable adverse events via behavioral or histochemical analysis.
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Affiliation(s)
- Haining Dai
- PixarBio Corporation, Salem, New Hampshire, U.S.A
| | | | | | | | - Amitabh Gulati
- Department of Anesthesiology and Critical Care, Memorial Sloan Kettering Cancer Center, New York City, New York, U.S.A
| | - Neel Mehta
- Department of Anesthesiology, Weill Cornell Medical College, New York City, New York, U.S.A
| | - Amer Khalil
- PixarBio Corporation, Salem, New Hampshire, U.S.A.,Department of Neurosurgery, University of California Irvine, Irvine, California, U.S.A
| | | | - Francis M Reynolds
- PixarBio Corporation, Salem, New Hampshire, U.S.A.,Frank Reynolds Corporation, Salem, New Hampshire, U.S.A
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Does low-dose gapapentin reduce opioid use postoperatively?: A randomized controlled trial in women undergoing reconstructive pelvic surgery. Int Urogynecol J 2018; 30:211-217. [PMID: 29564507 DOI: 10.1007/s00192-018-3617-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 01/25/2018] [Indexed: 10/17/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Pre-emptive gabapentin has been shown to decrease postoperative pain in abdominal and vaginal hysterectomy. However, the effect of pre-emptive low-dose gabapentin has not been studied in vaginal hysterectomy combined with concomitant pelvic reconstruction. METHODS A randomized double-blind placebo-controlled trial assessed all women seen for symptomatic prolapse requiring vaginal hysterectomy with concomitant pelvic reconstruction with or without midurethral sling. Gabapentin dosing was 600 mg (<65 years) or 300 mg (>65 years). The primary outcome was reduction in opioid consumption in the first 24 h after surgery. Secondary outcomes included sedation and prolongation of recovery room stay. Sample-size calculations indicated a need for 22 participants/group. Student's t test was used to compare differences in oral administration of morphine equivalents in the first 24 h postoperatively, time from end of surgery to leaving the recovery room, and length of recovery room stay. Mann-Whitney U test was used to compare visual analog scale (VAS) scores for anxiety, drowsiness/sedation, pain, and nausea. RESULTS Twenty-one patients received gabapentin and 26 a placebo capsule. Groups were similar with respect to age, menopause status, parity, American Society of Anesthesiologist (ASA) class, and concomitant procedures. There were also no significant differences between groups in opioid requirements within the first 24 h after surgery, time from end of surgery to leaving the recovery room, length of time in recovery room, or VAS scores. CONCLUSIONS Pre-emptive gabapentin at our institutional low doses did not significantly affect postoperative pain and opioid requirements in women undergoing vaginal hysterectomy with concomitant reconstruction. TRIAL REGISTRATION www.clinicaltrials.gov , #NCT02999724.
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Affiliation(s)
- Darin J Correll
- From the Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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38
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Salama ER, Amer AF. The effect of pre-emptive gabapentin on anaesthetic and analgesic requirements in patients undergoing rhinoplasty: A prospective randomised study. Indian J Anaesth 2018; 62:197-201. [PMID: 29643553 PMCID: PMC5881321 DOI: 10.4103/ija.ija_736_17] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background and Aims: Hypotensive anaesthesia is necessary in rhinoplasty for better visualisation of surgical field and reduction of surgery time. Gabapentin is a new generation anticonvulsant with anti-hyperalgesic and anti-nociceptive properties. We aimed to investigate the effect of pre-operative administration of oral gabapentin (1200 mg) on anaesthetic requirements and post-operative analgesic consumption and its role in hypotensive anaesthesia for rhinoplasty. Methods: Seventy adult patients undergoing rhinoplasty, were randomly allocated to two groups. Group I (G I) (n = 35) received gabapentin 1.2 g and Group II (G II) (n = 35) received oral placebo capsules 2 h before surgery. General anaesthesia was maintained with sevoflurane in oxygen-nitrous oxide to maintain bispectral index value between 40 and 60, and remifentanil infusion to keep mean arterial pressure (MAP) at 55–60 mmHg. End-tidal sevoflurane concentration, intra-operative remifentanil consumption and time to intended MAP were recorded. Visual analogue scale (VAS) scores, post-operative analgesic requirements and side effects for the first 24 h were recorded. Results: G I required significantly lower intra-operative remifentanil (G I = 0.8 ± 0.26 mg and G II = 1.7 ± 0.42 mg; P = 0.001) and end-tidal sevoflurane concentration, with reduced doses of post-operative tramadol and diclofenac sodium. Time to the intended MAP was significantly less in G I than G II (59.1 ± 12.3 vs. 73.6 ± 16.4, respectively, with P = 0.001). Conclusion: Pre-operative oral gabapentin significantly reduced intra-operative remifentanil and sevoflurane requirements during hypotensive anaesthesia along with decreased post-operative analgesic requirement.
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Affiliation(s)
- Eman Ramadan Salama
- Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Asmaa Fawzy Amer
- Department of Anesthesia and Surgical Intensive Care, Faculty of Medicine, Tanta University, Tanta, Egypt
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Buchakjian MR, Davis AB, Sciegienka SJ, Pagedar NA, Sperry SM. Longitudinal Perioperative Pain Assessment in Head and Neck Cancer Surgery. Ann Otol Rhinol Laryngol 2017; 126:646-653. [DOI: 10.1177/0003489417723034] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: To evaluate perioperative pain in patients undergoing major head and neck cancer surgery and identify associations between preoperative and postoperative pain characteristics. Methods: Patients undergoing head and neck surgery with regional/free tissue transfer were enrolled. Preoperative pain and validated screens for symptoms (neuropathic pain, anxiety, depression, fibromyalgia) were assessed. Postoperatively, patients completed a pain diary for 4 weeks. Results: Twenty-seven patients were enrolled. Seventy-eight percent had pain prior to surgery, and for 38%, the pain had neuropathic characteristics. Thirteen patients (48%) completed at least 2 weeks of the postoperative pain diary. Patients with moderate/severe preoperative pain report significantly greater pain scores postoperatively, though daily pain decreased at a similar linear rate for all patients. Patients with more severe preoperative pain consumed greater amounts of opioids postoperatively, and this correlated with daily postoperative pain scores. Patients who screened positive for neuropathic pain also reported worse postoperative pain. Conclusion: Longitudinal perioperative pain assessment in head and neck patients undergoing surgery suggests that patients with worse preoperative pain continue to endorse worse pain postoperatively and require more narcotics. Patients with preoperative neuropathic pain also report poor pain control postoperatively, suggesting an opportunity to identify these patients and intervene with empiric neuropathic pain treatment.
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Affiliation(s)
- Marisa R. Buchakjian
- Department of Otolaryngology–Head and Neck Surgery, University of Iowa Hospitals & Clinics, Iowa City, Iowa, USA
- Holden Comprehensive Cancer Center, University of Iowa Hospitals & Clinics, Iowa City, Iowa, USA
| | - Andrew B. Davis
- Department of Otolaryngology–Head and Neck Surgery, University of Iowa Hospitals & Clinics, Iowa City, Iowa, USA
| | | | - Nitin A. Pagedar
- Department of Otolaryngology–Head and Neck Surgery, University of Iowa Hospitals & Clinics, Iowa City, Iowa, USA
| | - Steven M. Sperry
- Department of Otolaryngology–Head and Neck Surgery, University of Iowa Hospitals & Clinics, Iowa City, Iowa, USA
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Wiffen PJ, Derry S, Bell RF, Rice ASC, Tölle TR, Phillips T, Moore RA. Gabapentin for chronic neuropathic pain in adults. Cochrane Database Syst Rev 2017; 6:CD007938. [PMID: 28597471 PMCID: PMC6452908 DOI: 10.1002/14651858.cd007938.pub4] [Citation(s) in RCA: 157] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Gabapentin is commonly used to treat neuropathic pain (pain due to nerve damage). This review updates a review published in 2014, and previous reviews published in 2011, 2005 and 2000. OBJECTIVES To assess the analgesic efficacy and adverse effects of gabapentin in chronic neuropathic pain in adults. SEARCH METHODS For this update we searched CENTRAL), MEDLINE, and Embase for randomised controlled trials from January 2014 to January 2017. We also searched the reference lists of retrieved studies and reviews, and online clinical trials registries. SELECTION CRITERIA We included randomised, double-blind trials of two weeks' duration or longer, comparing gabapentin (any route of administration) with placebo or another active treatment for neuropathic pain, with participant-reported pain assessment. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed trial quality and potential bias. Primary outcomes were participants with substantial pain relief (at least 50% pain relief over baseline or very much improved on Patient Global Impression of Change scale (PGIC)), or moderate pain relief (at least 30% pain relief over baseline or much or very much improved on PGIC). We performed a pooled analysis for any substantial or moderate benefit. Where pooled analysis was possible, we used dichotomous data to calculate risk ratio (RR) and number needed to treat for an additional beneficial outcome (NNT) or harmful outcome (NNH). We assessed the quality of the evidence using GRADE and created 'Summary of findings' tables. MAIN RESULTS We included four new studies (530 participants), and excluded three previously included studies (126 participants). In all, 37 studies provided information on 5914 participants. Most studies used oral gabapentin or gabapentin encarbil at doses of 1200 mg or more daily in different neuropathic pain conditions, predominantly postherpetic neuralgia and painful diabetic neuropathy. Study duration was typically four to 12 weeks. Not all studies reported important outcomes of interest. High risk of bias occurred mainly due to small size (especially in cross-over studies), and handling of data after study withdrawal.In postherpetic neuralgia, more participants (32%) had substantial benefit (at least 50% pain relief or PGIC very much improved) with gabapentin at 1200 mg daily or greater than with placebo (17%) (RR 1.8 (95% CI 1.5 to 2.1); NNT 6.7 (5.4 to 8.7); 8 studies, 2260 participants, moderate-quality evidence). More participants (46%) had moderate benefit (at least 30% pain relief or PGIC much or very much improved) with gabapentin at 1200 mg daily or greater than with placebo (25%) (RR 1.8 (95% CI 1.6 to 2.0); NNT 4.8 (4.1 to 6.0); 8 studies, 2260 participants, moderate-quality evidence).In painful diabetic neuropathy, more participants (38%) had substantial benefit (at least 50% pain relief or PGIC very much improved) with gabapentin at 1200 mg daily or greater than with placebo (21%) (RR 1.9 (95% CI 1.5 to 2.3); NNT 5.9 (4.6 to 8.3); 6 studies, 1277 participants, moderate-quality evidence). More participants (52%) had moderate benefit (at least 30% pain relief or PGIC much or very much improved) with gabapentin at 1200 mg daily or greater than with placebo (37%) (RR 1.4 (95% CI 1.3 to 1.6); NNT 6.6 (4.9 to 9.9); 7 studies, 1439 participants, moderate-quality evidence).For all conditions combined, adverse event withdrawals were more common with gabapentin (11%) than with placebo (8.2%) (RR 1.4 (95% CI 1.1 to 1.7); NNH 30 (20 to 65); 22 studies, 4346 participants, high-quality evidence). Serious adverse events were no more common with gabapentin (3.2%) than with placebo (2.8%) (RR 1.2 (95% CI 0.8 to 1.7); 19 studies, 3948 participants, moderate-quality evidence); there were eight deaths (very low-quality evidence). Participants experiencing at least one adverse event were more common with gabapentin (63%) than with placebo (49%) (RR 1.3 (95% CI 1.2 to 1.4); NNH 7.5 (6.1 to 9.6); 18 studies, 4279 participants, moderate-quality evidence). Individual adverse events occurred significantly more often with gabapentin. Participants taking gabapentin experienced dizziness (19%), somnolence (14%), peripheral oedema (7%), and gait disturbance (14%). AUTHORS' CONCLUSIONS Gabapentin at doses of 1800 mg to 3600 mg daily (1200 mg to 3600 mg gabapentin encarbil) can provide good levels of pain relief to some people with postherpetic neuralgia and peripheral diabetic neuropathy. Evidence for other types of neuropathic pain is very limited. The outcome of at least 50% pain intensity reduction is regarded as a useful outcome of treatment by patients, and the achievement of this degree of pain relief is associated with important beneficial effects on sleep interference, fatigue, and depression, as well as quality of life, function, and work. Around 3 or 4 out of 10 participants achieved this degree of pain relief with gabapentin, compared with 1 or 2 out of 10 for placebo. Over half of those treated with gabapentin will not have worthwhile pain relief but may experience adverse events. Conclusions have not changed since the previous update of this review.
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Affiliation(s)
| | | | - Rae Frances Bell
- Haukeland University HospitalRegional Centre of Excellence in Palliative CareBergenNorway
| | - Andrew SC Rice
- Imperial College LondonPain Research, Department of Surgery and Cancer, Faculty of MedicineLondonUKSW10 9NH
| | - Thomas Rudolf Tölle
- Technische Universität MünchenDepartment of Neurology, Klinikum Rechts der IsarMöhlstrasse 28MunichGermany81675
| | - Tudor Phillips
- University of OxfordPain Research and Nuffield Department of Clinical Neurosciences (Nuffield Division of Anaesthetics)Churchill HospitalOxfordUKOX3 7LJ
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Kim KM, Huh J, Lee SK, Park EY, Lee JM, Kim HJ. Combination of gabapentin and ramosetron for the prevention of postoperative nausea and vomiting after gynecologic laparoscopic surgery: a prospective randomized comparative study. BMC Anesthesiol 2017; 17:65. [PMID: 28525981 PMCID: PMC5438521 DOI: 10.1186/s12871-017-0357-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 05/11/2017] [Indexed: 11/21/2022] Open
Abstract
Background As a drug originally introduced for its anticonvulsant effects, gabapentin has been recently shown to be effective in the treatment of nausea and vomiting in various clinical settings. This study compared the antiemetic efficacy of oral gabapentin, intravenous ramosetron and gabapentin plus ramosetron in patients receiving fentanyl-based patient-controlled analgesia after laparoscopic gynecologic surgery. Methods One hundred and thirty two patients undergoing laparoscopic gynecologic surgery under general anesthesia were allocated randomly into three groups: group G received 300 mg oral gabapentin 1 h before anesthesia, group R received 0.3 mg intravenous ramosetron at the end of surgery, and group GR received a combination of 300 mg oral gabapentin 1 h before anesthesia and 0.3 mg intravenous ramosetron at the end of surgery. Postoperative nausea, retching, vomiting, rescue antiemetic drug use, pain, rescue analgesic requirements and adverse effects were assessed at 0–2, 2–24 and 24–48 h after surgery. Postoperative nausea and vomiting (PONV) was defined as the presence of nausea, retching or vomiting. Results The incidence of complete response (no PONV and no rescue antiemetics up to 48 h postoperatively) was significantly higher in group GR (26/40, 65%) than group G (16/40, 40%; P = 0.025) and group R (18/44, 41%; P = 0.027), whereas there was no significant difference between group G and group R (P = 0.932). There were no significant between-group differences in the incidence of emetic episodes, use of rescue antiemetics, severe emesis, use of rescue analgesics or any adverse effects. Postoperative pain scores were also similar among groups. Conclusions The combination with gabapentin and ramosetron is superior to either drug alone for prevention of PONV after laparoscopic gynecologic surgery. Trial registration ClinicalTrials.gov NCT02617121, registered November 25, 2015.
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Affiliation(s)
- Kyung Mi Kim
- Department of Anesthesiology and Pain Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22 Gwanpyeong-ro, 170 beon-gil, Dongan-gu, Anyang, 431-796, Republic of Korea
| | - Jin Huh
- Department of Anesthesiology and Pain Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, 156 Baengnyeong-Ro, Chuncheon, Gangwon-Do, 200-722, Republic of Korea.
| | - Soo Kyung Lee
- Department of Anesthesiology and Pain Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22 Gwanpyeong-ro, 170 beon-gil, Dongan-gu, Anyang, 431-796, Republic of Korea
| | - Eun Young Park
- Department of Anesthesiology and Pain Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22 Gwanpyeong-ro, 170 beon-gil, Dongan-gu, Anyang, 431-796, Republic of Korea
| | - Jung Min Lee
- Department of Anesthesiology and Pain Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22 Gwanpyeong-ro, 170 beon-gil, Dongan-gu, Anyang, 431-796, Republic of Korea
| | - Hyo Ju Kim
- Department of Anesthesiology and Pain Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22 Gwanpyeong-ro, 170 beon-gil, Dongan-gu, Anyang, 431-796, Republic of Korea
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Surcheva S, Todorova L, Maslarov D, Vlaskovska M. Preclinic and clinic effectiveness of gabapentin and pregabalin for treatment of neuropathic pain in rats and diabetic patients. BIOTECHNOL BIOTEC EQ 2017. [DOI: 10.1080/13102818.2017.1290550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Slavina Surcheva
- Department of Pharmacology and Toxicology, Medical Faculty, Medical University of Sofia, Sofia, Bulgaria
| | - Lubina Todorova
- Department of Pharmacology and Toxicology, Medical Faculty, Medical University of Sofia, Sofia, Bulgaria
| | - Dimitar Maslarov
- Neurology Department, First MHAT-Sofia, Medical College “Y. Filaretova”, Medical University of Sofia, Sofia, Bulgaria
| | - Mila Vlaskovska
- Department of Pharmacology and Toxicology, Medical Faculty, Medical University of Sofia, Sofia, Bulgaria
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43
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Khuvtsagaan B, Lundeg G. Perioperative gabapentin as a component of multimodal analgesia for postoperative pain after total knee arthroplasty. Anesth Pain Med (Seoul) 2017. [DOI: 10.17085/apm.2017.12.2.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
| | - Ganbold Lundeg
- Department of Critical Care and Anesthesiology, School of Medicine, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
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Abstract
BACKGROUND This review replaces part of an earlier review that evaluated gabapentin for both neuropathic pain and fibromyalgia, now split into separate reviews for the two conditions. This review will consider pain in fibromyalgia only.Fibromyalgia is associated with widespread pain lasting longer than three months, and is frequently associated with symptoms such as poor sleep, fatigue, depression, and reduced quality of life. Fibromyalgia is more common in women.Gabapentin is an antiepileptic drug widely licensed for treatment of neuropathic pain. It is not licensed for the treatment of fibromyalgia, but is commonly used because fibromyalgia can respond to the same medicines as neuropathic pain. OBJECTIVES To assess the analgesic efficacy of gabapentin for fibromyalgia pain in adults and the adverse events associated with its use in clinical trials. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) via the Cochrane Register of Studies Online, MEDLINE via Ovid and Embase via Ovid from inception to 24 May 2016. We also searched the reference lists of retrieved studies and reviews, and searched online clinical trial registries. SELECTION CRITERIA Randomised, double-blind trials of eight weeks' duration or longer for treating fibromyalgia pain in adults, comparing gabapentin with placebo or an active comparator. DATA COLLECTION AND ANALYSIS Two independent review authors extracted data and assessed trial quality and risk of bias. We planned to use dichotomous data to calculate risk ratio and number needed to treat for one additional event, using standard methods. We assessed the evidence using GRADE (Grading of Recommendations Assessment, Development and Evaluation) and created a 'Summary of findings' table. MAIN RESULTS Two studies tested gabapentin to treat fibromyalgia pain. One was identified in previous versions of the review and is included here. We identified another study as a conference abstract, with insufficient detail to determine eligibility for inclusion; it is awaiting assessment. The one included study of 150 participants was a 12-week, multi-centre, randomised, double-blind, placebo-controlled, parallel-group study using last-observation-carried-forward imputation for withdrawals. The maximum dose was 2400 mg daily. The overall risk of bias was low, except for attrition bias.At the end of the trial, the outcome of 50% reduction in pain over baseline was not reported. The outcome of 30% or greater reduction in pain over baseline was achieved by 38/75 participants (49%) with gabapentin compared with 23/75 (31%) with placebo (very low quality). A patient global impression of change any category of "better" was achieved by 68/75 (91%) with gabapentin and 35/75 (47%) with placebo (very low quality).Nineteen participants discontinued the study because of adverse events: 12 in the gabapentin group (16%) and 7 in the placebo group (9%) (very low quality). The number of serious adverse events were not reported, and no deaths were reported (very low quality). AUTHORS' CONCLUSIONS We have only very low quality evidence and are very uncertain about estimates of benefit and harm because of a small amount of data from a single trial. There is insufficient evidence to support or refute the suggestion that gabapentin reduces pain in fibromyalgia.
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Affiliation(s)
- Tess E Cooper
- Pain Research Unit, Churchill HospitalCochrane Pain, Palliative and Supportive Care GroupChurchill HospitalOxfordOxfordshireUKOX3 7LE
| | - Sheena Derry
- University of OxfordPain Research and Nuffield Department of Clinical Neurosciences (Nuffield Division of Anaesthetics)Pain Research UnitChurchill HospitalOxfordOxfordshireUKOX3 7LE
| | - Philip J Wiffen
- University of OxfordPain Research and Nuffield Department of Clinical Neurosciences (Nuffield Division of Anaesthetics)Pain Research UnitChurchill HospitalOxfordOxfordshireUKOX3 7LE
| | - R Andrew Moore
- University of OxfordPain Research and Nuffield Department of Clinical Neurosciences (Nuffield Division of Anaesthetics)Pain Research UnitChurchill HospitalOxfordOxfordshireUKOX3 7LE
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Min J. The treatment of postcraniotomy pain. Anesth Pain Med (Seoul) 2016. [DOI: 10.17085/apm.2016.11.4.327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Jinhye Min
- Department of Anesthesiology and Pain Medicine, Myongji Hospital, Seonam University College of Medicine, Goyang, Korea
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Ehieli E, Yalamuri S, Brudney CS, Pyati S. Analgesia in the surgical intensive care unit. Postgrad Med J 2016; 93:38-45. [PMID: 27777355 DOI: 10.1136/postgradmedj-2016-134047] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 07/10/2016] [Accepted: 08/27/2016] [Indexed: 01/30/2023]
Abstract
Critically ill patients are a heterogeneous group with diverse comorbidities and physiological derangements. The management of pain in the critically ill population is emerging as a standard of care in the intensive care unit (ICU). Pain control of critically ill patients in the ICU presents numerous challenges to intensivists. Inconsistencies in pain assessment, analgesic prescription and variation in monitoring sedation and analgesia result in suboptimal pain management. Inadequate pain control can have deleterious effects on several organ systems in critically ill patients. Therefore, it becomes incumbent on physicians and nurses caring for these patients to carefully evaluate their practice on pain management and adopt an optimal pain management strategy that includes a reduction in noxious stimuli, adequate analgesia and promoting education regarding sedation and analgesia to the ICU staff. Mechanistic approaches and multimodal analgesic techniques have been clearly demonstrated to be the most effective pain management strategy to improve outcomes. For example, recent evidence suggests that the use of short acting analgesics and analgesic adjuncts for sedation is superior to hypnotic based sedation in intubated patients. This review will address analgesia in the ICU, including opioid therapy, adjuncts, regional anaesthesia and non-pharmacological options that can provide a multimodal approach to treating pain.
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Affiliation(s)
- Eric Ehieli
- Department of Anesthesiology, Duke University Medical Center, Surgical Intensive Care Unit, Veterans Affairs Medical Center, Durham, North Carolina, USA
| | - Suraj Yalamuri
- Department of Anesthesiology, Duke University Medical Center, Surgical Intensive Care Unit, Veterans Affairs Medical Center, Durham, North Carolina, USA
| | - Charles S Brudney
- Department of Anesthesiology, Duke University Medical Center, Surgical Intensive Care Unit, Veterans Affairs Medical Center, Durham, North Carolina, USA
| | - Srinivas Pyati
- Department of Anesthesiology, Duke University Medical Center, Surgical Intensive Care Unit, Veterans Affairs Medical Center, Durham, North Carolina, USA
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Sarıtaş TB, Korkmaz M, Sevimli A, Sarıtaş ZK. Comparison of the effects of gabapentin and pregabalin on wound healing in rats. Int Wound J 2016; 13:748-53. [PMID: 25348659 PMCID: PMC7949902 DOI: 10.1111/iwj.12364] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 08/04/2014] [Accepted: 08/06/2014] [Indexed: 11/26/2022] Open
Abstract
Gabapentinoids are effective adjunct drugs for reducing postoperative pain. However, the effects of gabapentinoids on wound healing have not been evaluated yet. In this study we evaluated their effects on wound healing. A total of 17 male Wistar-Albino rats, 250-350 g, were divided into three groups randomly: control group (n = 5, 2 ml saline), gabapentin group (n = 6, 20 mg/kg gabapentin) and pregabalin group (n = 6, 20 mg/kg pregabalin). Until day 13 inflammation scores were significantly lower (P < 0·05) and wound healing was significantly better in the control group when compared with gabapentin and pregabalin groups (P < 0·001). Inflammation scores were significantly lower in pregabalin group when compared with gabapentin group until day 13. But wound healing was significantly better in gabapentin group than in pregabalin group between days 13 and 21. In conclusion when gabapentin and pregabalin were compared, although pregabalin decreases inflammation scores, gabapentin has better results in wound healing.
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Affiliation(s)
- Tuba Berra Sarıtaş
- Department of Anesthesiology and Reanimation, Meram Medical School, Necmettin Erbakan University, Konya, Turkey.
| | - Musa Korkmaz
- Department of Surgery, Faculty of Veterinary Medicine, Afyon Kocatepe University, Afyonkarahisar, Turkey
| | - Alper Sevimli
- Department of Pathology, Faculty of Veterinary Medicine, Afyon Kocatepe University, Afyonkarahisar, Turkey
| | - Zulfikar Kadir Sarıtaş
- Department of Surgery, Faculty of Veterinary Medicine, Afyon Kocatepe University, Afyonkarahisar, Turkey
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Arumugam S, Lau CS, Chamberlain RS. Use of preoperative gabapentin significantly reduces postoperative opioid consumption: a meta-analysis. J Pain Res 2016; 9:631-40. [PMID: 27672340 PMCID: PMC5026214 DOI: 10.2147/jpr.s112626] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Effective postoperative pain management is crucial in the care of surgical patients. Opioids, which are commonly used in managing postoperative pain, have a potential for tolerance and addiction, along with sedating side effects. Gabapentin's use as a multimodal analgesic regimen to treat neuropathic pain has been documented as having favorable side effects. This meta-analysis examined the use of preoperative gabapentin and its impact on postoperative opioid consumption. MATERIALS AND METHODS A comprehensive literature search was conducted to identify randomized control trials that evaluated preoperative gabapentin on postoperative opioid consumption. The outcomes of interest were cumulative opioid consumption following the surgery and the incidence of vomiting, somnolence, and nausea. RESULTS A total of 1,793 patients involved in 17 randomized control trials formed the final analysis for this study. Postoperative opioid consumption was reduced when using gabapentin within the initial 24 hours following surgery (standard mean difference -1.35, 95% confidence interval [CI]: -1.96 to -0.73; P<0.001). There was a significant reduction in morphine, fentanyl, and tramadol consumption (P<0.05). While a significant increase in postoperative somnolence incidence was observed (relative risk 1.30, 95% CI: 1.10-1.54, P<0.05), there were no significant effects on postoperative vomiting and nausea. CONCLUSION The administration of preoperative gabapentin reduced the consumption of opioids during the initial 24 hours following surgery. The reduction in postoperative opioids with preoperative gabapentin increased postoperative somnolence, but no significant differences were observed in nausea and vomiting incidences. The results from this study demonstrate that gabapentin is more beneficial in mastectomy and spinal, abdominal, and thyroid surgeries. Gabapentin is an effective analgesic adjunct, and clinicians should consider its use in multimodal treatment plans among patients undergoing elective surgery.
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Affiliation(s)
- Sudha Arumugam
- Department of Surgery, Saint Barnabas Medical Center, Livingston, NJ, USA
| | - Christine Sm Lau
- Department of Surgery, Saint Barnabas Medical Center, Livingston, NJ, USA; Saint George's University School of Medicine, Grenada, West Indies
| | - Ronald S Chamberlain
- Department of Surgery, Saint Barnabas Medical Center, Livingston, NJ, USA; Saint George's University School of Medicine, Grenada, West Indies; Department of Surgery, Rutgers University, New Jersey Medical School, Newark, NJ, USA
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Grant MC, Lee H, Page AJ, Hobson D, Wick E, Wu CL. The Effect of Preoperative Gabapentin on Postoperative Nausea and Vomiting: A Meta-Analysis. Anesth Analg 2016; 122:976-85. [PMID: 26991615 DOI: 10.1213/ane.0000000000001120] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Preoperative gabapentin has been shown to improve postoperative pain and limit reliance on opioid analgesia. On the basis of an alternative mechanism, our group investigated the ability of preoperative gabapentin to prevent postoperative nausea and vomiting (PONV). METHODS We performed a meta-analysis of trials that reported outcomes on the effect of preoperative gabapentin on PONV end points in patients undergoing general anesthesia. In our primary analysis, we calculated the pooled antiemetic effects of preoperative gabapentin in studies with PONV as the primary end point. In our secondary analysis, we calculated the pooled effects in trials involving preoperative gabapentin that reported on the side effects, nausea and vomiting. RESULTS Among the trials designed with PONV as a primary end point (8 trials; n = 838), preoperative gabapentin was associated with a significant reduction in PONV (risk ratio [RR] = 0.60; 99% confidence interval [CI], 0.50-0.72; P < 0.0001), nausea (RR = 0.34; 99% CI, 0.20-0.56; P < 0.0001), and vomiting (RR = 0.34; 99% CI, 0.19-0.61; P = 0.0002) at 24 hours. Among all included trials (44 trials; n = 3489) that reported on the side effects, nausea and vomiting, similar reductions were noted in PONV with preoperative gabapentin administration. Subgroup analysis of trials excluding repeat dosing, thiopental induction, and nitrous oxide maintenance and including high-risk surgery resulted in similar PONV efficacy. Preoperative gabapentin is also associated with significantly increased rates of postoperative sedation (RR = 1.22; 95% CI, 1.02-1.47; P = 0.03) compared with control. CONCLUSIONS Preoperative gabapentin is associated with a significant reduction in PONV among studies designed to investigate this end point. Preoperative gabapentin should be considered not only as part of a multimodal approach to postoperative analgesia, but also for prevention of PONV.
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Affiliation(s)
- Michael C Grant
- From the Department of Anesthesiology, The Johns Hopkins Medical Institutions, Baltimore, Maryland
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50
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Enzymatic production of key intermediate of gabapentin by recombinant amidase from Pantoea sp. with high ratio of substrate to biocatalyst. Process Biochem 2016. [DOI: 10.1016/j.procbio.2016.02.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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